Investigation of Endoscopic and Pathologic Features for Safe Endoscopic Treatment of Superficial Spreading Early Gastric Cancer

Kyong Joo Lee, Kyung Ho Pak, Woo Jin Hyung, Sung Hoon Noh, Choong Bai Kim, Yong Chan Lee, Hee Man Kim, Sang Kil Lee

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Abstract

Superficial spreading early gastric cancer (EGC) is a rare disease that is treated mainly by surgery. There are few studies on the safety of endoscopic treatment for patients with superficial spreading EGC. The aims of this study were to (1) investigate the risk of lymph node metastasis of superficial spreading EGC and (2) investigate the potential criteria for endoscopic treatment of superficial spreading EGC using surgical specimens. Between 2000 and 2010, patients who received curative surgery of R0 resection at Severance Hospital (Seoul, Korea) for early gastric cancer were enrolled. The superficial spreading EGC was defined as cancer in which the longest tumor length was ≥6cm. The medical records of the patients were reviewed retrospectively. Of the 3813 patients with EGC, 140 (3.7%) had lesions ≥ 6cm, whereas 3673 (96.3%) had lesions<6cm. Patients with superficial spreading EGC had higher rates of submucosal cancer (59.3% vs 45.7%, P=0.002), lymphovascular invasion (18.6% vs 9.8%, P<0.001), and lymph node metastasis (15.7% vs 10.1%, P=0.033) compared with patients with common EGC (< 6cm). Multivariate analysis revealed that a tumor ≥ 6cm was not strongly associated with lymph node metastasis in EGC, as compared with a tumor<6cm, but submucosal invasion and lymphovascular invasion were strongly associated with lymph node metastasis in EGC. In mucosal cancer without ulcers, tumors ≥ 6cm had a higher rate of lymph node metastasis than tumors ≤ 2cm; however, this trend was not significant (7.7% vs 5.3%, P=0.455). Superficial spreading EGC was not associated with an increased risk of lymph node metastasis compared with common EGC. We suggest that differentiated intramucosal superficial spreading EGC without ulceration can be treated by endoscopic submucosal dissection.

Original languageEnglish
Article numbere3242
JournalMedicine (United States)
Volume95
Issue number14
DOIs
Publication statusPublished - 2016 Apr 1

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Stomach Neoplasms
Lymph Nodes
Neoplasm Metastasis
Therapeutics
Neoplasms
Korea
Rare Diseases
Ulcer
Medical Records
Multivariate Analysis
Safety

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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title = "Investigation of Endoscopic and Pathologic Features for Safe Endoscopic Treatment of Superficial Spreading Early Gastric Cancer",
abstract = "Superficial spreading early gastric cancer (EGC) is a rare disease that is treated mainly by surgery. There are few studies on the safety of endoscopic treatment for patients with superficial spreading EGC. The aims of this study were to (1) investigate the risk of lymph node metastasis of superficial spreading EGC and (2) investigate the potential criteria for endoscopic treatment of superficial spreading EGC using surgical specimens. Between 2000 and 2010, patients who received curative surgery of R0 resection at Severance Hospital (Seoul, Korea) for early gastric cancer were enrolled. The superficial spreading EGC was defined as cancer in which the longest tumor length was ≥6cm. The medical records of the patients were reviewed retrospectively. Of the 3813 patients with EGC, 140 (3.7{\%}) had lesions ≥ 6cm, whereas 3673 (96.3{\%}) had lesions<6cm. Patients with superficial spreading EGC had higher rates of submucosal cancer (59.3{\%} vs 45.7{\%}, P=0.002), lymphovascular invasion (18.6{\%} vs 9.8{\%}, P<0.001), and lymph node metastasis (15.7{\%} vs 10.1{\%}, P=0.033) compared with patients with common EGC (< 6cm). Multivariate analysis revealed that a tumor ≥ 6cm was not strongly associated with lymph node metastasis in EGC, as compared with a tumor<6cm, but submucosal invasion and lymphovascular invasion were strongly associated with lymph node metastasis in EGC. In mucosal cancer without ulcers, tumors ≥ 6cm had a higher rate of lymph node metastasis than tumors ≤ 2cm; however, this trend was not significant (7.7{\%} vs 5.3{\%}, P=0.455). Superficial spreading EGC was not associated with an increased risk of lymph node metastasis compared with common EGC. We suggest that differentiated intramucosal superficial spreading EGC without ulceration can be treated by endoscopic submucosal dissection.",
author = "Lee, {Kyong Joo} and Pak, {Kyung Ho} and Hyung, {Woo Jin} and Noh, {Sung Hoon} and Kim, {Choong Bai} and Lee, {Yong Chan} and Kim, {Hee Man} and Lee, {Sang Kil}",
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Investigation of Endoscopic and Pathologic Features for Safe Endoscopic Treatment of Superficial Spreading Early Gastric Cancer. / Lee, Kyong Joo; Pak, Kyung Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Choong Bai; Lee, Yong Chan; Kim, Hee Man; Lee, Sang Kil.

In: Medicine (United States), Vol. 95, No. 14, e3242, 01.04.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Investigation of Endoscopic and Pathologic Features for Safe Endoscopic Treatment of Superficial Spreading Early Gastric Cancer

AU - Lee, Kyong Joo

AU - Pak, Kyung Ho

AU - Hyung, Woo Jin

AU - Noh, Sung Hoon

AU - Kim, Choong Bai

AU - Lee, Yong Chan

AU - Kim, Hee Man

AU - Lee, Sang Kil

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N2 - Superficial spreading early gastric cancer (EGC) is a rare disease that is treated mainly by surgery. There are few studies on the safety of endoscopic treatment for patients with superficial spreading EGC. The aims of this study were to (1) investigate the risk of lymph node metastasis of superficial spreading EGC and (2) investigate the potential criteria for endoscopic treatment of superficial spreading EGC using surgical specimens. Between 2000 and 2010, patients who received curative surgery of R0 resection at Severance Hospital (Seoul, Korea) for early gastric cancer were enrolled. The superficial spreading EGC was defined as cancer in which the longest tumor length was ≥6cm. The medical records of the patients were reviewed retrospectively. Of the 3813 patients with EGC, 140 (3.7%) had lesions ≥ 6cm, whereas 3673 (96.3%) had lesions<6cm. Patients with superficial spreading EGC had higher rates of submucosal cancer (59.3% vs 45.7%, P=0.002), lymphovascular invasion (18.6% vs 9.8%, P<0.001), and lymph node metastasis (15.7% vs 10.1%, P=0.033) compared with patients with common EGC (< 6cm). Multivariate analysis revealed that a tumor ≥ 6cm was not strongly associated with lymph node metastasis in EGC, as compared with a tumor<6cm, but submucosal invasion and lymphovascular invasion were strongly associated with lymph node metastasis in EGC. In mucosal cancer without ulcers, tumors ≥ 6cm had a higher rate of lymph node metastasis than tumors ≤ 2cm; however, this trend was not significant (7.7% vs 5.3%, P=0.455). Superficial spreading EGC was not associated with an increased risk of lymph node metastasis compared with common EGC. We suggest that differentiated intramucosal superficial spreading EGC without ulceration can be treated by endoscopic submucosal dissection.

AB - Superficial spreading early gastric cancer (EGC) is a rare disease that is treated mainly by surgery. There are few studies on the safety of endoscopic treatment for patients with superficial spreading EGC. The aims of this study were to (1) investigate the risk of lymph node metastasis of superficial spreading EGC and (2) investigate the potential criteria for endoscopic treatment of superficial spreading EGC using surgical specimens. Between 2000 and 2010, patients who received curative surgery of R0 resection at Severance Hospital (Seoul, Korea) for early gastric cancer were enrolled. The superficial spreading EGC was defined as cancer in which the longest tumor length was ≥6cm. The medical records of the patients were reviewed retrospectively. Of the 3813 patients with EGC, 140 (3.7%) had lesions ≥ 6cm, whereas 3673 (96.3%) had lesions<6cm. Patients with superficial spreading EGC had higher rates of submucosal cancer (59.3% vs 45.7%, P=0.002), lymphovascular invasion (18.6% vs 9.8%, P<0.001), and lymph node metastasis (15.7% vs 10.1%, P=0.033) compared with patients with common EGC (< 6cm). Multivariate analysis revealed that a tumor ≥ 6cm was not strongly associated with lymph node metastasis in EGC, as compared with a tumor<6cm, but submucosal invasion and lymphovascular invasion were strongly associated with lymph node metastasis in EGC. In mucosal cancer without ulcers, tumors ≥ 6cm had a higher rate of lymph node metastasis than tumors ≤ 2cm; however, this trend was not significant (7.7% vs 5.3%, P=0.455). Superficial spreading EGC was not associated with an increased risk of lymph node metastasis compared with common EGC. We suggest that differentiated intramucosal superficial spreading EGC without ulceration can be treated by endoscopic submucosal dissection.

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