Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer
- Authors
- Yang, Hyo-Joon; Jang, Jae-Young; Kim, Sang Gyun; Ahn, Ji Yong; Nam, Su Youn; Kim, Jie-Hyun; Min, Byung-Hoon; Lee, Wan-Sik; Lee, Bong Eun; Joo, Moon Kyung; Park, Jae Myung; Shin, Woon Geon; Lee, Hang Lak; Gweon, Tae-Geun; Park, Moo In; Choi, Jeongmin; Tae, Chung Hyun; Kim, Young-Il; Choi, Il Ju
- Issue Date
- 1월-2021
- Publisher
- SPRINGER
- Keywords
- Stomach neoplasms; Undifferentiated-type histology; Non-curative resection; Lymph node Metastasis; Risk factors
- Citation
- GASTRIC CANCER, v.24, no.1, pp.168 - 178
- Indexed
- SCIE
SCOPUS
- Journal Title
- GASTRIC CANCER
- Volume
- 24
- Number
- 1
- Start Page
- 168
- End Page
- 178
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/129479
- DOI
- 10.1007/s10120-020-01103-2
- ISSN
- 1436-3291
- 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.
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