Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer
Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer作者机构：Department of Gastroenterology the Affiliated Hospital of Qingdao University Qingdao 266003 Shandong Province China Department of Pathology the Affiliated Hospital of Qingdao University Qingdao 266003 Shandong Province China Department of Epidemiology and Health Statistics School of Public Health Qingdao University Qingdao 266021 Shandong Province China Endoscopy Center the Affiliated Hospital of Qingdao University Qingdao 266003 Shandong Province China
出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)
年 卷 期：2019年第25卷第35期
页 面：5344-5355页
核心收录：
基 金：Supported by the National Natural Science Foundation of China,No.81502025 the China Postdoctoral Science Foundation,No.2018M632631
主 题：Early gastric cancer Lymph node metastasis Predictors Endoscopic submucosal dissection Expanded indications
摘 要：BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection. The indications for ESD have been recently expanded to include larger, ulcerated, and undifferentiated mucosal lesions, and differentiated lesions with slight submucosal invasion. The risk of lymph node metastasis (LNM) is the most important consideration when deciding on a treatment strategy for EGC. Despite the advantages over surgical procedures, lymph nodes cannot be removed by ESD. In addition, whether patients who meet the expanded indications for ESD can be managed safely remains controversial. AIM To determine whether the ESD indications are applicable to Chinese patients and to investigate the predictors of LNM in EGC. METHODS We retrospectively analyzed 12552 patients who underwent surgery for gastric cancer between June 2007 and December 2018 at the Affiliated Hospital of Qingdao University. A total of 1262 (10.1%) EGC patients were eligible for inclusion in this study. Data on the patients’ clinical, endoscopic, and histopathological characteristics were collected. The absolute and expanded indications for ESD were validated by regrouping the enrolled patients and determining the positive LNM results in each subgroup. Predictors of LNM in patients were evaluated by univariate and multivariate analyses. RESULTS LNM was observed in 182 (14.4%) patients. No LNM was detected in the patients who met the absolute indications (0/90). LNM occurred in 4/311 (1.3%) patients who met the expanded indications. According to univariate analysis, LNM was significantly associated with positive tumor marker status, medium (20-30 mm) and large (30 mm) lesion sizes, excavated macroscopic-type tumors, ulcer presence, submucosal invasion (SM1 and SM2), poor differentiation, lymphovascular invasion (LVI), perineural invasion, and diffuse and mixed Lauren’s type
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