Elvira L Vos1, Masaya Nakauchi, Mithat Gönen, Jason A Castellanos, Alberto Biondi, Daniel G Coit, Johan L Dikken, Domenico D'Ugo, Henk Hartgrink, Ping Li, Makoto Nishimura, Mark Schattner, Kyo Young Song, Laura H Tang, Ichiro Uyama, Santosha Vardhana, Rob H A Verhoeven, Bas P L Wijnhoven, Vivian E Strong. 1. Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States Division of General Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China Gastroenterology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea Experimental and Gastrointestinal Pathology Services, Department of Pathology, Memorial Sloan Kettering Cancer Center Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Abstract
OBJECTIVE: We sought to define criteria associated with low lymph node metastasis risk in patients with submucosal (pT1b) gastric cancer from 3 Western and 3 Eastern countries. SUMMARY BACKGROUND DATA: Accurate prediction of lymph node metastasis risk is essential when determining the need for gastrectomy with lymph node dissection following endoscopic resection. Under current guidelines, endoscopic resection is considered definitive treatment if submucosal invasion is only superficial, but this is not routinely assessed. METHODS: Lymph node metastasis rates were determined for patient groups defined according to tumor pathological characteristics. Clinicopathological predictors of lymph node metastasis were determined by multivariable logistic regression and used to develop a nomogram in a randomly selected subset that was validated in the remainder. Overall survival was compared between Eastern and Western countries. RESULTS: Lymph node metastasis was found in 701 of 3,166 (22.1%) Eastern and 153 of 560 (27.3%) Western patients. Independent predictors of lymph node metastasis were female gender, tumor size, distal stomach location, lymphovascular invasion, and moderate or poor differentiation. Patients fulfilling the National Comprehensive Cancer Network guideline criteria, excluding the requirement that invasion not extend beyond the superficial submucosa, had a lymph node metastasis rate of 8.9% (53 of 594). Excluding moderately differentiated tumors lowered the rate to 3.4% (10 of 296). The nomogram's AUC was 0.690. Regardless of lymph node status, overall survival was better in Eastern patients. CONCLUSIONS: The lymph node metastasis rate was lowest in patients with well differentiated tumors that were ≤ 3 cm and lacked lymphovascular invasion. These criteria may be useful in decisions regarding endoscopic resection as definitive treatment for pT1b gastric cancer.
OBJECTIVE: We sought to define criteria associated with low lymph node metastasis risk in patients with submucosal (pT1b) gastric cancer from 3 Western and 3 Eastern countries. SUMMARY BACKGROUND DATA: Accurate prediction of lymph node metastasis risk is essential when determining the need for gastrectomy with lymph node dissection following endoscopic resection. Under current guidelines, endoscopic resection is considered definitive treatment if submucosal invasion is only superficial, but this is not routinely assessed. METHODS: Lymph node metastasis rates were determined for patient groups defined according to tumor pathological characteristics. Clinicopathological predictors of lymph node metastasis were determined by multivariable logistic regression and used to develop a nomogram in a randomly selected subset that was validated in the remainder. Overall survival was compared between Eastern and Western countries. RESULTS: Lymph node metastasis was found in 701 of 3,166 (22.1%) Eastern and 153 of 560 (27.3%) Western patients. Independent predictors of lymph node metastasis were female gender, tumor size, distal stomach location, lymphovascular invasion, and moderate or poor differentiation. Patients fulfilling the National Comprehensive Cancer Network guideline criteria, excluding the requirement that invasion not extend beyond the superficial submucosa, had a lymph node metastasis rate of 8.9% (53 of 594). Excluding moderately differentiated tumors lowered the rate to 3.4% (10 of 296). The nomogram's AUC was 0.690. Regardless of lymph node status, overall survival was better in Eastern patients. CONCLUSIONS: The lymph node metastasis rate was lowest in patients with well differentiated tumors that were ≤ 3 cm and lacked lymphovascular invasion. These criteria may be useful in decisions regarding endoscopic resection as definitive treatment for pT1b gastric cancer.
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