Risk-Stratification Model Based on Lymph Node Metastasis After Noncurative Endoscopic Resection for Early Gastric Cancer

Da Hyun Jung, Cheal Wung Huh, Jie-Hyun Kim, Jung Hwa Hong, Jun Chul Park, Yongchan Lee, Young Hoon Youn, HyoJin Park, Seung Ho Choi, Sung Hoon Noh

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Patients with early gastric cancer (EGC) who have undergone noncurative endoscopic resection (ER) generally require additional surgery due to the possibility of lymph node metastasis (LNM). This study aimed to develop a reliable risk-stratification system to predict LNM after noncurative ER for EGC. Methods: A total of 2368 patients had a diagnosis of EGC and underwent ER. The study analyzed 321 patients who underwent additive gastrectomy and lymph node dissection after noncurative ER. Independent risk factors for LNM were identified and used to develop a risk-stratification system to estimate the relative risk of LNM. Results: Of the 321 patients, 23 (7.2%) had LNM. A logistic regression analysis showed that female sex, lymphovascular invasion (LVI), and a positive vertical margin were significantly associated with LNM. The authors established a risk-stratification system using sex, LVI, and positive vertical margin (area under the receiver-operating characteristic [AUROC] curve, 0.811). The high-risk LNM group (score, ≥ 2 points) showed a significantly higher risk of LNM than the low-risk LNM group (score, <2 points) (14.0 vs 1.2%). No LNM was found in patients with a risk score of zero. After internal and external validation, the AUROC curve for predicting LNM was 0.788 and 0.842, respectively. Conclusions: The risk-stratification system developed in this study will facilitate identification of patients who should undergo LN dissection after noncurative ER. Although additive surgery should be performed after noncurative ER for patients with a high risk of LNM, a close follow-up visit could be considered for low-risk patients with multiple comorbidities or high operative risks.

Original languageEnglish
Pages (from-to)1643-1649
Number of pages7
JournalAnnals of Surgical Oncology
Volume24
Issue number6
DOIs
Publication statusPublished - 2017 Jun 1

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Stomach Neoplasms
Lymph Nodes
Neoplasm Metastasis
ROC Curve
Gastrectomy
Lymph Node Excision
Dissection
Comorbidity
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Jung, Da Hyun ; Huh, Cheal Wung ; Kim, Jie-Hyun ; Hong, Jung Hwa ; Park, Jun Chul ; Lee, Yongchan ; Youn, Young Hoon ; Park, HyoJin ; Choi, Seung Ho ; Noh, Sung Hoon. / Risk-Stratification Model Based on Lymph Node Metastasis After Noncurative Endoscopic Resection for Early Gastric Cancer. In: Annals of Surgical Oncology. 2017 ; Vol. 24, No. 6. pp. 1643-1649.
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title = "Risk-Stratification Model Based on Lymph Node Metastasis After Noncurative Endoscopic Resection for Early Gastric Cancer",
abstract = "Background: Patients with early gastric cancer (EGC) who have undergone noncurative endoscopic resection (ER) generally require additional surgery due to the possibility of lymph node metastasis (LNM). This study aimed to develop a reliable risk-stratification system to predict LNM after noncurative ER for EGC. Methods: A total of 2368 patients had a diagnosis of EGC and underwent ER. The study analyzed 321 patients who underwent additive gastrectomy and lymph node dissection after noncurative ER. Independent risk factors for LNM were identified and used to develop a risk-stratification system to estimate the relative risk of LNM. Results: Of the 321 patients, 23 (7.2{\%}) had LNM. A logistic regression analysis showed that female sex, lymphovascular invasion (LVI), and a positive vertical margin were significantly associated with LNM. The authors established a risk-stratification system using sex, LVI, and positive vertical margin (area under the receiver-operating characteristic [AUROC] curve, 0.811). The high-risk LNM group (score, ≥ 2 points) showed a significantly higher risk of LNM than the low-risk LNM group (score, <2 points) (14.0 vs 1.2{\%}). No LNM was found in patients with a risk score of zero. After internal and external validation, the AUROC curve for predicting LNM was 0.788 and 0.842, respectively. Conclusions: The risk-stratification system developed in this study will facilitate identification of patients who should undergo LN dissection after noncurative ER. Although additive surgery should be performed after noncurative ER for patients with a high risk of LNM, a close follow-up visit could be considered for low-risk patients with multiple comorbidities or high operative risks.",
author = "Jung, {Da Hyun} and Huh, {Cheal Wung} and Jie-Hyun Kim and Hong, {Jung Hwa} and Park, {Jun Chul} and Yongchan Lee and Youn, {Young Hoon} and HyoJin Park and Choi, {Seung Ho} and Noh, {Sung Hoon}",
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Risk-Stratification Model Based on Lymph Node Metastasis After Noncurative Endoscopic Resection for Early Gastric Cancer. / Jung, Da Hyun; Huh, Cheal Wung; Kim, Jie-Hyun; Hong, Jung Hwa; Park, Jun Chul; Lee, Yongchan; Youn, Young Hoon; Park, HyoJin; Choi, Seung Ho; Noh, Sung Hoon.

In: Annals of Surgical Oncology, Vol. 24, No. 6, 01.06.2017, p. 1643-1649.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk-Stratification Model Based on Lymph Node Metastasis After Noncurative Endoscopic Resection for Early Gastric Cancer

AU - Jung, Da Hyun

AU - Huh, Cheal Wung

AU - Kim, Jie-Hyun

AU - Hong, Jung Hwa

AU - Park, Jun Chul

AU - Lee, Yongchan

AU - Youn, Young Hoon

AU - Park, HyoJin

AU - Choi, Seung Ho

AU - Noh, Sung Hoon

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background: Patients with early gastric cancer (EGC) who have undergone noncurative endoscopic resection (ER) generally require additional surgery due to the possibility of lymph node metastasis (LNM). This study aimed to develop a reliable risk-stratification system to predict LNM after noncurative ER for EGC. Methods: A total of 2368 patients had a diagnosis of EGC and underwent ER. The study analyzed 321 patients who underwent additive gastrectomy and lymph node dissection after noncurative ER. Independent risk factors for LNM were identified and used to develop a risk-stratification system to estimate the relative risk of LNM. Results: Of the 321 patients, 23 (7.2%) had LNM. A logistic regression analysis showed that female sex, lymphovascular invasion (LVI), and a positive vertical margin were significantly associated with LNM. The authors established a risk-stratification system using sex, LVI, and positive vertical margin (area under the receiver-operating characteristic [AUROC] curve, 0.811). The high-risk LNM group (score, ≥ 2 points) showed a significantly higher risk of LNM than the low-risk LNM group (score, <2 points) (14.0 vs 1.2%). No LNM was found in patients with a risk score of zero. After internal and external validation, the AUROC curve for predicting LNM was 0.788 and 0.842, respectively. Conclusions: The risk-stratification system developed in this study will facilitate identification of patients who should undergo LN dissection after noncurative ER. Although additive surgery should be performed after noncurative ER for patients with a high risk of LNM, a close follow-up visit could be considered for low-risk patients with multiple comorbidities or high operative risks.

AB - Background: Patients with early gastric cancer (EGC) who have undergone noncurative endoscopic resection (ER) generally require additional surgery due to the possibility of lymph node metastasis (LNM). This study aimed to develop a reliable risk-stratification system to predict LNM after noncurative ER for EGC. Methods: A total of 2368 patients had a diagnosis of EGC and underwent ER. The study analyzed 321 patients who underwent additive gastrectomy and lymph node dissection after noncurative ER. Independent risk factors for LNM were identified and used to develop a risk-stratification system to estimate the relative risk of LNM. Results: Of the 321 patients, 23 (7.2%) had LNM. A logistic regression analysis showed that female sex, lymphovascular invasion (LVI), and a positive vertical margin were significantly associated with LNM. The authors established a risk-stratification system using sex, LVI, and positive vertical margin (area under the receiver-operating characteristic [AUROC] curve, 0.811). The high-risk LNM group (score, ≥ 2 points) showed a significantly higher risk of LNM than the low-risk LNM group (score, <2 points) (14.0 vs 1.2%). No LNM was found in patients with a risk score of zero. After internal and external validation, the AUROC curve for predicting LNM was 0.788 and 0.842, respectively. Conclusions: The risk-stratification system developed in this study will facilitate identification of patients who should undergo LN dissection after noncurative ER. Although additive surgery should be performed after noncurative ER for patients with a high risk of LNM, a close follow-up visit could be considered for low-risk patients with multiple comorbidities or high operative risks.

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U2 - 10.1245/s10434-017-5791-9

DO - 10.1245/s10434-017-5791-9

M3 - Article

VL - 24

SP - 1643

EP - 1649

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 6

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