Risk factors predictive of lymph node metastasis in depressed early gastric cancer

Abe, Nobutsugu; Watanabe, Takashi; Suzuki, Kazufumi; Machida, Hiromichi; Toda, Hiroshi; Nakaya, Yuzo; Terabe, Masaki; Mori, Toshiyuki; Sugiyama, Masanori; Atomi, Yutaka

doi:10.1016/s0002-9610(01)00860-1

Cited by 86 publications

(71 citation statements)

References 20 publications

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“…Total score C3 Sensitivity 76.9 %, specificity 81.5 % poorly differentiated adenocarcinoma, the risk of lymph node metastasis is believed to be high [2][3][4][5]. In agreement with other work, in this study, histological classification of submucosally invasive gastric cancer at the site of invasion (specifically, undifferentiated) was significantly correlated with lymph node metastasis on univariate analysis.…”

Section: Observationsupporting

confidence: 90%

“…Circular tumor lesions with longer axes thus appear to present a higher risk of lymph node metastasis. Depth of submucosal cancer invasion has previously been found to be an important risk factor for lymph node metastasis [1][2][3][4][5][6]. In the present study in which depth of invasion was divided into two groups (i.e., greater and smaller) for the purposes of logistic regression analysis, the odds ratio was highest when the depth of invasion cutoff point was set at 2,000 lm.…”

Section: Discussionmentioning

confidence: 67%

“…In some cases, submucosally invasive gastric cancers are often endoscopically resected intentionally or unintentionally. Regional lymph node metastasis has been reported to occur in about 10 % of patients with submucosally invasive gastric cancers [2][3][4][5]. Therefore, endoscopic resection alone is considered insufficient as radical treatment of such cancers, which may metastasize to lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

“…Hence, additional gastrectomy with lymph node dissection is required. Unfortunately, however, there is no consensus regarding indications for additional gastrectomy following endoscopic resection of submucosally invasive gastric cancer [4][5][6]. In many cases, submucosally invasive gastric cancers persisting after endoscopic procedures require additional surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Conventionally, many factors including tumor axis length, submucosal invasion (distance, width, and area), lymphatic invasion, venous invasion, histological classification, mucus phenotype, ulceration or scar in the cancer lesion, and cancer invasion style and area have been considered to be pathological risk factors for lymph node metastasis of gastric cancer [2][3][4][5][6]. However, none of these risk factors provides 100 % sensitivity for detecting metastasis, and each risk factor has low individual specificity for metastasis.…”

Section: Introductionmentioning

confidence: 99%

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Pathological factors related to lymph node metastasis of submucosally invasive gastric cancer: criteria for additional gastrectomy after endoscopic resection

et al. 2012

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Background There are currently no universally accepted indications and criteria for additional gastrectomy after endoscopic resection of submucosally invasive cancer. The purpose of the present study was to establish accurate indications and criteria for such additional gastrectomy on the basis of lymph node metastasis risk. Methods We investigated 130 submucosally invasive gastric cancers and analyzed the pathological risk factors for lymph node metastasis. The tumors were evaluated for pathological factors in the area of invasion, and factors were compared between the cases with lymph node metastasis and those without. Results Univariate logistic regression analysis showed that tumor minor axis length, depth of invasion, histological classification of the area of submucosal invasion, absence of lymphoid infiltration, ulceration or scar in the lesion, and lymphatic and venous invasion are statistically significant risk factors for lymph node metastasis. Multivariate logistic regression analysis showed that the absence of lymphoid infiltration and the presence of lymphatic invasion are statistically significant as risk factors for lymph node metastasis. Conclusions We present a scoring system on the basis of the pathological criteria tested in this study. Our findings enable more accurate identification of patients who should undergo additional gastrectomy after endoscopic resection.Keywords Endoscopic submucosal dissection Á Submucosally invasive gastric cancers Á Additional gastrectomy after endoscopic resection Á Pathological risk factors for lymph node metastasis Background

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Section: Observationsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathological factors related to lymph node metastasis of submucosally invasive gastric cancer: criteria for additional gastrectomy after endoscopic resection

et al. 2012

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Carcinoma of the Stomach

Schmidt

Murphy

Yao

et al. 2017

Holland‐Frei Cancer Medicine

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Overview Gastric cancer is the second most common cause of cancer‐related death worldwide and risk factors include autoimmune gastritis, chronic Helicobacter pylori infection, obesity, and other causes. Some countries with higher incidence have established screening programs but methodology and eligibility remain controversial. Despite knowledge of risk factors and screening for high‐risk populations, identification of earlier stage potentially curable disease remains a challenge. Multiple genetic mutations are involved in gastric cancer pathogenesis, and mutations in the cellular adhesion protein CDH1 result in familial diffuse gastric cancer. Certain patterns of metastatic disease have been associated with particular molecular alterations. Increasing understanding of molecular pathways involved in gastric cancer has led to efficacious use of targeted biologic therapies with cytotoxic chemotherapy in the advanced setting, such as use of trastuzumab in patients with gastric cancer and HER2/neu overexpression. Surgical resection is the primary potentially curative therapy in those without metastatic disease. Type of resection and extent of lymphadenectomy are not consistent, and standards for best practice are needed. Chemotherapy and radiation play an important role in the adjuvant setting and, therefore, decisions regarding choice and timing of these therapies require accurate staging by thorough evaluation with endoscopy, cross‐sectional imaging and, in some cases, endoscopic ultrasound or positron emission tomography. Palliative interventions and therapy are often important, both for patients with symptoms in the metastatic setting and after recurrence as cure is not achieved in either situation. Results of recent clinical trials are encouraging, and there have been multiple positive phase III trials in the adjuvant and metastatic setting during the past 10 years. Despite this, most people diagnosed with gastric cancer will die from it eventually, so much more research is needed.

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Carcinoma of the Stomach

Schmidt¹,

Daboul²,

Likar³

et al. 2022

Holland‐Frei Cancer Medicine

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Overview Gastric cancer is the fifth most common cancer and third most common cause of cancer‐related death worldwide. Risk factors include chronic Helicobacter pylori infection, smoking, autoimmune gastritis, obesity, and other causes. Some countries with higher incidence have established screening programs but methodology and eligibility remain controversial. Despite knowledge of risk factors and screening for high‐risk populations, identification of earlier stage potentially curable disease remains a challenge. Multiple genetic mutations are involved in gastric cancer pathogenesis, and mutations in the cellular adhesion protein E‐cadherin result in familial diffuse gastric cancer. Certain patterns of metastatic disease have been associated with particular molecular alterations. Increasing understanding of molecular pathways involved in gastric cancer allows efficacious use of targeted biologic therapies with cytotoxic chemotherapy in the advanced setting, such as trastuzumab in patients with gastric cancer and HER2 / neu overexpression. Surgical resection is the primary potentially curative therapy in those without metastatic disease. Type of resection, extent of lymphadenectomy, and use of laparoscopic or robotic surgery are variable emphasizing the need for best practice standards. Chemotherapy and radiation play an important role in the adjuvant setting. Choice and timing of these therapies require accurate staging by thorough evaluation with endoscopy, cross‐sectional imaging, and in some cases endoscopic ultrasound ( EUS ) or positron emission tomography. Palliative therapy is important for patients with symptoms in the metastatic setting and after recurrence since cure is not possible in either situation. Results of recent clinical trials are encouraging including hope that immunotherapy will add to the collective therapies available. Ultimately, most people diagnosed with gastric cancer in the world will die. Research is ongoing in all areas from epidemiology to screening to diagnosis to staging and therapy.

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Risk factors predictive of lymph node metastasis in depressed early gastric cancer

Cited by 86 publications

References 20 publications

Pathological factors related to lymph node metastasis of submucosally invasive gastric cancer: criteria for additional gastrectomy after endoscopic resection

Pathological factors related to lymph node metastasis of submucosally invasive gastric cancer: criteria for additional gastrectomy after endoscopic resection

Carcinoma of the Stomach

Carcinoma of the Stomach

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