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Risk factors for lymph node metastasis in mucosal gastric cancer and re-evaluation of endoscopic submucosal dissection

View Article: PubMed Central - PubMed

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.

No MeSH data available.


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A 51-year-old woman with a preoperative clinical diagnosis of mucosal gastric cancer without lymph node (LN) metastasis, who was eventually pathologically confirmed as having LN metastasis after surgery. (A) Endoscopic image: early gastric cancer (EGC) gross type IIc with irregular margin at the lesser curvature of the lower body. (B) Endoscopic ultrasound image: a hypoechoic disruption of the superficial and deep mucosal layers is noted. The third (submucosal) layer is intact. (C) Abdominal computed tomography image: no evidence of focal wall thickening or a mass in the stomach is observed. (D) Final histological report.
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Figure 1: A 51-year-old woman with a preoperative clinical diagnosis of mucosal gastric cancer without lymph node (LN) metastasis, who was eventually pathologically confirmed as having LN metastasis after surgery. (A) Endoscopic image: early gastric cancer (EGC) gross type IIc with irregular margin at the lesser curvature of the lower body. (B) Endoscopic ultrasound image: a hypoechoic disruption of the superficial and deep mucosal layers is noted. The third (submucosal) layer is intact. (C) Abdominal computed tomography image: no evidence of focal wall thickening or a mass in the stomach is observed. (D) Final histological report.

Mentions: Despite the development of novel diagnostic and treatment methods, we often treat the patients diagnosed preoperatively as MGC without LN metastasis, but they are pathologically confirmed as having LN metastasis after the surgery (Fig. 1). The prognostic factors for EGC include depth of tumor invasion, LN metastasis, grade of histologic differentiation, and curative surgery, and many studies have reported that LN metastasis is the most important risk factor for MGC recurrence [789].


Risk factors for lymph node metastasis in mucosal gastric cancer and re-evaluation of endoscopic submucosal dissection
A 51-year-old woman with a preoperative clinical diagnosis of mucosal gastric cancer without lymph node (LN) metastasis, who was eventually pathologically confirmed as having LN metastasis after surgery. (A) Endoscopic image: early gastric cancer (EGC) gross type IIc with irregular margin at the lesser curvature of the lower body. (B) Endoscopic ultrasound image: a hypoechoic disruption of the superficial and deep mucosal layers is noted. The third (submucosal) layer is intact. (C) Abdominal computed tomography image: no evidence of focal wall thickening or a mass in the stomach is observed. (D) Final histological report.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016601&req=5

Figure 1: A 51-year-old woman with a preoperative clinical diagnosis of mucosal gastric cancer without lymph node (LN) metastasis, who was eventually pathologically confirmed as having LN metastasis after surgery. (A) Endoscopic image: early gastric cancer (EGC) gross type IIc with irregular margin at the lesser curvature of the lower body. (B) Endoscopic ultrasound image: a hypoechoic disruption of the superficial and deep mucosal layers is noted. The third (submucosal) layer is intact. (C) Abdominal computed tomography image: no evidence of focal wall thickening or a mass in the stomach is observed. (D) Final histological report.
Mentions: Despite the development of novel diagnostic and treatment methods, we often treat the patients diagnosed preoperatively as MGC without LN metastasis, but they are pathologically confirmed as having LN metastasis after the surgery (Fig. 1). The prognostic factors for EGC include depth of tumor invasion, LN metastasis, grade of histologic differentiation, and curative surgery, and many studies have reported that LN metastasis is the most important risk factor for MGC recurrence [789].

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus