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

被引:11
作者
Choi, Ji Young [1 ]
Park, Young Soo [2 ]
Jung, Hwoon-Yong [3 ]
Son, Da Hye [2 ]
Ahn, Ji Yong [3 ]
Han, Seungbong [4 ]
Lim, Hyun [3 ]
Choi, Kwi-Sook [3 ]
Lee, Jeong Hoon [3 ]
Kim, Do Hoon [3 ]
Choi, Kee Don [3 ]
Song, Ho June [3 ]
Lee, Gin Hyug [3 ]
Kim, Jin-Ho [3 ]
机构
[1] Univ Ulsan, Coll Med, Asan Med Ctr, Hlth Screening & Promot Ctr, Seoul 138736, South Korea
[2] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Pathol, Seoul 138736, South Korea
[3] Univ Ulsan, Coll Med, Dept Gastroenterol, Asan Med Ctr,Asan Digest Dis Res Inst, Seoul 138736, South Korea
[4] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Clin Epidemiol & Biostat, Seoul 138736, South Korea
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2015年 / 29卷 / 06期
关键词
Stomach neoplasms; Lymph nodes; Endoscopy; Resection; Therapeutics; Pathology; EARLY GASTRIC-CANCER; DISSECTION; CARCINOMA;
D O I
10.1007/s00464-014-3828-8
中图分类号
R61 [外科手术学];
学科分类号
摘要
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. 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. 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 A mu m (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 a parts per thousand currency sign500 A mu m, and SM invasion width/superficial tumor size ratio a parts per thousand currency sign0.04 besides the current expanded indications. Endoscopic resection can be performed on patients with minute SM invasive, differentiated cancers of a parts per thousand currency sign3 cm without LNM on pretreatment examination. In addition, if histological assessment shows the absence of LVI and ulceration, SM invasion depth a parts per thousand currency sign500 A mu m, and SM invasion width/superficial tumor size ratio a parts per thousand currency sign0.04, the patient can be carefully observed without additional treatment.
引用
收藏
页码:1476 / 1483
页数:8
相关论文
共 23 条
[1]   Long-Term Outcome of Extended Endoscopic Submucosal Dissection for Early Gastric Cancer with Differentiated Histology [J].
Ahn, Ji Yong ;
Jung, Hwoon-Yong .
CLINICAL ENDOSCOPY, 2013, 46 (05) :463-466
[2]  
[Anonymous], 2003, GASTROINTEST ENDOSC, V58, pS3
[3]  
[Anonymous], 1998, GASTRIC CANCER, DOI DOI 10.1007/PL00011681
[4]   Treatment and prognosis of early multiple gastric cancer [J].
Borie, F ;
Plaisant, N ;
Millat, B ;
Hay, JM ;
Fagniez, PL ;
De Saxce, B .
EUROPEAN JOURNAL OF SURGICAL ONCOLOGY, 2003, 29 (06) :511-514
[5]   Lymph node metastasis in multiple synchronous early gastric cancer [J].
Choi, Jeongmin ;
Kim, Sang Gyun ;
Im, Jong Pil ;
Kang, Seung Joo ;
Lee, Hyuk-Joon ;
Yang, Han-Kwang ;
Kim, Joo Sung ;
Kim, Woo Ho ;
Jung, Hyun Chae ;
Song, In Sung .
GASTROINTESTINAL ENDOSCOPY, 2011, 74 (02) :276-284
[6]   Extended indication of endoscopic resection for mucosal early gastric cancer: Analysis of a single center experience [J].
Chung, Jun-Won ;
Jung, Hwoon-Yong ;
Choi, Kee Don ;
Song, Ho June ;
Lee, Gin Hyug ;
Jang, Se Jin ;
Park, Young-Su ;
Yook, Jeong Hwan ;
Oh, Sung Tae ;
Kim, Byung-Sik ;
Kim, Jin-Ho .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2011, 26 (05) :884-887
[7]  
FIDLER IJ, 1990, CANCER RES, V50, P6130
[8]   Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer [J].
Gotoda, T ;
Sasako, M ;
Ono, H ;
Katai, H ;
Sano, T ;
Shimoda, T .
BRITISH JOURNAL OF SURGERY, 2001, 88 (03) :444-449
[9]   Incidence of lymph node metastasis from early gastric cancer: Estimation with a large number of cases at two large centers [J].
Gotoda T. ;
Yanagisawa A. ;
Sasako M. ;
Ono H. ;
Nakanishi Y. ;
Shimoda T. ;
Kato Y. .
Gastric Cancer, 2000, 3 (4) :219-225
[10]   ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUBMUCOSAL INVASIVE GASTRIC CANCER AND CURABILITY CRITERIA [J].
Hoteya, Shu ;
Yamashita, Satoshi ;
Kikuchi, Daisuke ;
Nakamura, Masanori ;
Fujimoto, Ai ;
Matsui, Akira ;
Nishida, Noriko ;
Mitani, Toshihumi ;
Kuroki, Yuichiro ;
Iizuka, Toshiro ;
Yahagi, Naohisa .
DIGESTIVE ENDOSCOPY, 2011, 23 (01) :30-36