Koji Miyahara1, Waku Hatta2, Masahiro Nakagawa3, Tsuneo Oyama4, Noboru Kawata5, Akiko Takahashi4, Yoshikazu Yoshifuku6, Shu Hoteya7, Masaaki Hirano8, Mitsuru Esaki9, Mitsuru Matsuda10, Ken Ohnita11, Ryo Shimoda12, Motoyuki Yoshida13, Osamu Dohi14, Jun Takada15, Keiko Tanaka16, Shinya Yamada17, Tsuyotoshi Tsuji18, Hirotaka Ito19, Hiroyuki Aoyagi20, Tooru Shimosegawa2. 1. Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan. 2. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 3. Department of Endoscopy, Hiroshima City Hospital, Hiroshima, Japan. 4. Division of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan. 5. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 6. Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. 7. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. 8. Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan. 9. Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. 10. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan. 11. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. 12. Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. 13. Department of Gastroenterology and Endocrinology and Metabolism, Nara Medical University, Kashihara, Japan. 14. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 15. Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan. 16. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan. 17. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan. 18. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 19. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 20. Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan.
Abstract
BACKGROUND/AIMS: The role of an undifferentiated component in submucosal invasion and submucosal invasion depth (SID) for lymph node metastasis (LNM) of early gastric cancer (EGC) with deep submucosal invasion (SID ≥500 μm from the muscularis mucosa) after endoscopic submucosal dissection (ESD) has not been fully understood. This study aimed to clarify the risk factors (RFs), including these factors, for LNM in such patients. METHODS: We enrolled 513 patients who underwent radical surgery after ESD for EGC with deep submucosal invasion. We evaluated RFs for LNM, including an undifferentiated component in submucosal invasion and the SID, which was subdivided into 500-999, 1,000-1,499, 1,500-1,999, and ≥2,000 µm. RESULTS: LNM was detected in 7.6% of patients. Multivariate analysis revealed that an undifferentiated component in submucosal invasion (OR 2.22), in addition to tumor size >30 mm (OR 2.51) and lymphatic invasion (OR 3.07), were the independent RFs for LNM. However, the SID was not significantly associated with LNM. CONCLUSION: An undifferentiated component in submucosal invasion was one of the RFs for LNM, in contrast to SID, in patients who underwent ESD for EGC with deep submucosal invasion. This insight would be helpful in managing such patients.
BACKGROUND/AIMS: The role of an undifferentiated component in submucosal invasion and submucosal invasion depth (SID) for lymph node metastasis (LNM) of early gastric cancer (EGC) with deep submucosal invasion (SID ≥500 μm from the muscularis mucosa) after endoscopic submucosal dissection (ESD) has not been fully understood. This study aimed to clarify the risk factors (RFs), including these factors, for LNM in such patients. METHODS: We enrolled 513 patients who underwent radical surgery after ESD for EGC with deep submucosal invasion. We evaluated RFs for LNM, including an undifferentiated component in submucosal invasion and the SID, which was subdivided into 500-999, 1,000-1,499, 1,500-1,999, and ≥2,000 µm. RESULTS: LNM was detected in 7.6% of patients. Multivariate analysis revealed that an undifferentiated component in submucosal invasion (OR 2.22), in addition to tumor size >30 mm (OR 2.51) and lymphatic invasion (OR 3.07), were the independent RFs for LNM. However, the SID was not significantly associated with LNM. CONCLUSION: An undifferentiated component in submucosal invasion was one of the RFs for LNM, in contrast to SID, in patients who underwent ESD for EGC with deep submucosal invasion. This insight would be helpful in managing such patients.