Risk factors for lymph node metastasis in mucosal gastric cancer and re-evaluation of endoscopic submucosal dissection.
10.4174/astr.2016.91.3.118
- Author:
Si Hak LEE
1
;
Cheol Woong CHOI
;
Su Jin KIM
;
Chang In CHOI
;
Dae Hwan KIM
;
Tae Yong JEON
;
Dong Heon KIM
;
Hyun Jung LEE
;
Ki Hyun KIM
;
Sun Hwi HWANG
Author Information
1. Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. hwangsh@pusan.ac.kr
- Publication Type:Original Article
- Keywords:
Lymph nodes;
Neoplasm metastasis;
Stomach neoplasms;
Risk factors
- MeSH:
Classification;
Gastrectomy;
Humans;
Lymph Nodes*;
Mucous Membrane;
Multivariate Analysis;
Neoplasm Metastasis*;
Odds Ratio;
Pathology;
Risk Factors*;
Stomach Neoplasms*;
Ulcer
- From:Annals of Surgical Treatment and Research
2016;91(3):118-126
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The selection of the appropriate treatment strategy for patients with mucosal gastric cancer (MGC) remains controversial. In the present study, we aimed to determine the risk factors for lymph node (LN) metastasis in MGC and reassess the role of endoscopic submucosal dissection (ESD). METHODS: We examined 1,191 MGC patients who underwent curative gastrectomy between January 2005 and December 2014. We determined the clinicopathologic risk factors for LN metastasis among the MGC patients. RESULTS: Among 1,191 patients with MGC, 42 patients (3.5%) had LN metastasis. Univariate analysis indicated that age ≤ 50 years (P = 0.045), tumor invasion to the muscularis mucosa (P < 0.001), tumor size > 2 cm (P = 0.014), presence of ulceration (P = 0.01), diffuse type as per Lauren classification (P = 0.005), and undifferentiated-type histology (P = 0.001) were associated with LN metastasis. Moreover, multivariate analysis indicated that tumor invasion to the muscularis mucosa (P = 0.001; odds ratio [OR], 4.909), presence of ulceration (P = 0.036; OR, 1.982), and undifferentiated-type histology (P = 0.025; OR, 4.233) were independent risk factors for LN metastasis. In particular, LN metastasis was observed in some MGC cases with indications for ESD, including absolute indications (1 of 179, 0.6%) and expanded indications (9 of 493, 1.8%). CONCLUSION: Although MGC patients can be treated via ESD, we recommend that they undergo a more aggressive treatment strategy if they have tumor invasion to the muscularis mucosa, ulceration, or undifferentiated-type histology in the final pathology report.
