Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer

Hyo Joon Yang, Jae Young Jang, Sang Gyun Kim, Ji Yong Ahn, Su Youn Nam, Jie Hyun Kim, Byung Hoon Min, Wan Sik Lee, Bong Eun Lee, Moon Kyung Joo, Jae Myung Park, Woon Geon Shin, Hang Lak Lee, Tae Geun Gweon, Moo In Park, Jeongmin Choi, Chung Hyun Tae, Young Il Kim, Il Ju Choi

Research output: Contribution to journalArticle

Abstract

Background: This study aimed to investigate risk factors for lymph node (LN) or distant metastasis after non-curative endoscopic resection (ER) of undifferentiated-type early gastric cancer (EGC). Methods: Of 1124 patients who underwent ER for undifferentiated-type gastric cancer at 18 tertiary hospitals across six geographic areas in Korea between 2005 and 2014, 634 with non-curative ER beyond the expanded criteria were retrospectively enrolled. According to the treatment after ER, patients were divided into additional surgery (n = 270) and follow-up (n = 364) groups. The median follow-up duration was 59 months for recurrence and 84 months for mortality. Results: LN metastasis was found in 6.7% (18/270) of patients at surgery. Ulcer [odds ratio (OR) 3.83; 95% confidence interval (CI) 1.21–12.13; p = 0.022] and submucosal invasion (OR 10.35; 95% CI 1.35–79.48; p = 0.025) were independent risk factors. In the follow-up group, seven patients (1.9%) developed LN or distant recurrence. Ulcer [hazard ratio (HR) 7.60; 95% CI 1.39–35.74; p = 0.018], LVI (HR 6.80; 95% CI 1.07–42.99; p = 0.042), and positive vertical margin (HR 6.71; 95% CI 1.28–35.19; p = 0.024) were independent risk factors. In the overall cohort, LN metastasis rates were 9.6% in patients with two or more risk factors and 1.2% in those with no or one risk factor. Conclusions: LVI, ulcer, submucosal invasion, and positive vertical margin are independently associated with LN or distant metastasis after non-curative ER of undifferentiated-type EGC. Surgical resection is strongly recommended for patients with two or more risk factors.

Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Lymph node Metastasis
  • Non-curative resection
  • Risk factors
  • Stomach neoplasms
  • Undifferentiated-type histology

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

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  • Cite this

    Yang, H. J., Jang, J. Y., Kim, S. G., Ahn, J. Y., Nam, S. Y., Kim, J. H., Min, B. H., Lee, W. S., Lee, B. E., Joo, M. K., Park, J. M., Shin, W. G., Lee, H. L., Gweon, T. G., Park, M. I., Choi, J., Tae, C. H., Kim, Y. I., & Choi, I. J. (Accepted/In press). Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer. Gastric Cancer. https://doi.org/10.1007/s10120-020-01103-2