The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Miyahara, Koji; Hatta, Waku; Nakagawa, Masahiro; Oyama, Tsuneo; Kawata, Noboru; Takahashi, Akiko; Yoshifuku, Yoshikazu; Hoteya, Shu; Hirano, Masaaki; Esaki, Mitsuru; Matsuda, Mitsuru; Ohnita, Ken; Shimoda, Ryo; Yoshida, Motoyuki; Dohi, Osamu; Takada, Jun; Tanaka, Keiko; Yamada, Shinya; Tsuji, Takeshi; Ito, Hirotaka; Aoyagi, Haruhiko; Shimosegawa, Tooru

doi:10.1159/000488529

Cited by 18 publications

(15 citation statements)

References 24 publications

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“…43 In addition, a previous study elucidated that an undifferentiated component in submucosal invasion was an independent predictor for LNM. 44 Although Ishigami et al revealed that there was no evident asscociation between tumor size and the depth of submucosal infiltration (p = 0.1), both submucosal layer invasion and horizontal tumor expansion were significantly correlated with LNM (p < 0.05). 45 For the assessment of the impact of macroscopic appearance on LNM, Sunagawa et al elucidated that the difference for the prevalence of LNM between patients with flat or elevated tumor macroscopic type and patients with depressed tumor macroscopic type was found statistically significant not only in univariate analysis (p = 0.004), but in multivariate analysis as well (p = 0.011), 24 which is consistent with the result of our present pooled analysis (p = 0.002).…”

Section: Number Of Studiesmentioning

confidence: 95%

Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis

Jiang

Zhou

Lü

et al. 2020

Therap Adv Gastroenterol

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Background: It is challenging to identify the prevalence of lymph node metastasis (LNM) and residual tumor in patients with early gastric cancer (EGC) who underwent noncurative endoscopic resection (ER). This present meta-analysis was aimed to establish imperative potential predictive factors in order to select the optimal treatment method. Methods: A systematic literature search of PubMed, Embase, and Cochrane Library databases was performed through 1 February 2019 to identify relevant studies, which investigated risk factors for LNM and residual tumor in patients with EGC who underwent noncurative ER. Eligible data were systematically reviewed through a meta-analysis. Results: Overall, 12 studies investigating the risk factor of LNM were included, totaling 3015 patients, 7 of which also involved cancer residues. After the present meta-analysis, six predictors, including tumor size >30 mm, tumor invasion depth (⩾500 μm from the muscularis mucosae), macroscopic appearance, undifferentiated histopathological type, positive vertical margin, and presence of lymphovascular invasion (including lymphatic invasion and vascular invasion) were significantly associated with LNM, whereas tumor size >30 mm, positive horizontal margin, and positive vertical margin were identified as significant predictors for the risk of residual tumor. No evidence of publication bias was observed. Conclusions: Six and three variables were established as significant risk factors for LNM and residual tumor in patients with EGC who underwent noncurative ER, respectively. Patients with EGC who present these risk factors after noncurative ER are strongly suggested to receive additional surgery, while others might be suitable for strict follow-up. This might shed some new light on the selection of follow-up treatment for noncurative ER.

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Section: Number Of Studiesmentioning

confidence: 95%

Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis

Jiang

Zhou

Lü

et al. 2020

Therap Adv Gastroenterol

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“…According to the current Japanese gastric cancer treatment guidelines, ESD for EGC-HH is regarded as non-curative if an undifferentiated-type component invades the submucosal layer in SM1 tumor ≤3 cm [1]. Jung et al [12] and Miyahara et al [13] reported that the presence of an undifferentiated component in the submucosal invasion area was a significant risk factor for LN metastasis based on surgical specimens. In the study by Jung et al [12], LN metastasis was found in 36.4% (4/11) of SM1 EGC-HH with a minor poorly differentiated carcinoma component accounting for more than 5% of the tumor area.…”

Section: Discussionmentioning

confidence: 99%

“…This study did not evaluate the LN metastasis rate in EGC-HH with SM1 invasion meeting the expanded curative resection criteria. Miyahara et al [13] reported the LN metastasis rate in EGC-HH cases with deep submucosal invasion (submucosal invasion depth ≥500 µm from the muscularis mucosa). EGC-HH cases with SM1 invasion were not included in the study population.…”

Section: Discussionmentioning

confidence: 99%

Favorable Long-Term Outcomes of Endoscopic Submucosal Dissection for Differentiated-Type-Predominant Early Gastric Cancer with Histological Heterogeneity

Kim

Shin

Min

et al. 2020

JCM

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It remains unclear whether endoscopic submucosal dissection (ESD) can be indicated for differentiated-type-predominant early gastric cancer mixed with a minor undifferentiated component (EGC with histological heterogeneity (HH)). Here, we reviewed and compared clinicopathologic characteristics and long-term outcomes of ESD of 257 patients with EGC-HH and those of 2386 patients with pure differentiated-type EGC (PuD-EGC). After ESD, EGC-HH was managed in the same way as PuD-EGC. EGC-HHs were significantly associated with larger tumor size, more frequent submucosal invasion, and lymphovascular invasion compared to PuD-EGCs. Despite these aggressive features of EGC-HH, no local recurrence or gastric cancer-related death occurred during a median of 58 months of follow up after ESD for EGC-HH, if curative resection was achieved. After curative ESD for EGC-HH, six patients had metachronous recurrence (5.0%) and one patient underwent extragastric recurrence in a regional lymph node (0.8%). All these recurrence cases were curatively treated with ESD or gastrectomy. For patients with EGC-HH, five-year overall survival and recurrence-free survival rates after curative ESD were 97.0% and 94.8%, respectively, which were comparable to those of patients with PuD-EGC. In conclusion, ESD showed favorable long-term outcomes after curative resection and may be an acceptable treatment option for EGC-HH meeting curative endoscopic resection criteria.

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“…In addition, although undifferentiated type was 0 points in both systems, 51,53 a recent report showed that a submucosal undifferentiated component was an independent risk factor for LNM in patients who underwent additional gastrectomy after ER for submucosal gastric cancer. 56 Therefore, we should be careful in managing patients with a submucosal undifferentiated component even if the patients with undifferentiated-type EGC were regarded as low-risk in the scoring systems.…”

Section: Lymph Node Metastasis In Patients With Additional Gastrectommentioning

confidence: 99%

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

Hatta

Gotoda

Koike

et al. 2020

Digestive Endoscopy

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With the ongoing increase in the aging population in Japan, the number of elderly patients among the total population with upper gastrointestinal (GI) neoplasia has also been increasing. As elderly patients present unique age‐related variations in their physical condition, the therapeutic approach for upper GI neoplasia should be differentiated between elderly and nonelderly patients. According to the existing guidelines, additional treatment is the standard therapy in patients who undergo endoscopic resection (ER) with a possible risk of lymph node metastasis (LNM) for upper GI neoplasia. However, due to the relatively low rate of LNM, applying additional treatment in all elderly patients may be excessive. Although additional treatment has the advantage of reducing cancer‐specific mortality, its disadvantages include deteriorated quality of life, complications, and mortality in surgery. In patients with early gastric cancer, we propose treatment decisions be made using a risk‐scoring system for LNM and upon considering the physical condition of the patient after ER with curability C‐2. In those with superficial esophageal squamous cell carcinoma with a possible risk of LNM after ER, selective chemoradiotherapy may be a less‐invasive treatment option, although the present standard treatment is esophagectomy. When considering the treatment decision, achieving a “cure” of the tumor has been regarded as critical. However, as the main cause of mortality in elderly patients with ER for upper GI neoplasia is noncancer‐related death, both achieving a “cure” and also a good level of “care” is important in the management of elderly patients.

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The Role of an Undifferentiated Component in Submucosal Invasion and Submucosal Invasion Depth After Endoscopic Submucosal Dissection for Early Gastric Cancer

Cited by 18 publications

References 24 publications

Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis

Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis

Favorable Long-Term Outcomes of Endoscopic Submucosal Dissection for Differentiated-Type-Predominant Early Gastric Cancer with Histological Heterogeneity

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

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