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©The Author(s) 2022.
World J Gastroenterol. Apr 21, 2022; 28(15): 1548-1562
Published online Apr 21, 2022. doi: 10.3748/wjg.v28.i15.1548
Published online Apr 21, 2022. doi: 10.3748/wjg.v28.i15.1548
Table 1 Clinical and endoscopic features of the patients according to the presence of lymph node metastasis
Variables | LNM- (n = 73) | LNM+ (n = 14) | P value |
Age at diagnosis, yr (median, IQR) | 47.0 (41.0-52.0) | 43.5 (37.0-51.0) | 0.276 |
Lesion size, cm (median, IQR) | 1.5 (1.2-1.7) | 1.5 (1.3-1.8) | 0.485 |
Male, n (%) | 25 (34.2) | 4 (28.6) | 0.918 |
Longitudinal location, n (%) | 0.269 | ||
Upper | 4 (5.5) | 0 (0.0) | |
Middle | 22 (30.1) | 2 (14.3) | |
Lower | 47 (64.4) | 12 (85.7) | |
Cross-sectional circumference, n (%) | 0.421 | ||
Anterior wall | 16 (21.9) | 6 (42.9) | |
Great curvature | 16 (21.9) | 2 (14.3) | |
Posterior wall | 23 (31.5) | 3 (21.4) | |
Lesser curvature | 18 (24.7) | 3 (21.4) | |
Gross type, n (%) | 0.440 | ||
Depressed | 42 (57.5) | 10 (71.4) | |
Flat | 25 (34.2) | 4 (28.6) | |
Elevated | 6 (8.2) | 0 (0.0) | |
Number of retrieved LNs (median, IQR) | 30.0 (25.0-37.0) | 30.5 (25.5-37.0) | 0.862 |
Endoscopic appearances, n (%) | |||
Exudate | 6 (8.2) | 1 (7.1) | > 0.999 |
Endoscopic ulcer | 30 (41.1) | 7 (50.0) | 0.747 |
Converging fold | 11 (15.1) | 1 (7.1) | 0.715 |
Tumor island | 14 (19.2) | 3 (21.4) | > 0.999 |
Table 2 Detailed clinical information of the 14 patients with lymph node metastasis
Case No. | Age (yr) | Sex | Type | Size (cm) | Location | Histology | Depth of invasion | Total number of dissected LNs | Number of metastatic LNs |
1 | 59 | Female | IIb | 1.5 | Middle | PD with SRC | LP | 31 | 3 |
2 | 41 | Female | IIc | 1.3 | Lower | PD with SRC | LP | 18 | 3 |
3 | 57 | Male | IIc | 1.3 | Lower | SRC | LP | 21 | 1 |
4 | 47 | Female | IIc | 1.8 | Middle | PD with SRC | LP | 21 | 3 |
5 | 46 | Female | IIb | 2.0 | Lower | PD with SRC | LP | 25 | 6 |
6 | 37 | Female | IIc | 1.5 | Lower | PD with SRC | MM | 31 | 3 |
7 | 48 | Female | IIc | 1.5 | Lower | PD with SRC | LP | 37 | 1 |
8 | 35 | Male | IIc | 0.9 | Lower | PD with SRC | LP | 38 | 1 |
9 | 35 | Female | IIc | 1.5 | Lower | PD with SRC | LP | 27 | 1 |
10 | 52 | Female | IIb | 0.7 | Lower | PD with SRC | LP | 29 | 1 |
11 | 60 | Male | III | 0.6 | Lower | PD with SRC | MM | 30 | 1 |
12 | 39 | Female | IIc | 2.0 | Lower | PD with SRC | LP | 37 | 1 |
13 | 37 | Female | IIb | 1.8 | Lower | PD with SRC | LP | 42 | 1 |
14 | 33 | Male | IIc | 2.0 | Lower | PD with SRC | LP | 48 | 3 |
Table 3 Histologic features of the tumors and background stomach according to the presence of lymph node metastasis
Variables | LNM- (n = 73) | LNM+ (n = 14) | P value |
Depth of invasion | 0.503 | ||
LP | 53 (72.6) | 12 (85.7) | |
MM | 20 (27.4) | 2 (14.3) | |
Size, cm | 1.5 (1.2-1.7) | 1.5 (1.3-1.8) | 0.642 |
% of SRCs | 0.157 | ||
< 10% | 17 (23.3) | 0 (0) | |
≥ 10% and < 50% | 35 (47.9) | 10 (71.4) | |
≥ 50% and < 90% | 14 (19.2) | 3 (21.4) | |
≥ 90% | 7 (9.6) | 1 (7.1) | |
Diagnostic category according to the proportion of SRCs | 0.059 | ||
Non-mixed (SRCC and PD) | 24 (32.9) | 1 (7.1) | |
Mixed (PD with SRC component) | 49 (67.1) | 13 (92.9) | |
Background stomach | 0.278 | ||
Mild CG | 8 (11.0) | 0 (0) | |
Moderate CG or IM | 24 (32.9) | 3 (21.4) | |
CAG | 22 (30.1) | 4 (28.6) | |
CAG with visible H. pylori | 19 (26.0) | 7 (50.0) | |
H. pylori abundance, n/total n | 0.263 | ||
0 | 23/71 (32.4) | 2/14 (14.3) | |
1+ | 14/71 (19.7) | 3/14 (21.4) | |
2+ | 14/71 (19.7) | 6/14 (42.9) | |
3+ | 20/71 (28.2) | 3/14 (21.4) | |
TP53 expression, n/total | > 0.999 | ||
Loss (0) | 3/70 (4.3) | 0/14 (0) | |
Wildtype pattern (1+/2+) | 63/70 (90.0) | 13/14 (92.9) | |
Overexpression (3+) | 4/70 (5.7) | 1/14 (7.1) |
Table 4 Histologic features of the tumor microenvironment according to the presence of lymph node metastasis
Variables | LNM- (n = 73) | LNM+ (n = 14) | P value |
TIL abundance | 0.438 | ||
< 10% | 25 (34.2) | 7 (50.0) | |
10%-20% | 33 (45.2) | 6 (42.9) | |
≥ 20% | 15 (20.5) | 1 (7.1) | |
Degree of central fibrosis | 0.522 | ||
Mild | 6 (8.5) | 2 (14.3) | |
Moderate | 35 (49.3) | 8 (57.1) | |
Marked | 30 (42.3) | 4 (28.6) | |
Degree of peripheral fibrosis | |||
Mild | 11 (15.5) | 2 (14.3) | 0.495 |
Moderate | 53 (74.6) | 9 (64.3) | |
Marked | 7 (9.9) | 3 (21.4) | |
Distribution of fibrosis | |||
Central = peripheral | 32 (45.1) | 7 (50.0) | 0.204 |
Central > peripheral | 33 (46.5) | 4 (28.6) | |
Central < peripheral | 6 (8.5) | 3 (21.4) | |
Fibrosis score | 0.55 (0.38-0.83) | 0.53 (0.31-0.77) | 0.273 |
Blurring of MM, n/total | 0.028 | ||
Non-diffuse (absent/focal) | 43/71 (60.6) | 13/14 (92.9) | |
Diffuse | 28/71 (39.4) | 1/14 (7.1) |
Table 5 Logistic regression analysis for the risk of Lymph node metastasis
Variable | OR | 95%CI | P value |
Depth of invasion | |||
LP | 1 | ||
MM | 0.44 | 0.09-2.15 | 0.312 |
Diagnostic category according to % of SRCs | |||
Non-mixed (SRC and PD) | 1 | ||
Mixed (PD with SRC component) | 6.37 | 0.79-51.6 | 0.083 |
Background stomach | |||
CG | 1 | ||
CAG | 2.86 | 0.74-11.1 | 0.129 |
Presence of H. pylori | |||
Absent (0) | 1 | ||
Present (≥ 1+) | 2.88 | 0.59–13.9 | 0.190 |
TIL abundance | 0.409 | ||
< 10% | 1 | ||
10%-20% | 0.65 | 0.19-2.17 | 0.484 |
≥ 20% | 0.24 | 0.03-2.13 | 0.199 |
Fibrosis score | 0.34 | 0.05-2.49 | 0.285 |
Blurring of MM | |||
Non-diffuse (absent/focal) | 1 | ||
Diffuse | 0.12 | 0.02-0.95 | 0.045 |
- Citation: Yoon J, Yoo SY, Park YS, Choi KD, Kim BS, Yoo MW, Lee IS, Yook JH, Kim GH, Na HK, Ahn JY, Lee JH, Jung KW, Kim DH, Song HJ, Lee GH, Jung HY. Reevaluation of the expanded indications in undifferentiated early gastric cancer for endoscopic submucosal dissection. World J Gastroenterol 2022; 28(15): 1548-1562
- URL: https://www.wjgnet.com/1007-9327/full/v28/i15/1548.htm
- DOI: https://dx.doi.org/10.3748/wjg.v28.i15.1548