Ji Won Park1, Sangjeong Ahn2, Hyuk Lee1, Byung-Hoon Min1, Jun Haeng Lee1, Poong-Lyul Rhee1, Kyoung-Mee Kim2, Jae J Kim3. 1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea. 2. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 3. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea. jjkim@skku.edu.
Abstract
BACKGROUND: Lymph node (LN) metastasis is found in only about 5-10% of the patients who undergo additional surgery after non-curative endoscopic resection. Lymphatic invasion after endoscopic submucosal dissection (ESD) is regarded as non-curative resection due to risk of reginal LN metastasis. This study was aimed to identify clinicopathologic predictive factors for LN metastasis in early gastric cancer (EGC) with lymphatic invasion after endoscopic resection. METHODS: Among a total of 2036 patients who underwent endoscopic resection for EGC at Samsung Medical Center from April 2000 to May 2011, 146 patients were diagnosed with lymphatic invasion. And 123 patients who had gastrectomy with LN dissection due to presence of lymphatic invasion as one of the non-curative factors were included in this study. Demographics, endoscopic tumor findings, histological findings, surgical findings with pathologic reports, and follow-up data were collected from the patient's medical records. Pathological re-evaluation of resected specimens was performed. RESULTS: Among a total of 123 patients, LN metastases were found in seven patients (5.7%). The univariate analysis revealed that the LN metastasis was significantly more frequent in patients with certain morphology of lymphatic invasion that shows adhesion to endothelium of lymphatic tumor emboli (p = 0.016), higher number of lymphatic tumor emboli in whole section (p < 0.001) and papillary adenocarcinoma component (p = 0.024). In multivariate analysis, the number of lymphatic tumor emboli [OR 93.5, 95% CI (2.62-3330.81)] and the presence of papillary adenocarcinoma component [OR 552.5, 95% CI (1.20-254871.81)] were identified as independent predictors of LN metastasis in patients with lymphatic invasion after endoscopic resection. CONCLUSIONS: The number of lymphatic tumor emboli and the presence of papillary adenocarcinoma component were significant predictors for LN metastasis in patients with lymphatic invasion after endoscopic resection.
BACKGROUND: Lymph node (LN) metastasis is found in only about 5-10% of the patients who undergo additional surgery after non-curative endoscopic resection. Lymphatic invasion after endoscopic submucosal dissection (ESD) is regarded as non-curative resection due to risk of reginal LN metastasis. This study was aimed to identify clinicopathologic predictive factors for LN metastasis in early gastric cancer (EGC) with lymphatic invasion after endoscopic resection. METHODS: Among a total of 2036 patients who underwent endoscopic resection for EGC at Samsung Medical Center from April 2000 to May 2011, 146 patients were diagnosed with lymphatic invasion. And 123 patients who had gastrectomy with LN dissection due to presence of lymphatic invasion as one of the non-curative factors were included in this study. Demographics, endoscopic tumor findings, histological findings, surgical findings with pathologic reports, and follow-up data were collected from the patient's medical records. Pathological re-evaluation of resected specimens was performed. RESULTS: Among a total of 123 patients, LN metastases were found in seven patients (5.7%). The univariate analysis revealed that the LN metastasis was significantly more frequent in patients with certain morphology of lymphatic invasion that shows adhesion to endothelium of lymphatic tumor emboli (p = 0.016), higher number of lymphatic tumor emboli in whole section (p < 0.001) and papillary adenocarcinoma component (p = 0.024). In multivariate analysis, the number of lymphatic tumor emboli [OR 93.5, 95% CI (2.62-3330.81)] and the presence of papillary adenocarcinoma component [OR 552.5, 95% CI (1.20-254871.81)] were identified as independent predictors of LN metastasis in patients with lymphatic invasion after endoscopic resection. CONCLUSIONS: The number of lymphatic tumor emboli and the presence of papillary adenocarcinoma component were significant predictors for LN metastasis in patients with lymphatic invasion after endoscopic resection.
Authors: Byung-Hoon Min; Sun-Ju Byeon; Jun Haeng Lee; Kyoung-Mee Kim; Ji Yeong An; Min Gew Choi; Jun Ho Lee; Tae Sung Sohn; Jae Moon Bae; Sung Kim Journal: Gastric Cancer Date: 2017-12-26 Impact factor: 7.370
Authors: Won Hyuk Choi; Min Jeong Kim; Jun Ho Park; Jin Gu Kang; Seung In Seo; Hak Yang Kim; Woon Geon Shin Journal: J Clin Med Date: 2020-04-28 Impact factor: 4.241
Authors: Steffi E M van de Ven; Lucia Suzuki; Annieke W Gotink; Fiebo J C Ten Kate; Daan Nieboer; Bas L A M Weusten; Lodewijk A A Brosens; Richard van Hillegersberg; Lorenza Alvarez Herrero; Cees A Seldenrijk; Alaa Alkhalaf; Freek C P Moll; Wouter Curvers; Ineke G van Lijnschoten; Thjon J Tang; Hans van der Valk; Wouter B Nagengast; Gursah Kats-Ugurlu; John T M Plukker; Martin H M G Houben; Jaap S van der Laan; Roos E Pouw; Jacques J G H M Bergman; Sybren L Meijer; Mark I van Berge Henegouwen; Bas P L Wijnhoven; Pieter J F de Jonge; Michael Doukas; Marco J Bruno; Katharina Biermann; Arjun D Koch Journal: United European Gastroenterol J Date: 2021-10-05 Impact factor: 4.623