Da Hyun Jung1, Cheal Wung Huh1, Jie-Hyun Kim2, Jung Hwa Hong3, Jun Chul Park4, Yong Chan Lee5, Young Hoon Youn1, Hyojin Park1, Seung Ho Choi6, Sung Hoon Noh7. 1. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. otilia94@yuhs.ac. 3. Department of Research Affairs, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. junchul75@yuhs.ac. 5. Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 6. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 7. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Patients with early gastric cancer (EGC) who have undergone noncurative endoscopic resection (ER) generally require additional surgery due to the possibility of lymph node metastasis (LNM). This study aimed to develop a reliable risk-stratification system to predict LNM after noncurative ER for EGC. METHODS: A total of 2368 patients had a diagnosis of EGC and underwent ER. The study analyzed 321 patients who underwent additive gastrectomy and lymph node dissection after noncurative ER. Independent risk factors for LNM were identified and used to develop a risk-stratification system to estimate the relative risk of LNM. RESULTS: Of the 321 patients, 23 (7.2%) had LNM. A logistic regression analysis showed that female sex, lymphovascular invasion (LVI), and a positive vertical margin were significantly associated with LNM. The authors established a risk-stratification system using sex, LVI, and positive vertical margin (area under the receiver-operating characteristic [AUROC] curve, 0.811). The high-risk LNM group (score, ≥ 2 points) showed a significantly higher risk of LNM than the low-risk LNM group (score, <2 points) (14.0 vs 1.2%). No LNM was found in patients with a risk score of zero. After internal and external validation, the AUROC curve for predicting LNM was 0.788 and 0.842, respectively. CONCLUSIONS: The risk-stratification system developed in this study will facilitate identification of patients who should undergo LN dissection after noncurative ER. Although additive surgery should be performed after noncurative ER for patients with a high risk of LNM, a close follow-up visit could be considered for low-risk patients with multiple comorbidities or high operative risks.
BACKGROUND:Patients with early gastric cancer (EGC) who have undergone noncurative endoscopic resection (ER) generally require additional surgery due to the possibility of lymph node metastasis (LNM). This study aimed to develop a reliable risk-stratification system to predict LNM after noncurative ER for EGC. METHODS: A total of 2368 patients had a diagnosis of EGC and underwent ER. The study analyzed 321 patients who underwent additive gastrectomy and lymph node dissection after noncurative ER. Independent risk factors for LNM were identified and used to develop a risk-stratification system to estimate the relative risk of LNM. RESULTS: Of the 321 patients, 23 (7.2%) had LNM. A logistic regression analysis showed that female sex, lymphovascular invasion (LVI), and a positive vertical margin were significantly associated with LNM. The authors established a risk-stratification system using sex, LVI, and positive vertical margin (area under the receiver-operating characteristic [AUROC] curve, 0.811). The high-risk LNM group (score, ≥ 2 points) showed a significantly higher risk of LNM than the low-risk LNM group (score, <2 points) (14.0 vs 1.2%). No LNM was found in patients with a risk score of zero. After internal and external validation, the AUROC curve for predicting LNM was 0.788 and 0.842, respectively. CONCLUSIONS: The risk-stratification system developed in this study will facilitate identification of patients who should undergo LN dissection after noncurative ER. Although additive surgery should be performed after noncurative ER for patients with a high risk of LNM, a close follow-up visit could be considered for low-risk patients with multiple comorbidities or high operative risks.
Authors: Paola Ulivi; Luca Saragoni; Chiara Molinari; Gianluca Tedaldi; Francesca Rebuzzi; Paolo Morgagni; Laura Capelli; Sara Ravaioli; Maria Maddalena Tumedei; Emanuela Scarpi; Anna Tomezzoli; Riccardo Bernasconi; Maria Raffaella Ambrosio; Alessia D'Ignazio; Leonardo Solaini; Francesco Limarzi; Giorgio Ercolani; Giovanni Martinelli Journal: Gastric Cancer Date: 2020-11-06 Impact factor: 7.370