Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer View Full Text


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Article Info

DATE

2014-08-30

AUTHORS

Hyo-Joon Yang, Sang Gyun Kim, Joo Hyun Lim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, Woo Ho Kim, Hyun Chae Jung

ABSTRACT

BackgroundAlthough surgery is recommend for non-curative endoscopic resection of early gastric cancer (EGC), only a part of patients are found to have lymph node (LN) metastasis. This study aimed to identify the predictors of LN metastasis in patients with non-curative endoscopic resection.MethodsBetween April 2005 and July 2013, consecutive patients who received non-curative endoscopic resection and then underwent gastrectomy with lymphadenectomy or followed at least 1 year with abdominal computed tomography were retrospectively enrolled at a single tertiary hospital. Non-curative resection was defined as a resection beyond the expanded criteria in pathologic mapping. The predictors for LN metastasis were identified by fitting a multivariate logistic regression model.ResultsAmong the 1783 consecutive patients who received endoscopic resection of EGC, non-curative resection was performed in 323 (18.1 %) patients. Of these patients, a total of 267 patients were enrolled, and the rate of LN metastasis was 6.7 % (18/267). In multivariate analysis, venous invasion [odds ratio (OR), 7.83; 95 % confidence interval (CI) 2.20–27.86; p = 0.001], sm2 invasion (tumor invasion ≥500 µm into submucosa; OR 4.98; 95 % CI 1.34–18.47; p = 0.016), or antral tumor location (OR 12.65; 95 % CI 1.57–102.00; p = 0.017) were independent predictors for LN metastasis. The rates of LN metastasis were 1.1 % (95 % CI 0–2.7) for patients with one or no predictor and 17.8 % (95 % CI 9.7–25.8) for those with two or more predictors.ConclusionsAdditional gastrectomy with lymphadenectomy after non-curative endoscopic resection of EGC is recommended for the patients with two or more identified predictors. However, close follow-up without immediate surgery might be considered cautiously for those with only one or no predictor. More... »

PAGES

1145-1155

References to SciGraph publications

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    34 schema:description BackgroundAlthough surgery is recommend for non-curative endoscopic resection of early gastric cancer (EGC), only a part of patients are found to have lymph node (LN) metastasis. This study aimed to identify the predictors of LN metastasis in patients with non-curative endoscopic resection.MethodsBetween April 2005 and July 2013, consecutive patients who received non-curative endoscopic resection and then underwent gastrectomy with lymphadenectomy or followed at least 1 year with abdominal computed tomography were retrospectively enrolled at a single tertiary hospital. Non-curative resection was defined as a resection beyond the expanded criteria in pathologic mapping. The predictors for LN metastasis were identified by fitting a multivariate logistic regression model.ResultsAmong the 1783 consecutive patients who received endoscopic resection of EGC, non-curative resection was performed in 323 (18.1 %) patients. Of these patients, a total of 267 patients were enrolled, and the rate of LN metastasis was 6.7 % (18/267). In multivariate analysis, venous invasion [odds ratio (OR), 7.83; 95 % confidence interval (CI) 2.20–27.86; p = 0.001], sm2 invasion (tumor invasion ≥500 µm into submucosa; OR 4.98; 95 % CI 1.34–18.47; p = 0.016), or antral tumor location (OR 12.65; 95 % CI 1.57–102.00; p = 0.017) were independent predictors for LN metastasis. The rates of LN metastasis were 1.1 % (95 % CI 0–2.7) for patients with one or no predictor and 17.8 % (95 % CI 9.7–25.8) for those with two or more predictors.ConclusionsAdditional gastrectomy with lymphadenectomy after non-curative endoscopic resection of EGC is recommended for the patients with two or more identified predictors. However, close follow-up without immediate surgery might be considered cautiously for those with only one or no predictor.
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    45 analysis
    46 cancer
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    48 consecutive patients
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    50 early gastric cancer
    51 endoscopic resection
    52 gastrectomy
    53 gastric cancer
    54 hospital
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    56 independent predictors
    57 invasion
    58 location
    59 logistic regression models
    60 lymph
    61 lymph node metastasis
    62 lymphadenectomy
    63 mapping
    64 metastasis
    65 model
    66 more predictors
    67 multivariate analysis
    68 multivariate logistic regression model
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    70 non-curative endoscopic resection
    71 non-curative resection
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