Skip to main content
SpringerLink
Log in

Hierarchical Analysis of Factors Associated with T Staging of Gastric Cancer by Endoscopic Ultrasound

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Size, ulcer, differentiation, and location are known to be factors affecting the T stage accuracy of EUS in gastric cancer. However, whether an interaction exists among recognized variables is poorly understood. The aim of this study was to identify the combinatorial characteristics of group with high overestimation rate to determine which group should be considered carefully for EUS-based treatment plans.

Methods

We retrospectively analyzed early gastric cancer patients who underwent EUS from 2005 to 2016. The accuracy of EUS T stage and factors affecting over-/underestimation were examined by using decision tree analysis, the CHAID method.

Results

The most significant factor affecting the accuracy of the EUS T stage was the size. The rate of overestimation was higher in lesions > 3 cm (37.2% vs. 28.8% vs. 17.1%, p < 0.001). In lesions > 3 cm, the rate of overestimation was higher in lesions with an ulcer (62.1% vs. 35.0%, p < 0.001). Moreover, for lesions ≤ 3 cm, the accuracy of the EUS T stage was more affected by differentiation and location. The rate of overestimation was higher in undifferentiated-type lesions ≤ 2 cm (24.5% vs. 13.9%, p < 0.001) and 2–3 cm (33.3% vs. 25.7%, p = 0.011). In the differentiated type, the location affected the accuracy of the EUS T stage.

Conclusion

In this hierarchical analysis, the rate of overestimation was higher in lesions > 3 cm with ulcer, lesions > 3 cm irrespective of ulcer, and undifferentiated-type lesions measuring 2–3 cm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ono H, Yao K, Fujishiro M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc. 2016;28:3–15. https://doi.org/10.1111/den.12518.

    Article  PubMed  Google Scholar 

  2. Min YW, Lee JH. Endoscopic resection for early gastric cancer beyond absolute indication with emphasis on controversial issues. J Gastric Cancer. 2014;14:7–14. https://doi.org/10.5230/jgc.2014.14.1.7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mouri R, Yoshida S, Tanaka S, Oka S, Yoshihara M, Chayama K. Usefulness of endoscopic ultrasonography in determining the depth of invasion and indication for endoscopic treatment of early gastric cancer. J Clin Gastroenterol. 2009;43:318–322. https://doi.org/10.1097/MCG.0b013e3181775966.

    Article  PubMed  Google Scholar 

  4. Yoshida S, Tanaka S, Kunihiro K, et al. Diagnostic ability of high-frequency ultrasound probe sonography in staging early gastric cancer, especially for submucosal invasion. Abdom Imaging. 2005;30:518–523. https://doi.org/10.1007/s00261-004-0287-z.

    Article  CAS  PubMed  Google Scholar 

  5. Puli SR, Batapati Krishna Reddy J, Bechtold ML, Antillon MR, Ibdah JA. How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review. World J Gastroenterol. 2008;14:4011–4019.

    Article  Google Scholar 

  6. Mocellin S, Marchet A, Nitti D. EUS for the staging of gastric cancer: a meta-analysis. Gastrointest Endosc. 2011;73:1122–1134. https://doi.org/10.1016/j.gie.2011.01.030.

    Article  PubMed  Google Scholar 

  7. Okada K, Fujisaki J, Kasuga A, et al. Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection. Surg Endosc. 2011;25:841–848. https://doi.org/10.1007/s00464-010-1279-4.

    Article  PubMed  Google Scholar 

  8. Watari J, Ueyama S, Tomita T, et al. What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth? World J Gastrointest Endosc. 2016;8:558–567. https://doi.org/10.4253/wjge.v8.i16.558.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Choi J, Kim SG, Im JP, Kim JS, Jung HC, Song IS. Is endoscopic ultrasonography indispensable in patients with early gastric cancer prior to endoscopic resection? Surg Endosc. 2010;24:3177–3185. https://doi.org/10.1007/s00464-010-1112-0.

    Article  PubMed  Google Scholar 

  10. Choi J, Kim SG, Im JP, Kim JS, Jung HC, Song IS. Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer. Endoscopy. 2010;42:705–713. https://doi.org/10.1055/s-0030-1255617.

    Article  CAS  PubMed  Google Scholar 

  11. Kim J, Kim SG, Chung H, et al. Clinical efficacy of endoscopic ultrasonography for decision of treatment strategy of gastric cancer. Surg Endosc. 2018;. https://doi.org/10.1007/s00464-018-6104-5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Park CH, Park JC, Chung H, Shin SK, Lee SK, Lee YC. A specific role of endoscopic ultrasonography for therapeutic decision-making in patients with gastric cardia cancer. Surg Endosc. 2016;30:4193–4199. https://doi.org/10.1007/s00464-015-4728-2.

    Article  PubMed  Google Scholar 

  13. Lee JY, Choi IJ, Kim CG, et al. Therapeutic decision-making using endoscopic ultrasonography in endoscopic treatment of early gastric cancer. Gut Liver. 2016;10:42–50. https://doi.org/10.5009/gnl14401.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tsujii Y, Kato M, Inoue T, et al. Integrated diagnostic strategy for the invasion depth of early gastric cancer by conventional endoscopy and EUS. Gastrointest Endosc. 2015;82:452–459. https://doi.org/10.1016/j.gie.2015.01.022.

    Article  PubMed  Google Scholar 

  15. Kim SJ, Choi CW, Kang DH, et al. Factors associated with the efficacy of miniprobe endoscopic ultrasonography after conventional endoscopy for the prediction of invasion depth of early gastric cancer. Scand J Gastroenterol. 2017;52:864–869. https://doi.org/10.1080/00365521.2017.1315167.

    Article  PubMed  Google Scholar 

  16. Fukunaga S, Nagami Y, Shiba M, et al. Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis. Gastrointest Endosc. 2017;85:143–152. https://doi.org/10.1016/j.gie.2016.06.049.

    Article  PubMed  Google Scholar 

  17. Choi JH, Kim ES, Lee YJ, et al. Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer. Gastrointest Endosc. 2015;82:299–307. https://doi.org/10.1016/j.gie.2015.01.019.

    Article  PubMed  Google Scholar 

  18. Park CH, Lee SK. Understanding the role of endoscopic ultrasonography in early gastric cancer. Gut Liver. 2016;10:3–5. https://doi.org/10.5009/gnl15387.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2011;14:101–112. https://doi.org/10.1007/s10120-011-0041-5.

    Article  Google Scholar 

  20. Jonghoo C, Sang Tae H, Hyun Cheol K, Kim E. Decision tree analysis of data mining using answer tree. Seoul: Information Industry; 1998 (Korean).

  21. Citterio D, Facciorusso A, Sposito C, Rota R, Bhoori S, Mazzaferro V. Hierarchic interaction of factors associated with liver decompensation after resection for hepatocellular carcinoma. JAMA Surg. 2016;151:846–853. https://doi.org/10.1001/jamasurg.2016.1121.

    Article  PubMed  Google Scholar 

  22. Hyun Cheol K, Sang Tae H, Jonghoo C, Seong Keon L, Eunseok K, Um IH. Data mining methodology for big data analysis. Paju: Free Academy; 2014 (Korean).

  23. Abe S, Oda I, Shimazu T, et al. Depth-predicting score for differentiated early gastric cancer. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2011;14:35–40. https://doi.org/10.1007/s10120-011-0002-z.

    Article  Google Scholar 

  24. Choi J, Kim SG, Im JP, Kim JS, Jung HC, Song IS. Endoscopic prediction of tumor invasion depth in early gastric cancer. Gastrointest Endosc. 2011;73:917–927. https://doi.org/10.1016/j.gie.2010.11.053.

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education no. NRF-2017R1D1A1B03036304.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jung Kim, Hyunsoo Chung, Jue Lie Kim, Eunwoo Lee & Sang Gyun Kim

Authors
  1. Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyunsoo Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jue Lie Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eunwoo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sang Gyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JK: manuscript writing, drafting conception and design and data analysis; HC: manuscript writing, drafting conception and design, and data analysis; JLK and EL: drafting conception and making critical revision; SGK: making critical revision, drafting conception and performing procedures.

Corresponding author

Correspondence to Hyunsoo Chung.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest regarding the contents of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J., Chung, H., Kim, J.L. et al. Hierarchical Analysis of Factors Associated with T Staging of Gastric Cancer by Endoscopic Ultrasound. Dig Dis Sci 66, 612–618 (2021). https://doi.org/10.1007/s10620-020-06194-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06194-6

Keywords

Search

Navigation