Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.
Department of Gastroenterology and Hepatology, The Third People's Hospital of Chengdu, Chengdu, China.
Scand J Gastroenterol. 2020 Jul;55(7):834-842. doi: 10.1080/00365521.2020.1786158. Epub 2020 Jul 10.
To investigate whether endoscopic treatment is applicable to American patients and explores the predictors of lymph node metastasis (LNM) in early gastric cancer (EGC).
Patients with EGC confined to either mucosa (T1a, = 1799) and submucosa (T1b, = 1689) were identified from the Surveillance, Epidemiology, and End Result database. Multivariate logistic regression, Kaplan-Meier method, and univariate/multivariate Cox regression were used to assess the correlation between invasion depth and LNM or prognosis. A nomogram for predicting LNM was constructed and internally validated.
EGC limited to T1a exhibited a 2.4% incidence of LNM, which increased to 11.1% when the depth invaded T1b.LNM was present at 1.4%, 5.2%, and 5.0% for sizes ≤2, 2-5, and >5cm of low-grade T1a EGC, respectively, ( .019) and at 4.8%, 12.4%, and 28.6% of T1b EGC, respectively ( < .001).The multivariate logistic model revealed that older age, T1b invasion, larger tumor size, and high-grade lesions were associated with a higher risk of LNM. Moreover, the T1a EGC patients had better cancer-specific survival (OS) and overall survival(CSS) compared with the T1b EGC patients (5-year OS: 77.2% versus 67.4%, < .001; 5-year CSS: 90.6% versus 81.4%, < .001). The discrimination of the prediction model was 0.745.
Endoscopic treatment may only be suitable for patients in the US population who have low-grade T1a lesions of less than 2 cm in size. Patients with T1a lesions of greater than 2 cm in size, lesions with high-grade, and all T1b lesions may benefit from radical surgical resection with lymphadenectomy.
探讨内镜治疗是否适用于美国患者，并探讨早期胃癌（EGC）中淋巴结转移（LNM）的预测因素。
从监测、流行病学和最终结果数据库中确定局限于黏膜（T1a，=1799）和黏膜下层（T1b，=1689）的 EGC 患者。使用多变量逻辑回归、Kaplan-Meier 方法和单变量/多变量 Cox 回归评估浸润深度与 LNM 或预后的相关性。构建并内部验证预测 LNM 的列线图。
局限于 T1a 的 EGC 的 LNM 发生率为 2.4%，当深度侵犯 T1b 时增加至 11.1%。低级别 T1a EGC 中大小≤2、2-5 和>5cm 的 LNM 发生率分别为 1.4%、5.2%和 5.0%（.019），T1b EGC 分别为 4.8%、12.4%和 28.6%（ <.001）。多变量逻辑模型显示，年龄较大、T1b 浸润、肿瘤较大和高级别病变与 LNM 风险增加相关。此外，与 T1b EGC 患者相比，T1a EGC 患者具有更好的癌症特异性生存（OS）和总生存（CSS）（5 年 OS：77.2%比 67.4%， <.001；5 年 CSS：90.6%比 81.4%， <.001）。预测模型的判别能力为 0.745。
内镜治疗可能仅适用于美国人群中大小小于 2cm、低级别 T1a 病变的患者。对于大小大于 2cm、高级别病变和所有 T1b 病变的患者，可能受益于根治性手术切除和淋巴结清扫。
