Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer
| Autor: | Wen Song, Xiao-Bin Zhou, Yuning Chu, Ya-Nan Yu, Zibin Tian, Yun-Qing Chen, Xian-Zhi Zhao, Tao Mao, Xue Jing |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Tumor burden Lymph node metastasis 0302 clinical medicine Risk Factors digestive oral and skin physiology Gastroenterology General Medicine Middle Aged Endoscopic submucosal dissection Prognosis Adenocarcinoma Mucinous Tumor Burden Neoplasm Invasiveness Lymphatic Metastasis 030220 oncology & carcinogenesis Practice Guidelines as Topic Adenocarcinoma Female 030211 gastroenterology & hepatology Radiology Expanded indications Endoscopic treatment medicine.medical_specialty Endoscopic Mucosal Resection 03 medical and health sciences Retrospective Study Gastrectomy Stomach Neoplasms Gastroscopy Biomarkers Tumor medicine Humans Retrospective Studies Early gastric cancer Predictors business.industry Patient Selection Retrospective cohort study medicine.disease digestive system diseases Early Gastric Cancer Gastric Mucosa Feasibility Studies Lymph Node Excision Lymph Nodes business |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 1007-9327 |
| DOI: | 10.3748/wjg.v25.i35.5344 |
| Popis: | BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection. The indications for ESD have been recently expanded to include larger, ulcerated, and undifferentiated mucosal lesions, and differentiated lesions with slight submucosal invasion. The risk of lymph node metastasis (LNM) is the most important consideration when deciding on a treatment strategy for EGC. Despite the advantages over surgical procedures, lymph nodes cannot be removed by ESD. In addition, whether patients who meet the expanded indications for ESD can be managed safely remains controversial. AIM To determine whether the ESD indications are applicable to Chinese patients and to investigate the predictors of LNM in EGC. METHODS We retrospectively analyzed 12552 patients who underwent surgery for gastric cancer between June 2007 and December 2018 at the Affiliated Hospital of Qingdao University. A total of 1262 (10.1%) EGC patients were eligible for inclusion in this study. Data on the patients’ clinical, endoscopic, and histopathological characteristics were collected. The absolute and expanded indications for ESD were validated by regrouping the enrolled patients and determining the positive LNM results in each subgroup. Predictors of LNM in patients were evaluated by univariate and multivariate analyses. RESULTS LNM was observed in 182 (14.4%) patients. No LNM was detected in the patients who met the absolute indications (0/90). LNM occurred in 4/311 (1.3%) patients who met the expanded indications. According to univariate analysis, LNM was significantly associated with positive tumor marker status, medium (20-30 mm) and large (>30 mm) lesion sizes, excavated macroscopic-type tumors, ulcer presence, submucosal invasion (SM1 and SM2), poor differentiation, lymphovascular invasion (LVI), perineural invasion, and diffuse and mixed Lauren’s types. Multivariate analysis demonstrated SM1 invasion (odds ration [OR] = 2.285, P = 0.03), SM2 invasion (OR = 3.230, P < 0.001), LVI (OR = 15.702, P < 0.001), mucinous adenocarcinoma (OR = 2.823, P = 0.015), and large lesion size (OR = 1.900, P = 0.006) to be independent risk factors. CONCLUSION The absolute indications for ESD are reasonable, and the feasibility of expanding the indications for ESD requires further investigation. The predictors of LNM include invasion depth, LVI, mucinous adenocarcinoma, and lesion size. |
| Databáze: | OpenAIRE |
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