The risk of lymph node metastases in 3951 surgically resected mucosal gastric cancers: implications for endoscopic resection

被引:29
作者
Choi, Kang Kook [1 ]
Bae, Jae Moon [2 ]
Kim, Su Mi [2 ]
Sohn, Tae Sung [2 ]
Noh, Jae Hyung [2 ]
Lee, Jun Ho [2 ]
Choi, Min-Gew [2 ]
Kim, Sung [2 ]
机构
[1] Gachon Gil Hosp, Dept Trauma Surg, Reg Trauma Ctr, Inchon, South Korea
[2] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Surg, 50 Irwon Dong, Seoul 135710, South Korea
关键词
CLASSIFICATION;
D O I
10.1016/j.gie.2015.08.051
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims: Endoscopic resection for mucosal gastric cancer (MGC) is highly recommended in the absence of lymph node metastasis (LNM). We aimed to clarify the risk factors for LNM in MGC and to investigate the association of LNM with the indication criteria for endoscopic submucosal dissection (ESD). Methods: A retrospective cohort study was performed on 3951 patients with MGC who underwent radical gastrectomy at the Samsung Medical Center in Seoul, Republic of Korea, between September 1994 and September 2010. Results: Of the patients with MGC, 101 (2.60%) were positive for LNM. Multivariate analysis, followed by univariate analysis, revealed the following risk factors for LNM in MGC: large tumor size, undifferentiated tumor type, lymphatic invasion, perineural invasion, and associated ulceration in the tumor (hazard ratio 1.25, 7.49, 20.65, 23.45, and 4.07, respectively). Patients without LNM had significantly increased survival and/or recurrence-free survival rates than patients with LNM (188.4/209.8 months vs 169.5/188.0 months; P = .029/.004, respectively). Only 3 of 1065 patients (0.3%) who met the absolute indication criteria for ESD had LNM. Of those who met the expanded indication criteria for ESD, 11 of 2678 patients (0.4%) had LNM. LNM also was found in 2 patients who had a differentiated tumor < 0.5 cm without ulceration. Conclusion: The risk for LNM was very low when patients with MGC met the absolute and/or expanded criteria for endoscopic resection, which meant the indication criteria for ESD was safe and acceptable. However, although the risk for LNM is very low, it should not be considered negligible in endoscopic resection.
引用
收藏
页码:896 / 901
页数:6
相关论文
共 21 条
[1]  
[Anonymous], 2003, GASTROINTEST ENDOSC, V58, pS3
[2]  
[Anonymous], 2012, NAT SURV POST MORT M
[3]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[4]   The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM [J].
Edge, Stephen B. ;
Compton, Carolyn C. .
ANNALS OF SURGICAL ONCOLOGY, 2010, 17 (06) :1471-1474
[5]   Clinicopathological study of lymph-node metastasis in 1389 patients with early gastric cancer: Assessment of indications for endoscopic resection [J].
Haruta, Hidenori ;
Hosoya, Yoshinori ;
Sakuma, Kazuya ;
Shibusawa, Hiroyuki ;
Satoh, Kiichi ;
Yamamoto, Hironori ;
Tanaka, Akira ;
Niki, Toshiro ;
Sugano, Kentaro ;
Yasuda, Yoshikazu .
JOURNAL OF DIGESTIVE DISEASES, 2008, 9 (04) :213-218
[6]   Early Gastric Cancer Lymph Node Metastasis Starts With Deep Mucosal Infiltration [J].
Hoelscher, Arnulf H. ;
Drebber, Uta ;
Moenig, Stefan P. ;
Schulte, Christian ;
Vallboehmer, Daniel ;
Bollschweiler, Elfriede .
ANNALS OF SURGERY, 2009, 250 (05) :791-797
[7]   Japanese gastric cancer treatment guidelines 2010 (ver. 3) [J].
Sano T. ;
Kodera Y. .
GASTRIC CANCER, 2011, 14 (02) :113-123
[8]   Clinicopathological Features and Surgical Treatment of Gastric Cancer in South Korea: The Results of 2009 Nationwide Survey on Surgically Treated Gastric Cancer Patients [J].
Jeong, Oh ;
Park, Young-Kyu .
JOURNAL OF GASTRIC CANCER, 2011, 11 (02) :69-77
[9]   Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2008 [J].
Jung, Kyu-Won ;
Park, Sohee ;
Kong, Hyun-Joo ;
Won, Young-Joo ;
Lee, Joo Young ;
Park, Eun-Cheol ;
Lee, Jin-Soo .
CANCER RESEARCH AND TREATMENT, 2011, 43 (01) :1-11
[10]  
KAJITANI T, 1981, JPN J SURG, V11, P127