Risk assessment of lymph node metastases in early gastric adenocarcinoma fulfilling expanded endoscopic resection criteria

Pessorrusso, Fernanda Cristina Simões; Felipe-Silva, Aloísio; Jacob, Carlos Eduardo; Ramos, Marcus Fernando Kodama Pertille; Ferreira, Vinícius Guimarães; Mello, Evandro Sobroza de; Zilberstein, Bruno; Ribeiro, Ulysses; Maluf‐Filho, Fauze

doi:10.1016/j.gie.2018.07.023

Cited by 13 publications

(11 citation statements)

References 23 publications

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“…Although endoscopic resection is the preferred option for EGC patients in accordance with indications, the impossibility of regional lymph node clearance is a serious limitation. Approximately 8.9-15.8% of EGC cases will have regional lymph node metastasis, which may lead to tumor recurrence and the need for invasive radical gastrectomy (Roviello et al, 2006;Pessorrusso et al, 2018). Radical surgical treatment can achieve sufficient tumor clearance and lymph node dissection range and its recurrence rate is low, with a 5-year survival rate of >90% (Zeng et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Nomogram for Early Gastric Cancer After Surgery to Assist Decision-Making for Treatment With Adjuvant Chemotherapy

Zhang

Wang

2022

Front. Pharmacol.

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Background: Most patients with early gastric cancer (EGC) can achieve a better 5-year survival rate after endoscopic resection or surgery. However, indications for adjuvant chemotherapy (ACT) after surgery have not yet been determined.Methods: A total of 4,108 patients with EGC diagnosed in 2004–2016 were retrospectively analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. Of these, 3,521 patients received postoperative ACT and 587 patients did not. Propensity score matching was used to balance the two groups’ confounding factors. Kaplan-Meier method was utilized to perform survival analysis. Log-rank test was used to compare the differences between survival curves. Cox proportional-hazards regression model was used to screen independent risk factors and build a nomogram for the non-ACT group. The X-tile software was employed to artificially divide all patients into low-, moderate-, and high-risk groups according to the overall survival score prediction based on the nomogram. A total of 493 patients with EGC diagnosed between 2010 and 2014 in our hospital were included for external validation.Results: Multivariate analysis found that age, sex, race, marital status, primary site, surgical extent, and metastatic lymph node ratio in the non-ACT group were independent prognostic factors for EGC and were included in the construction of the nomogram. The model C-index was 0.730 (95% confidence interval: 0.677–0.783). The patients were divided into three different risk groups based on the nomogram prediction score. Patients in the low-risk group did not benefit from ACT, while patients in the moderate- and high-risk groups did. External validation also demonstrated that moderate- and high-risk patients benefited from ACT.Conclusion: The study nomogram can effectively evaluate postoperative prognosis of patients with EGC. Postoperative ACT is therefore recommended for moderate- and high-risk patients, but not for low-risk patients.

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Section: Introductionmentioning

confidence: 99%

Prognostic Nomogram for Early Gastric Cancer After Surgery to Assist Decision-Making for Treatment With Adjuvant Chemotherapy

Zhang

Wang

2022

Front. Pharmacol.

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“…Additionally, as described before, previous studies have reported on the risk of LNM in this patient group. Pessorrusso et al [22] report 7.7% LNM in patients with intramucosal, undifferentiated adenocarcinoma lesions. Abdelfatah et al [23] have suggested an expansion of the indications for undifferentiated cancer that are 2 cm or less so that they are balanced with the risk of surgery, given that a meta-analysis has found an increased risk of LNM in these patients.…”

Section: Discussionmentioning

confidence: 96%

Assessment of lymphatic flow based on the sentinel node concept in early gastric adenocarcinoma that satisfies expanded endoscopic resection criteria

et al. 2019

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Background Even though indications for endoscopic resection (ER) in early gastric cancer are determined based on the potential risk of lymph node metastasis, the criteria for ER remain controversial. Sentinel node (SN) mapping for early gastric cancer can help determine regional lymphatic flow patterns. The aim of this study was to assess lymphatic flow according to the SN concept in patients with early gastric cancer, especially those who satisfy the expanded criteria for ER. Methods We retrospectively enrolled 301 patients diagnosed with pT1 adenocarcinoma who had undergone gastrectomy with SN mapping and had no lymphovascular invasion. Patients were categorized into six groups based on oncological assessment. We analyzed lymphatic flow, including the number of identified SN and SN basin, and the rate of SN metastasis in each group. Results Of the 301 patients, 128 (42.5%) met the criteria for ER, with 18 in the absolute group and 110 in the expanded group; 173 (57.5%) were assigned to the surgical group. SN metastasis rate tended to be higher in surgical group patients than in ER criteria patients. In the expanded criteria group, the subgroup of patients with intramucosal, undifferentiated adenocarcinoma measuring 20 mm or less had a significantly greater number of identified SNs (p = 0.013) and SN basins (p = 0.032). Furthermore, SN metastasis was observed only in this group. Conclusions Patients with intramucosal, nonulcerated, undifferentiated adenocarcinoma measuring 20 mm or less could develop a lymphatic network. For these patients, careful follow-up is required after ER.

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“…A recent multicenter US-based study noted positive lymph node status in 7.5% of lesions meeting expanded criteria [16]. Other non-Asian countries have reported varying rates, from <3% in Brazil among those meeting expanded criteria to 13.3% in Germany [15,20]. In Asian countries, positive lymph node status among tumors meeting expanded criteria is far lower, almost uniformly <3% [7,21,22].…”

Section: Esd Of Gastric Lesions Is An Evolving Technique In the Unitedmentioning

confidence: 99%

The impact of endoscopic submucosal dissection for gastric adenocarcinomas in the United States

Kumar

Metz

Chandrasekhara

et al. 2020

Techniques and Innovations in Gastrointestinal Endoscopy

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Risk assessment of lymph node metastases in early gastric adenocarcinoma fulfilling expanded endoscopic resection criteria

Cited by 13 publications

References 23 publications

Prognostic Nomogram for Early Gastric Cancer After Surgery to Assist Decision-Making for Treatment With Adjuvant Chemotherapy

Prognostic Nomogram for Early Gastric Cancer After Surgery to Assist Decision-Making for Treatment With Adjuvant Chemotherapy

Assessment of lymphatic flow based on the sentinel node concept in early gastric adenocarcinoma that satisfies expanded endoscopic resection criteria

The impact of endoscopic submucosal dissection for gastric adenocarcinomas in the United States

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