Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 23;23(1):175.
doi: 10.1186/s12876-023-02771-x.

Risk of lymph node metastasis and feasibility of endoscopic submucosal dissection in undifferentiated-type early gastric cancer

Pengyue Zhang  1 , Tingting Xu  1 , Hui Feng  1 , Zhen Zhu  1   2 , Jingjing Wang  3 , Yalei Wang  4
Affiliations

Risk of lymph node metastasis and feasibility of endoscopic submucosal dissection in undifferentiated-type early gastric cancer

Pengyue Zhang et al. BMC Gastroenterol. .

Abstract

Background: Whether endoscopic submucosal dissection (ESD) applies to undifferentiated-type early gastric cancer (UEGC) remains controversial. We aimed to analyze the risk factors for lymph node metastasis (LNM) in UEGC and evaluate the feasibility of ESD.

Methods: This study included 346 patients with UEGC who underwent curative gastrectomy between January 2014 and December 2021. Univariate and multivariate analyses of the correlation between clinicopathological features and LNM were conducted, and the risk factors for exceeding the expanded ESD indications were evaluated.

Results: The overall LNM rate in UEGC was 19.94%. Among the preoperatively assessable factors, submucosal invasion (odds ratio [OR] = 4.77, 95% confidence interval [CI]: 2.14-10.66) and > 2 cm(OR = 2.49, 95% CI: 1.20-5.15) were independent risk factors for LNM, while postoperative independent risk factors were > 2 cm (OR = 3.35, 95% CI: 1.02-5.40) and lymphovascular invasion(OR = 13.21, 95% CI: 5.18-33.70). Patients who met the expanded indications had a low LNM risk (4.1%). Additionally, tumors located in the cardia (P = 0.03), non-elevated type (P < 0.01) were independent risk factors for exceeding the expanded indications in UEGC.

Conclusions: ESD may be applicable for UEGC meeting the expanded indications, and preoperative evaluation should be cautious when the lesion is non-elevated type or located in the cardia.

Trial registration: Chinese Clinical Trial Registry (12/05/2022 ChiCTR2200059841 ).

Keywords: Endoscopic submucosal dissection; Gastric cancer; Lymph node metastasis; Retrospective analysis; Undifferentiated.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
ROC curve of the risk prediction for lymph node metastasis of undifferentiated-type early gastric cancer LVI: lymphovascular invasion; AUROC:Area under the receiver operating characteristic curve
Fig. 2
Fig. 2
Multivariate logistic regression analysis of undifferentiated-type early gastric cancer according to endoscopic submucosal dissection indications. por:poorly differentiated adenocarcinoma,muc:mucinous adenocarcinoma, sig: signet ring cell carcinoma;LNM: lymph node metastasis; OR: odds ratio;CI:Confidence intervals
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Japanese Gastric Cancer Association Japanese gastric cancer treatment guidelines 2014 (ver. 4) Gastric Cancer. 2017;20(1):1–19. doi: 10.1007/s10120-016-0622-4. - DOI - PMC - PubMed
    1. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H, Nagahori Y, Hosoi H, Takahashi M, Kito F, et al. Significance of long-term follow-up of early gastric cancer. ANN SURG ONCOL. 2006;13(3):363–9. doi: 10.1245/ASO.2006.03.061. - DOI - PubMed
    1. Song W, Qiao X, Gao X. A comparison of endoscopic submucosal dissection (ESD) and radical surgery for early gastric cancer: a retrospective study. World J Surg Oncol 2015;13(1). - PMC - PubMed
    1. Sekiguchi M, Oda I, Taniguchi H, Suzuki H, Morita S, Fukagawa T, Sekine S, Kushima R, Katai H. Risk stratification and predictive risk-scoring model for lymph node metastasis in early gastric cancer. J GASTROENTEROL. 2016;51(10):961–70. doi: 10.1007/s00535-016-1180-6. - DOI - PubMed
    1. Feng H, Wang Y, Cao L, Zhang C, Sun B, Zhao Y, Xu J. Lymph node metastasis in differentiated-type early gastric cancer: a single-center retrospective analysis of surgically resected cases. SCAND J GASTROENTERO. 2015;51(1):48–54. doi: 10.3109/00365521.2015.1054425. - DOI - PubMed