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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Reevaluation of the expanded indications in undifferentiated early gastric cancer for endoscopic submucosal dissection
Jiyoung Yoon, Seung-Yeon Yoo, Young Soo Park, Kee Don Choi, Beom Su Kim, Moon-Won Yoo, In Seob Lee, Jeong Hwan Yook, Ga Hee Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Jiyoung Yoon, Kee Don Choi, Ga Hee Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, -Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Seung-Yeon Yoo, Young Soo Park, Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Beom Su Kim, Moon-Won Yoo, In Seob Lee, Jeong Hwan Yook, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Yoon J and Yoo SY equally contributed to this article; Yoon JY and Yoo SY collected and analyzed data, and drafted the manuscript; Kim BS, Yoo MW, Lee IS, Yook JH, Kim GH, Na HK, Ahn JY, Lee JH, Jung KW, Kim DH, Song HJ, Lee GH and Jung HY were involved in study patient enrollment, data collection, and data analysis; Choi KD and Park YS were involved in study design, supervision, and critical revision of the study; Choi KD and Park YS equally contributed as co-corresponding authors; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Asan Medical Center.
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board considering the retrospective design of the study.
Conflict-of-interest statement: All authors have no conflict of interest related to the study.
Data sharing statement: Data used in this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kee Don Choi, MD, PhD, Doctor, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. keedon@amc.seoul.kr
Received: December 2, 2021
Peer-review started: December 2, 2021
First decision: January 23, 2022
Revised: February 5, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: April 21, 2022
ARTICLE HIGHLIGHTS
Research background
There have been several reports of lymph node or distant metastases arising after curative endoscopic submucosal dissection (ESD) in undifferentiated early gastric cancer (UD-EGC) cases meeting the expanded criteria.
Research motivation
The clinicopathologic features associated with the risk of lymph node metastasis (LNM) in UD-EGC have not been well-studied.
Research objectives
To investigate the prevalence and risk factors of LNM in UD-EGC cases meeting the criteria for the expanded indication for ESD.
Research methods
In this retrospective study, we investigated the risk of LNM of UD-EGC meeting the criteria for the expanded indication for ESD, and performed a matched case-control study to identify the clinical, endoscopic, and histopathological features associated with the risk of LNM. Univariate and multivariate logistic regression analyses were performed to identify the risk factors by estimating the odds ratios.
Research results
The incidence rate of LNM in UD-EGC cases meeting the criteria for the expanded indication for ESD was 1.1% (14/1240). No significant differences existed between the LNM group and the matched non-LNM group in terms of preoperative clinical endoscopic features and conventional histologic features. In the tumor microenvironment, blurring of muscularis mucosa (MM) underneath the tumorous epithelium was associated with the risk of LNM.
Research conclusions
The risk of LNM was higher than expected when using the current expanded indication for UD-EGC. Evaluation of blurring of MM could provide useful clues for reducing the risk of LNM.
Research perspectives
Further studies are needed to validate the significance of MM blurring and elucidate its mechanistic basis. Eventually, an improved model for patient stratification based on detailed histologic evaluation of ESD specimens should be established to identify patients with a high risk of LNM.
