Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer

Abstract

Background When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration. Patients and Methods We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed. Results LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P < 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P < 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions < 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer. Conclusions Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC < 30 mm in size, and additional investigation is needed to evaluate its safety.

Nomograms for Predicting the Lymph Node Metastasis in Early Gastric Cancer by Gender: A Retrospective Multicentric Study

“…In the EGC patients with LVI, the risk for LNM reached >10% and >70% in male and female EGC patients, respectively ( Figures 2 and 4 ), which was similar with the results from Ren et al. ( 28 ), and LVI might be considered an evaluation index for effective removal of EGC after ER. When LVI is positive, the extension of gastric resection and lymph node dissection are necessary.…”

The risk of lymph node metastasis in gastric cancer conforming to indications of endoscopic resection and pylorus-preserving gastrectomy: a single-center retrospective study

“…However, a Chinese study in 2016 also reported that the LNM rate was as high as 8.70% when the Japanese expanded criteria were used [ 26 ]. Another study reported that the rate of LNM was high (8.00–14.30%) when tumors were > 30 mm in diameter for patients with T1a stage EGC [ 27 ]. Therefore, our data suggested that ESD/EMR treatment of EGC should be considered carefully in different racial populations [ 19 ], and more data are needed to draw a firm conclusion about the expanded indication for ESD.…”

Clinical significance of additional gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective single-center study

“…LNM rates for patients who underwent additional gastrectomy after non-curative ESD ranged from 7.5% to 17.8% [ 12 – 14 , 16 ]. Depth of invasion, lymphatic invasion, vascular invasion, and differentiation were the associated risk factors for LNM [ 12 , 13 , 16 ].…”

“…LNM rates for patients who underwent additional gastrectomy after non-curative ESD ranged from 7.5% to 17.8% [ 12 – 14 , 16 ]. Depth of invasion, lymphatic invasion, vascular invasion, and differentiation were the associated risk factors for LNM [ 12 , 13 , 16 ]. In our study, the LNM rate after additional gastrectomy was 8.2% (6/73), and lymphatic invasion was the only risk factor for LNM (P=0.012).…”