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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) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of endoscopic submucosal dissection (ESD) in mucosal gastric cancer within lamina propria. (B) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of ESD in with muscularis mucosa invasion. *Absolute indications according to the new Japanese classification and treatment guidelines for gastric cancer. **Expanded indications according to the new Japanese classifications and treatment guidelines for gastric cancer.
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Figure 3: (A) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of endoscopic submucosal dissection (ESD) in mucosal gastric cancer within lamina propria. (B) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of ESD in with muscularis mucosa invasion. *Absolute indications according to the new Japanese classification and treatment guidelines for gastric cancer. **Expanded indications according to the new Japanese classifications and treatment guidelines for gastric cancer.

Mentions: The patients with MGC were divided into 2 groups based on tumor invasion depth: invasion of the lamina propria and invasion of the muscularis mucosae without penetration. Moreover, the frequency of LN metastasis in each group was assessed according to differentiation, ulceration, and tumor size, based on the indications for ESD (Fig. 3). Among the cases of MGC invading the lamina propria, 5 of 444 (1.1%) exhibited LN metastasis, whereas only 1 of 186 (0.5%) had extended indications for ESD (Fig. 3, Table 3). Furthermore, among the cases of MGC invading the muscularis mucosae without penetration, 37 of 747 (5.0%) exhibited LN metastasis, whereas only 1 of 107 (0.9%) had absolute indications and 8 of 307 (2.6%) had expanded indication for ESD (Fig. 3).


Risk factors for lymph node metastasis in mucosal gastric cancer and re-evaluation of endoscopic submucosal dissection
(A) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of endoscopic submucosal dissection (ESD) in mucosal gastric cancer within lamina propria. (B) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of ESD in with muscularis mucosa invasion. *Absolute indications according to the new Japanese classification and treatment guidelines for gastric cancer. **Expanded indications according to the new Japanese classifications and treatment guidelines for gastric cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (A) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of endoscopic submucosal dissection (ESD) in mucosal gastric cancer within lamina propria. (B) The frequency of lymph node metastasis according to differentiation, ulceration, and size, based on the indications of ESD in with muscularis mucosa invasion. *Absolute indications according to the new Japanese classification and treatment guidelines for gastric cancer. **Expanded indications according to the new Japanese classifications and treatment guidelines for gastric cancer.
Mentions: The patients with MGC were divided into 2 groups based on tumor invasion depth: invasion of the lamina propria and invasion of the muscularis mucosae without penetration. Moreover, the frequency of LN metastasis in each group was assessed according to differentiation, ulceration, and tumor size, based on the indications for ESD (Fig. 3). Among the cases of MGC invading the lamina propria, 5 of 444 (1.1%) exhibited LN metastasis, whereas only 1 of 186 (0.5%) had extended indications for ESD (Fig. 3, Table 3). Furthermore, among the cases of MGC invading the muscularis mucosae without penetration, 37 of 747 (5.0%) exhibited LN metastasis, whereas only 1 of 107 (0.9%) had absolute indications and 8 of 307 (2.6%) had expanded indication for ESD (Fig. 3).

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