Identifying predictors of lymph node metastasis after endoscopic resection in patients with minute submucosal cancer of the stomach

Choi, Ji Young; Park, Young Soo; Jung, Hwoon‐Yong; Son, Da Hye; Ahn, Ji Yong; Han, Seungbong; Lim, Hyun; Choi, Kwi-Sook; Lee, Jeong Hoon; Kim, Do Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Kim, Jin-Ho

doi:10.1007/s00464-014-3828-8

Cited by 14 publications

(13 citation statements)

References 21 publications

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“…Since the study population in the report by Jung et al [19] was mainly patients who underwent gastrectomy as the initial treatment, this study firstly revealed the role of this factor for LNM in those who underwent ER for deep submucosal invasive EGC. This fact gave the present study the advantage over the previous studies [10, 19], which mainly evaluated this factor in surgical specimens and showed conflicting results because ESD specimens enable a more precise histopathological assessment than surgical specimen due to the difference in recommended tissue slice preparation (2 mm for ESD vs. 5–7 mm for surgical resection) [20]. Furthermore, the present study also found a difference in the rate of LNM between those with and without this factor at the low-risk category in the eCura system (7.9 vs. 2.3%).…”

Section: Discussionmentioning

confidence: 81%

“…[19] revealed that a poorly differentiated carcinoma component in the submucosal layer was associated with twice the risk of LNM. On the other hand, Choi et al [10] showed that undifferentiated carcinoma in the deepest portion of the tumor was not a significant RF for LNM in superficial submucosal invasive EGC. In this study, we evaluated the role of an undifferentiated component in submucosal invasion for LNM in patients who underwent ER for EGC with deep submucosal invasion.…”

Section: Discussionmentioning

confidence: 99%

“…There have been many studies showing differences in the clinical outcomes between the superficial (<500 µm) and deep (≥500 µm) submucosal invasive EGCs [8-10, 12, 19, 22]. However, the relationship between the SID and LNM has not been clarified in deep submucosal invasive EGC.…”

Section: Discussionmentioning

confidence: 99%

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The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Miyahara¹,

Hatta

Nakagawa³

et al. 2018

Digestion

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Background/Aims: The role of an undifferentiated component in submucosal invasion and submucosal invasion depth (SID) for lymph node metastasis (LNM) of early gastric cancer (EGC) with deep submucosal invasion (SID ≥500 μm from the muscularis mucosa) after endoscopic submucosal dissection (ESD) has not been fully understood. This study aimed to clarify the risk factors (RFs), including these factors, for LNM in such patients. Methods: We enrolled 513 patients who underwent radical surgery after ESD for EGC with deep submucosal invasion. We evaluated RFs for LNM, including an undifferentiated component in submucosal invasion and the SID, which was subdivided into 500–999, 1,000–1,499, 1,500–1,999, and ≥2,000 µm. Results: LNM was detected in 7.6% of patients. Multivariate analysis revealed that an undifferentiated component in submucosal invasion (OR 2.22), in addition to tumor size >30 mm (OR 2.51) and lymphatic invasion (OR 3.07), were the independent RFs for LNM. However, the SID was not significantly associated with LNM. Conclusion: An undifferentiated component in submucosal invasion was one of the RFs for LNM, in contrast to SID, in patients who underwent ESD for EGC with deep submucosal invasion. This insight would be helpful in managing such patients.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Miyahara¹,

Hatta

Nakagawa³

et al. 2018

Digestion

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“…Moreover, in the present study, we measured the width and depth of tumor invasion into the MP, and identified only the width of invasion, and not the depth, as a significant prognostic factor. Several studies have simultaneously measured the width and depth of tumor invasion in submucosal gastric cancer and investigated which of the two is of greater clinicopathological significance (19)(20)(21)(22). Sanomura et al described that the horizontal width of invasion is a more useful predictor of lymph node metastasis than the depth of invasion (19), while similar results were also demonstrated by Fang et al (21).…”

Section: Kaplan-meier Survival Curves For Relapse-free Survival Of mentioning

confidence: 85%

Clinical Implication of Tumor-invasive Status into the Muscularis Propria in T2 Gastric Cancer

Nakamura

Ogimi

Tomioku

et al. 2019

In Vivo

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Background/Aim: Several studies have investigated prognostic factors in patients with T2 gastric cancer, but no consensus has been reached to date. The aim was to investigate the clinicopathological significance of the status of tumor invasion into the muscularis propria (MP) in T2 gastric cancer patients. Patients and Methods: A total of 113 patients with T2 cancer were enrolled. The status of caner invasion was analyzed according to width (extent of horizontal invasion) and depth (extent of vertical invasion). Results: The prognosis of the group with wide width of invasion (≥1.5 cm) was significantly poorer than that of the group with narrow width of invasion (<1.5 cm) (p=0.001). Multivariate analysis identified the width, and not the depth, as an independent prognostic factor. The analysis according to AJCC N stage showed that the width, and not the nodal status, was an independent prognostic factor in the N2-N3 patients (p=0.005). Conclusion: Measurement of the width of tumor invasion into the MP was useful to understand the malignant potential of T2 gastric cancer. Advanced gastric cancer confined to the muscularis propria (T2 gastric cancer) is as an intermediate-stage carcinoma, between early and advanced cancer (1, 2). Therefore, it is considered to have a better prognosis than more advanced cancer, and recently minimally-invasive surgical procedures, such as laparoscopic gastrectomy, have been actively adopted (3, 4). However, although at a low frequency, recurrences do occur, and it is clinically important to investigate prognostic factors for T2 gastric cancer. Several studies have investigated prognostic factors in patients with T2 gastric cancer. While studies have been conducted to determine the influence of age (5, 6), tumor diameter (7, 8), lymph node metastasis (9, 10) and macroscopic type (11) on the prognosis, no consensus has been reached yet. Therefore, in this study, we investigated the clinicopathological significance of the status of tumor invasion at the invasive front, namely, in the muscularis propria (MP), in patients with T2 gastric cancer.

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“…The subsequent step of evaluating whether EGC are indicated for endoscopic treatment is the most important in managing patients with EGC. Many studies have shown that mucosal EGC have almost no risk of lymph node metastasis (LNM), while superficial submucosal EGC are at a relatively high risk of LNM ranging from none to 10.1% . Therefore, endoscopic resection can be considered for mucosal EGC and some of the submucosal EGC after evaluating the size, invasive depth, type of differentiation of the lesions, which can be determined by endoscopic devices including conventional endoscopy, chromoendoscopy and magnifying endoscopy with NBI.…”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 99%

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. K E Y W O R D Scurative resection, early gastric cancer, eCura system, endoscopy, gastric neoplasms, surveillance

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Identifying predictors of lymph node metastasis after endoscopic resection in patients with minute submucosal cancer of the stomach

Cited by 14 publications

References 21 publications

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Clinical Implication of Tumor-invasive Status into the Muscularis Propria in T2 Gastric Cancer

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

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