Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2015; 21(39): 11160-11167
Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11160
Prediction of the indication criteria for endoscopic resection of early gastric cancer
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Kyung Sik Park, Eun Soo Kim, Kwang Bum Cho
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea
Kyung Sik Park, Eun Soo Kim, Kwang Bum Cho, Department of Internal Medicine, Keimyung University College of Medicine, Daegu 705-717, South Korea
Author contributions: Park JH, Park JM and Park CS contributed equally to this work; Park JH collected and analyzed the data, and drafted the manuscript; Park JM and Park CS provided analytical oversight; Lee SH designed and supervised the study; Park KS, Kim ES and Cho KB revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Yeungnam University hospital Institutional Review Board.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at e-mail: dr9696@nate.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Si Hyung Lee, MD, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchungro, Nam-gu, Daegu 705-717, South Korea. dr9696@nate.com
Telephone: +82-53-6203830 Fax: +82-53-6548386
Received: April 1, 2015
Peer-review started: April 2, 2015
First decision: June 4, 2015
Revised: July 27, 2015
Accepted: August 29, 2015
Article in press: August 29, 2015
Published online: October 21, 2015
Processing time: 200 Days and 11.1 Hours
Abstract

AIM: To find risk factors of lymph node metastasis (LNM) in early gastric cancer (EGC) and to find proper endoscopic therapy indication in EGC.

METHODS: We retrospectively reviewed the 2270 patients who underwent curative operation for EGC from January 2001 to December 2008. EGC was defined as malignant lesions that do not invade beyond the submucosal layer of the stomach wall irrespective of presence of lymph node metastasis.

RESULTS: Among 2270 enrolled patients, LNM was observed in 217 (9%) patients. LNM in intramucosal (M) cancer and submucosal (SM) cancer was detected in 38 (2.8%, 38/1340) patients and 179 (19%, 179/930) patients, respectively. In univariate analysis, the risk factors for LNM in EGC were size of tumor, Lauren classification, ulcer, lymphatic invasion, vascular invasion, and depth of invasion. However, in multivariate analysis, size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in EGC. Size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in cases of intramucosal cancer and submucosal cancer. In particular, there was no lymph node metastasis in cases of well differentiated early gastric cancer below 1 cm in size without ulcer regardless of lymphovascular invasion.

CONCLUSION: Tumor size, perilymphatic-vascular invasion, and depth of invasion were risk factors for LNM in EGC. There was no LNM in EGC below 1 cm regardless risk factors.

Keywords: Early gastric cancer; Lymph node metastasis; Endoscopic resection

Core tip: Although the depth of tumor infiltration, tumor size as a maximum tumor diameter, and perilymphovascular invasion are independent risk factors for lymph node metastasis (LNM) in early gastric cancer (EGC), there was no LNM in intramucosal cancer which was not signet ring cell type and was below 1 cm without ulceration regardless of lymphatic invasion. This means that endoscopic submucosal dissection can be the treatment of choice in patients with intramucosal cancer below 1 cm without ulceration. There was LN metastasis in EGC of extended criteria in this study. But, the possibility of LNM in intramucosal cancer of extended indication was below 1%.