Goto Atsushi, Nishikawa Jun, Hideura Eizaburou, Ogawa Ryo, Nagao Misato, Sasaki Sho, Kawasato Ryo, Hashimoto Shinichi, Okamoto Takeshi, Ogihara Hiroyuki, Hamamoto Yoshihiko, Sakaida Isao
Departments of aGastroenterology and Hepatology bLaboratory Science, Yamaguchi University Graduate School of Medicine cDepartment of Biomolecular Engineering, Yamaguchi University Graduate School dDivision of Electrical, Electronic and Information Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Yamaguchi, Japan.
Eur J Gastroenterol Hepatol. 2017 Dec;29(12):1346-1350. doi: 10.1097/MEG.0000000000000987.
Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer (EGC) with negligible risk of lymph node metastasis (LNM). When a patient is determined to have noncurative resection after ESD, additional surgical resection with lymph node dissection is recommended. Previous studies report that LNM is found in about 10% of these patients. It may be possible to avoid unnecessary surgical resection by selecting patients properly. We aimed to clarify the risk factors associated with LNM in EGC patients who underwent ESD and to develop a highly accurate diagnostic algorithm for LNM.
Among 1005 patients with EGC who underwent ESD, 423 patients who could be followed up for more than 3 years after treatment or who underwent additional surgical resection were examined. We used the leave-one-out method to explore the combination of predictive factors of LNM and differentiated LNM by a unique classifier.
Curative resection was achieved in 322 patients, whereas noncurative resection was achieved in 101 patients. In the noncurative resection group, LNM occurred in eight patients with additional surgical resection and one patient during follow-up. The combination of depth of invasion, lymphatic, and venous invasion showed the highest diagnostic performance and could differentiate LNM with 100% sensitivity, 86% specificity, and 86% diagnostic accuracy.
More than 500 μm submucosal invasion and lymphatic and venous invasion will be useful in assessing LNM after ESD for patients with EGC. When these three factors are not observed, follow-up alone might be appropriate and it may be possible to reduce unnecessary surgical resection.
内镜黏膜下剥离术（ESD）是早期胃癌（EGC）的一种微创治疗方法，其淋巴结转移（LNM）风险可忽略不计。当患者在ESD术后被判定为非根治性切除时，建议进行额外的手术切除并清扫淋巴结。既往研究报道，这些患者中约10%会发生LNM。通过合理选择患者，有可能避免不必要的手术切除。我们旨在明确接受ESD的EGC患者中与LNM相关的危险因素，并开发一种用于LNM的高精度诊断算法。
在1005例行ESD的EGC患者中，对423例治疗后可随访3年以上或接受了额外手术切除的患者进行了检查。我们采用留一法来探索LNM预测因素的组合，并通过独特的分类器区分LNM。
322例患者实现了根治性切除，而101例患者为非根治性切除。在非根治性切除组中，8例接受额外手术切除的患者和1例随访期间的患者发生了LNM。浸润深度、淋巴管和静脉浸润的组合显示出最高的诊断性能，能够以100%的灵敏度、86%的特异度和86%的诊断准确率区分LNM。
对于EGC患者，ESD术后评估LNM时，黏膜下浸润超过500μm以及淋巴管和静脉浸润将很有用。当未观察到这三个因素时，单独进行随访可能就足够了，并且有可能减少不必要的手术切除。
