Abstract
Background
Conventional endoscopy and endoscopic ultrasonography (EUS) are used to estimate the invasion depth of early-stage gastric cancers (EGCs), but estimates made by either technique are often inaccurate. We developed a model to determine the invasion depth of EGCs using conventional endoscopy and EUS findings, with pathology results as the reference.
Methods
We performed a retrospective study of 195 patients (205 lesions) diagnosed with gastric cancers who underwent endoscopy and EUS followed by resection. Based on pathology analyses, lesions (n = 205) were assigned to categories of: mucosa invasion or minute invasion into the submucosal layer less than 500 μm from the muscularis mucosae (M-SM1) or penetration of 500 μm or more (≥SM2). The lesions were randomly assigned to derivation (138 lesions) and validation sets (67 lesions). A depth predictive model was proposed in the derivation set using multivariate logistic regression analyses. The discriminative power of this model was assessed in both sets.
Results
Remarkable redness (OR 5.42; 95% CI 1.32–22.29), abrupt cutting of converging folds (OR 8.58; 95% CI 1.65–44.72), lesions location in the upper third of the stomach (OR 10.26; 95% CI 2.19–48.09), and deep invasion based on EUS findings (OR 16.53; 95% CI 4.48–61.15) significantly associated with ≥SM2 invasion. A model that incorporated these 4 variables discriminated between M-SM1 and ≥SM2 lesions with the area under the ROC curve of 0.865 in the derivation set and 0.797 in the validation set. In the derivation set, a cut-off score of 8 identified lesions as ≥SM2 with 54% sensitivity and 97% specificity. The model correctly predicted the invasion depth 89.86% of lesions; it overestimated the depth of 2.17% of lesions.
Conclusions
We developed a model to identify EGCs with invasion depth ≥SM2 based on endoscopy and EUS findings. This model might reduce overestimation of gastric tumor depth and prevent unnecessary gastrectomy.
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Abbreviations
- AUROC:
-
Area under receiver operating characteristic
- CI:
-
Confidence interval
- EGC:
-
Early gastric cancer
- ESD:
-
Endoscopic submucosal dissection
- EUS:
-
Endoscopic ultrasonography
- LR+:
-
Positive likelihood ratio
- MPHD:
-
Model for prediction of histologic depth
- NCCN:
-
National comprehensive cancer network
- NPV:
-
Negative predictive value
- PPV:
-
Positive predictive value
- SM:
-
Submucosal cancer
- SGC:
-
Superficial gastric cancer
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Funding
National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2013BAI01B10); Beijing Municipal Science and Technology Project (D141100000414005).
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Drs. Jieyao Cheng, Xi Wu, Aiming Yang, Qingwei Jiang, Fang Yao, Yunlu Feng, Tao Guo, Weixun Zhou, Dongsheng Wu, Xuemin Yan, Yamin Lai, Jiaming Qian, Xinghua Lu, and Weigang Fang have no conflicts of interest or financial ties to disclose.
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Cheng, J., Wu, X., Yang, A. et al. Model to identify early-stage gastric cancers with deep invasion of submucosa based on endoscopy and endoscopic ultrasonography findings. Surg Endosc 32, 855–863 (2018). https://doi.org/10.1007/s00464-017-5754-z
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DOI: https://doi.org/10.1007/s00464-017-5754-z