Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
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ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer Ming-Han Ren, MM1 Yun-Qing Chen, MD2
, Xing-Si Qi, MM1 , Yu-Ning Chu, MM1 , Ya-Nan Yu, MD1 , , Peng Zhang, MM1 , Tao Mao, MD1 , and Zi-Bin Tian, MD1
1
Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; 2Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
ABSTRACT Background. When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration. Patients and Methods. We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed. Results. LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P \ 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P \ 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions \ 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate
Ó The Author(s) 2020 First Received: 5 June 2020 Accepted: 2 September 2020 Z.-B. Tian, MD e-mail: [email protected]
than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer. Conclusions. Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC \ 30 mm in size, and additional investigation is needed to evaluate its safety.
Early gastric cancer (EGC) is defined as carcinoma limited to the mucosa (T1a) or submucosa (T1b), regardless of presence of lymph node metastasis (LNM).1 Patients with EGC generally have extremely good prognosis after radical resection, and the 5-year survival rate is reported to be approximately 90%.2 When LNM develops, this survival rate decreases to less than 70%.3 The possibility of LNM makes gastrectomy the standard treatment for EGC. However, radical surgery is associated with various postoperative complications and a high mortality rate, as well as a decline in patient quality of life.4 Endoscopic submucosal dissection (ESD) is an effective alternative to surgical treatment for EGC when the risk of LNM is considered minimal.
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