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Analysis of Endoscopy Findings to Identify Early Gastric Cancers with Tumor Budding: A Retrospective Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

No reliable method has been reported for determining tumor budding with frozen sections during surgical procedures. This study investigated endoscopic features predictive of tumor budding in early gastric cancers (EGC).

Methods

This retrospective study evaluated data from 137 patients diagnosed with EGC who underwent endoscopy, followed by endoscopic submucosal dissection (ESD); 71 patients underwent a second gastrectomy. Based on pathological analyses, lesions were categorized as being positive (n = 80) or negative for tumor budding (n = 57). Endoscopic features were analyzed using multivariable logistic regression. Patient survival rates were analyzed with Kaplan–Meier method and log-rank test.

Results

Mean age of our study population was 66 years (range, 31–86 years). The tumor budding-positive cohort (73.3 ± 5.9 years) was significantly older than the tumor budding-negative cohort (56.7 ± 7.6 years) (p < 0.001). Endoscopic features significantly different between tumor budding-positive and budding-negative groups included tumor size (p = 0.003), remarkable redness (p = 0.015), and margin elevation (p < 0.001). Tumor size (odds ratio (OR): 1.561; 95% confidence interval (CI): 0.984, 2.285; p = 0.047) and margin elevation (OR: 2.141; 95% CI: 1.147, 5.117; p = 0.003) were independent predictors of tumor budding. Margin elevation was found in 19.3% of tumor budding-negative and 53.8% of budding-positive cases. In the tumor budding-positive group, ESD and second gastrectomy were associated with disease-free survival.

Conclusions

Margin elevation and large tumor size (> 29 mm) of EGCs on endoscopy are promising imaging biomarkers for predicting tumor budding in EGCs. ESD and a second gastrectomy can be better for tumor budding-positive patients with EGCs.

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Acknowledgments

The authors would like to thank Mr. Xianliang Sha for his technical assistance during the research.

Funding

This study was supported in part by grants from the Science and Technology Development Project of Jilin Province (#3D5197431429) and the Youth Program of the National Natural Science Foundation of China (#82002808).

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Authors and Affiliations

  1. Department of Pathology, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China

    Lanqing Cao & Zhaoyong Wang

  2. Department of Endoscopy, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China

    Liwei Duan & Lijuan Wei

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  1. Lanqing Cao
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  2. Zhaoyong Wang
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  3. Liwei Duan
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  4. Lijuan Wei
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by Lanqing Cao, Lijuan Wei, and Zhaoyong Wang. The first draft of the manuscript was written by Lanqing Cao, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lijuan Wei.

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This study was approved by the Institutional Ethics Committee of the Second Hospital of Jilin University, Jilin, China (IRB approval number: 2020022).

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Cao, L., Wang, Z., Duan, L. et al. Analysis of Endoscopy Findings to Identify Early Gastric Cancers with Tumor Budding: A Retrospective Study. J Gastrointest Surg 25, 1706–1715 (2021). https://doi.org/10.1007/s11605-020-04862-6

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  • DOI: https://doi.org/10.1007/s11605-020-04862-6

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