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Identifying predictors of lymph node metastasis after endoscopic resection in patients with minute submucosal cancer of the stomach

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Abstract

Background

The use of endoscopic submucosal dissection (ESD) for the treatment of minute submucosal (SM) invasive cancer that fulfills the current expanded criteria remains controversial. This study investigated the clinicopathological parameters of patients with sm1 gastric cancers to predict lymph node metastasis (LNM) and evaluate the feasibility of ESD as a curative treatment.

Methods

Data from 278 patients who underwent surgical resection of sm1 gastric cancer between 2006 and 2010 were retrospectively collected, and their clinicopathological parameters were analyzed to identify predictive factors of LNM.

Results

Of 278 patients, 28 patients (10.1 %) had LNM. Multivariate analysis identified multiple lesions (p = 0.018), lymphovascular invasion (LVI) (p < 0.001), SM invasion depth >500 µm (p = 0.007), undifferentiated histology (p = 0.012), and ulceration (p = 0.024) as factors significantly associated with LNM in patients with sm1 gastric cancer. Additionally, SM invasion width/superficial tumor size ratio >0.04 (p = 0.036) demonstrated a significant association with LNM in patients with sm1 gastric cancer falling within the current expanded criteria for ESD. LNM was not identified among 35 patients who met the absence of ulceration, SM invasion depth ≤500 µm, and SM invasion width/superficial tumor size ratio ≤0.04 besides the current expanded indications.

Conclusions

Endoscopic resection can be performed on patients with minute SM invasive, differentiated cancers of ≤3 cm without LNM on pretreatment examination. In addition, if histological assessment shows the absence of LVI and ulceration, SM invasion depth ≤500 µm, and SM invasion width/superficial tumor size ratio ≤0.04, the patient can be carefully observed without additional treatment.

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References

  1. Choi J, Kim SG, Im JP et al (2011) Lymph node metastasis in multiple synchronous early gastric cancer. Gastrointest Endosc 74:276–284

    Article  PubMed  Google Scholar 

  2. Lee H, Yun WK, Min BH et al (2011) A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 25:1985–1993

    Article  PubMed  Google Scholar 

  3. Ahn JY, Jung HY (2013) Long-term outcome of extended endoscopic submucosal dissection for early gastric cancer with differentiated histology. Clin Endosc 46:463–466

    Article  PubMed Central  PubMed  Google Scholar 

  4. Okada K, Fujisaki J, Yoshida T et al (2012) Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 44:122–127

    Article  CAS  PubMed  Google Scholar 

  5. Gotoda T, Yanagisawa A, Sasako M et al (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  6. Hoteya S, Yamashita S, Kikuchi D et al (2011) Endoscopic submucosal dissection for submucosal invasive gastric cancer and curability criteria. Dig Endosc 23:30–36

    Article  PubMed  Google Scholar 

  7. The Paris endoscopic classification of superficial neoplastic lesions (2002) esophagus, stomach, and colon: November 30 to December 1. Gastrointest Endosc 58:S3–S43

    Google Scholar 

  8. Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma-2nd English edition. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  9. Lauren P (1965) The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta pathologica et microbiologica Scandinavica 64:31–49

    CAS  PubMed  Google Scholar 

  10. Chung JW, Jung HY, Choi KD et al (2011) Extended indication of endoscopic resection for mucosal early gastric cancer: analysis of a single center experience. J Gastroenterol Hepatol 26:884–887

    Article  PubMed  Google Scholar 

  11. Sanomura Y, Oka S, Tanaka S et al (2010) Predicting the absence of lymph node metastasis of submucosal invasive gastric cancer: expansion of the criteria for curative endoscopic resection. Scand J Gastroenterol 45:1480–1487

    Article  PubMed  Google Scholar 

  12. Kang HJ, Kim DH, Jeon TY et al (2010) Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection. Gastrointest Endosc 72:508–515

    Article  PubMed  Google Scholar 

  13. Kunisaki C, Takahashi M, Nagahori Y et al (2009) Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer. Endoscopy 41:498–503

    Article  CAS  PubMed  Google Scholar 

  14. Gotoda T, Sasako M, Ono H, Katai H, Sano T, Shimoda T (2001) Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg 88:444–449

    Article  CAS  PubMed  Google Scholar 

  15. Kim JH, Lee YC, Kim H et al (2012) Additive lymph node dissection may be necessary in minute submucosal cancer of the stomach after endoscopic resection. Ann Surg Oncol 19:779–785

    Article  PubMed  Google Scholar 

  16. Kwee RM, Kwee TC (2008) Predicting lymph node status in early gastric cancer. Gastric Cancer 11:134–148

    Article  PubMed  Google Scholar 

  17. Park YD, Chung YJ, Chung HY et al (2008) Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach. Endoscopy 40:7–10

    Article  CAS  PubMed  Google Scholar 

  18. Sano T, Kobori O, Muto T (1992) Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 79:241–244

    Article  CAS  PubMed  Google Scholar 

  19. Jee YS, Hwang SH, Rao J et al (2009) Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines. Br J Surg 96:1157–1161

    Article  CAS  PubMed  Google Scholar 

  20. Fidler IJ (1990) Critical factors in the biology of human cancer metastasis: twenty-eighth G.H.A. Clowes memorial award lecture. Cancer Res 50:6130–6138

    CAS  PubMed  Google Scholar 

  21. Iriyama K, Asakawa T, Koike H, Nishiwaki H, Suzuki H (1989) Is extensive lymphadenectomy necessary for surgical treatment of intramucosal carcinoma of the stomach? Arch Surg 124:309–311

    Article  CAS  PubMed  Google Scholar 

  22. Borie F, Plaisant N, Millat B, Hay JM, Fagniez PL, De Saxce B (2003) Treatment and prognosis of early multiple gastric cancer. Eur J Surg Oncol 29:511–514

    Article  CAS  PubMed  Google Scholar 

  23. Ishigami S, Natsugoe S, Hokita S et al (1999) Carcinomatous lymphatic invasion in early gastric cancer invading into the submucosa. Ann Surg Oncol 6:286–289

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank the Korean Society of Gastrointestinal Endoscopy for supporting our research.

Disclosures

This study was supported by a research grants from the Korean Society of Gastrointestinal Endoscopy.

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Authors and Affiliations

  1. Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea

    Ji Young Choi

  2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea

    Young Soo Park & Da Hye Son

  3. Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea

    Hwoon-Yong Jung, Ji Yong Ahn, Hyun Lim, Kwi-Sook Choi, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee & Jin-Ho Kim

  4. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea

    Seungbong Han

Authors
  1. Ji Young Choi
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  2. Young Soo Park
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  3. Hwoon-Yong Jung
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  4. Da Hye Son
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  5. Ji Yong Ahn
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  6. Seungbong Han
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  7. Hyun Lim
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  8. Kwi-Sook Choi
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  9. Jeong Hoon Lee
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  10. Do Hoon Kim
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  11. Kee Don Choi
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  12. Ho June Song
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  13. Gin Hyug Lee
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  14. Jin-Ho Kim
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Corresponding author

Correspondence to Hwoon-Yong Jung.

Additional information

Ji Young Choi and Young Soo Park contributed equally as co-first author.

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Choi, J.Y., Park, Y.S., Jung, HY. et al. Identifying predictors of lymph node metastasis after endoscopic resection in patients with minute submucosal cancer of the stomach. Surg Endosc 29, 1476–1483 (2015). https://doi.org/10.1007/s00464-014-3828-8

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  • DOI: https://doi.org/10.1007/s00464-014-3828-8

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