Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer

Hyo Joon Yang; Jae Young Jang; Sang Gyun Kim; Ji Yong Ahn; Su Youn Nam; Jie Hyun Kim; Byung Hoon Min; Wan Sik Lee; Bong Eun Lee; Moon Kyung Joo; Jae Myung Park; Woon Geon Shin; Hang Lak Lee; Tae Geun Gweon; Moo In Park; Jeongmin Choi; Chung Hyun Tae; Young Il Kim; Il Ju Choi

doi:10.1007/s10120-020-01103-2

Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer

Hyo Joon Yang, Jae Young Jang, Sang Gyun Kim, Ji Yong Ahn, Su Youn Nam, Jie Hyun Kim, Byung Hoon Min, Wan Sik Lee, Bong Eun Lee, Moon Kyung Joo, Jae Myung Park, Woon Geon Shin, Hang Lak Lee, Tae Geun Gweon, Moo In Park, Jeongmin Choi, Chung Hyun Tae, Young Il Kim, Il Ju Choi

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: This study aimed to investigate risk factors for lymph node (LN) or distant metastasis after non-curative endoscopic resection (ER) of undifferentiated-type early gastric cancer (EGC). Methods: Of 1124 patients who underwent ER for undifferentiated-type gastric cancer at 18 tertiary hospitals across six geographic areas in Korea between 2005 and 2014, 634 with non-curative ER beyond the expanded criteria were retrospectively enrolled. According to the treatment after ER, patients were divided into additional surgery (n = 270) and follow-up (n = 364) groups. The median follow-up duration was 59 months for recurrence and 84 months for mortality. Results: LN metastasis was found in 6.7% (18/270) of patients at surgery. Ulcer [odds ratio (OR) 3.83; 95% confidence interval (CI) 1.21–12.13; p = 0.022] and submucosal invasion (OR 10.35; 95% CI 1.35–79.48; p = 0.025) were independent risk factors. In the follow-up group, seven patients (1.9%) developed LN or distant recurrence. Ulcer [hazard ratio (HR) 7.60; 95% CI 1.39–35.74; p = 0.018], LVI (HR 6.80; 95% CI 1.07–42.99; p = 0.042), and positive vertical margin (HR 6.71; 95% CI 1.28–35.19; p = 0.024) were independent risk factors. In the overall cohort, LN metastasis rates were 9.6% in patients with two or more risk factors and 1.2% in those with no or one risk factor. Conclusions: LVI, ulcer, submucosal invasion, and positive vertical margin are independently associated with LN or distant metastasis after non-curative ER of undifferentiated-type EGC. Surgical resection is strongly recommended for patients with two or more risk factors.

Original language	English
Pages (from-to)	168-178
Number of pages	11
Journal	Gastric Cancer
Volume	24
Issue number	1
DOIs	https://doi.org/10.1007/s10120-020-01103-2
Publication status	Published - 2021 Jan

Bibliographical note

Funding Information:
The authors also acknowledge the valuable contribution of Boram Park, PhD, Biostatistics Collaboration Team, Research Core Center, Research Institute, National Cancer Center, Goyang, Korea, who provided statistical analyses of data.

Funding Information:
This work was supported by the Korean College of Helicobacter and Upper Gastrointestinal Research (Woon Geon Shin 2017 and Hyo-Joon Yang 2018) and by the National Research Foundation of Korea (Grant No. 2020R1G1A1010927). Acknowledgements

Publisher Copyright:
© 2020, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

All Science Journal Classification (ASJC) codes

Oncology
Gastroenterology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s10120-020-01103-2

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Yang, H. J., Jang, J. Y., Kim, S. G., Ahn, J. Y., Nam, S. Y., Kim, J. H., Min, B. H., Lee, W. S., Lee, B. E., Joo, M. K., Park, J. M., Shin, W. G., Lee, H. L., Gweon, T. G., Park, M. I., Choi, J., Tae, C. H., Kim, Y. I., & Choi, I. J. (2021). Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer. Gastric Cancer, 24(1), 168-178. https://doi.org/10.1007/s10120-020-01103-2

@article{015aba4e714b42839fef04bc54d04ea3,

title = "Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer",

abstract = "Background: This study aimed to investigate risk factors for lymph node (LN) or distant metastasis after non-curative endoscopic resection (ER) of undifferentiated-type early gastric cancer (EGC). Methods: Of 1124 patients who underwent ER for undifferentiated-type gastric cancer at 18 tertiary hospitals across six geographic areas in Korea between 2005 and 2014, 634 with non-curative ER beyond the expanded criteria were retrospectively enrolled. According to the treatment after ER, patients were divided into additional surgery (n = 270) and follow-up (n = 364) groups. The median follow-up duration was 59 months for recurrence and 84 months for mortality. Results: LN metastasis was found in 6.7% (18/270) of patients at surgery. Ulcer [odds ratio (OR) 3.83; 95% confidence interval (CI) 1.21–12.13; p = 0.022] and submucosal invasion (OR 10.35; 95% CI 1.35–79.48; p = 0.025) were independent risk factors. In the follow-up group, seven patients (1.9%) developed LN or distant recurrence. Ulcer [hazard ratio (HR) 7.60; 95% CI 1.39–35.74; p = 0.018], LVI (HR 6.80; 95% CI 1.07–42.99; p = 0.042), and positive vertical margin (HR 6.71; 95% CI 1.28–35.19; p = 0.024) were independent risk factors. In the overall cohort, LN metastasis rates were 9.6% in patients with two or more risk factors and 1.2% in those with no or one risk factor. Conclusions: LVI, ulcer, submucosal invasion, and positive vertical margin are independently associated with LN or distant metastasis after non-curative ER of undifferentiated-type EGC. Surgical resection is strongly recommended for patients with two or more risk factors.",

author = "Yang, {Hyo Joon} and Jang, {Jae Young} and Kim, {Sang Gyun} and Ahn, {Ji Yong} and Nam, {Su Youn} and Kim, {Jie Hyun} and Min, {Byung Hoon} and Lee, {Wan Sik} and Lee, {Bong Eun} and Joo, {Moon Kyung} and Park, {Jae Myung} and Shin, {Woon Geon} and Lee, {Hang Lak} and Gweon, {Tae Geun} and Park, {Moo In} and Jeongmin Choi and Tae, {Chung Hyun} and Kim, {Young Il} and Choi, {Il Ju}",

note = "Funding Information: The authors also acknowledge the valuable contribution of Boram Park, PhD, Biostatistics Collaboration Team, Research Core Center, Research Institute, National Cancer Center, Goyang, Korea, who provided statistical analyses of data. Funding Information: This work was supported by the Korean College of Helicobacter and Upper Gastrointestinal Research (Woon Geon Shin 2017 and Hyo-Joon Yang 2018) and by the National Research Foundation of Korea (Grant No. 2020R1G1A1010927). Acknowledgements Publisher Copyright: {\textcopyright} 2020, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.",

year = "2021",

month = jan,

doi = "10.1007/s10120-020-01103-2",

language = "English",

volume = "24",

pages = "168--178",

journal = "Gastric Cancer",

issn = "1436-3291",

publisher = "Springer Japan",

number = "1",

}

Yang, HJ, Jang, JY, Kim, SG, Ahn, JY, Nam, SY, Kim, JH, Min, BH, Lee, WS, Lee, BE, Joo, MK, Park, JM, Shin, WG, Lee, HL, Gweon, TG, Park, MI, Choi, J, Tae, CH, Kim, YI & Choi, IJ 2021, 'Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer', Gastric Cancer, vol. 24, no. 1, pp. 168-178. https://doi.org/10.1007/s10120-020-01103-2

TY - JOUR

T1 - Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer

AU - Yang, Hyo Joon

AU - Jang, Jae Young

AU - Kim, Sang Gyun

AU - Ahn, Ji Yong

AU - Nam, Su Youn

AU - Kim, Jie Hyun

AU - Min, Byung Hoon

AU - Lee, Wan Sik

AU - Lee, Bong Eun

AU - Joo, Moon Kyung

AU - Park, Jae Myung

AU - Shin, Woon Geon

AU - Lee, Hang Lak

AU - Gweon, Tae Geun

AU - Park, Moo In

AU - Choi, Jeongmin

AU - Tae, Chung Hyun

AU - Kim, Young Il

AU - Choi, Il Ju

N1 - Funding Information: The authors also acknowledge the valuable contribution of Boram Park, PhD, Biostatistics Collaboration Team, Research Core Center, Research Institute, National Cancer Center, Goyang, Korea, who provided statistical analyses of data. Funding Information: This work was supported by the Korean College of Helicobacter and Upper Gastrointestinal Research (Woon Geon Shin 2017 and Hyo-Joon Yang 2018) and by the National Research Foundation of Korea (Grant No. 2020R1G1A1010927). Acknowledgements Publisher Copyright: © 2020, The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

PY - 2021/1

Y1 - 2021/1

N2 - Background: This study aimed to investigate risk factors for lymph node (LN) or distant metastasis after non-curative endoscopic resection (ER) of undifferentiated-type early gastric cancer (EGC). Methods: Of 1124 patients who underwent ER for undifferentiated-type gastric cancer at 18 tertiary hospitals across six geographic areas in Korea between 2005 and 2014, 634 with non-curative ER beyond the expanded criteria were retrospectively enrolled. According to the treatment after ER, patients were divided into additional surgery (n = 270) and follow-up (n = 364) groups. The median follow-up duration was 59 months for recurrence and 84 months for mortality. Results: LN metastasis was found in 6.7% (18/270) of patients at surgery. Ulcer [odds ratio (OR) 3.83; 95% confidence interval (CI) 1.21–12.13; p = 0.022] and submucosal invasion (OR 10.35; 95% CI 1.35–79.48; p = 0.025) were independent risk factors. In the follow-up group, seven patients (1.9%) developed LN or distant recurrence. Ulcer [hazard ratio (HR) 7.60; 95% CI 1.39–35.74; p = 0.018], LVI (HR 6.80; 95% CI 1.07–42.99; p = 0.042), and positive vertical margin (HR 6.71; 95% CI 1.28–35.19; p = 0.024) were independent risk factors. In the overall cohort, LN metastasis rates were 9.6% in patients with two or more risk factors and 1.2% in those with no or one risk factor. Conclusions: LVI, ulcer, submucosal invasion, and positive vertical margin are independently associated with LN or distant metastasis after non-curative ER of undifferentiated-type EGC. Surgical resection is strongly recommended for patients with two or more risk factors.

AB - Background: This study aimed to investigate risk factors for lymph node (LN) or distant metastasis after non-curative endoscopic resection (ER) of undifferentiated-type early gastric cancer (EGC). Methods: Of 1124 patients who underwent ER for undifferentiated-type gastric cancer at 18 tertiary hospitals across six geographic areas in Korea between 2005 and 2014, 634 with non-curative ER beyond the expanded criteria were retrospectively enrolled. According to the treatment after ER, patients were divided into additional surgery (n = 270) and follow-up (n = 364) groups. The median follow-up duration was 59 months for recurrence and 84 months for mortality. Results: LN metastasis was found in 6.7% (18/270) of patients at surgery. Ulcer [odds ratio (OR) 3.83; 95% confidence interval (CI) 1.21–12.13; p = 0.022] and submucosal invasion (OR 10.35; 95% CI 1.35–79.48; p = 0.025) were independent risk factors. In the follow-up group, seven patients (1.9%) developed LN or distant recurrence. Ulcer [hazard ratio (HR) 7.60; 95% CI 1.39–35.74; p = 0.018], LVI (HR 6.80; 95% CI 1.07–42.99; p = 0.042), and positive vertical margin (HR 6.71; 95% CI 1.28–35.19; p = 0.024) were independent risk factors. In the overall cohort, LN metastasis rates were 9.6% in patients with two or more risk factors and 1.2% in those with no or one risk factor. Conclusions: LVI, ulcer, submucosal invasion, and positive vertical margin are independently associated with LN or distant metastasis after non-curative ER of undifferentiated-type EGC. Surgical resection is strongly recommended for patients with two or more risk factors.

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U2 - 10.1007/s10120-020-01103-2

DO - 10.1007/s10120-020-01103-2

M3 - Article

C2 - 32623585

AN - SCOPUS:85087445098

SN - 1436-3291

VL - 24

SP - 168

EP - 178

JO - Gastric Cancer

JF - Gastric Cancer

IS - 1

ER -

Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer

Abstract

Bibliographical note

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UN SDGs

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