Department of Neurosurgery, Gansu Province People's Hospital, Gansu Province, China.
Department of Pathology, The 940th of Joint Logistics Support Force of the Chinese People's Liberation, China.
Asian J Surg. 2023 Sep;46(9):3705-3709. doi: 10.1016/j.asjsur.2023.04.110. Epub 2023 May 18.
BACKGROUND & AIM: The indication of endoscopic submucosal dissection (ESD) for mucosal undifferentiated early gastric cancer (EGC) remains controversial because of risk of lymph node metastasis (LNM). The aim of this study was to identify risk factors for lymph node metastasis (LNM) in mucosal undifferentiated EGC, and further to confirm feasibility of the ESD for the treatment of mucosal undifferentiated EGC.
We retrospectively reviewed data of patients who underwent surgical resection with lymph node dissection of T1a stage primary gastric adenocarcinoma at three medical centers between 2012 and 2022. We evaluated the frequency of lymph node metastasis and the associated risk factors, as well as the lymph node metastasis rate in the expanded indication of mucosal undifferentiated EGC.
A total of 100 surgically treated patients with mucosal undifferentiated EGC were enrolled. LNM was irrelevant to the age, tumor size, location, and macroscopic type (all P > 0.05), while it was significantly associated with lymphovascular invasion (LVI, P ＜0.001). And logistic regression analysis showed that the LVI was the only significant risk factors for LNM (OR: 0.34, 95%CI: 0.06-0.204; P ＜0.001). Of 44 mucosal undifferentiated EGC patients satisfying the expanded indication of ESD, 3 patients (6.8%) showed LN metastasis, all of them with undifferentiated cancer without ulceration, less than 2.0 cm in size.
Because LNM is present in mucosal undifferentiated EGC patients who satisfied the expanded indication of ESD, ESD cannot be considered a better choice than surgery for all undifferentiated EGC patients. LVI was significant risk factors for LNM in patients with mucosal undifferentiated EGC.
内镜黏膜下剥离术（ESD）治疗黏膜未分化型早期胃癌（EGC）的适应证仍存在争议，因为存在淋巴结转移（LNM）的风险。本研究旨在确定黏膜未分化型 EGC 发生 LNM 的危险因素，并进一步确认 ESD 治疗黏膜未分化型 EGC 的可行性。
我们回顾性分析了 2012 年至 2022 年间在三个医疗中心接受手术切除伴淋巴结清扫的 T1a 期原发性胃腺癌患者的数据。我们评估了淋巴结转移的频率和相关危险因素，以及扩大黏膜未分化型 EGC 适应证后的淋巴结转移率。
共纳入 100 例接受手术治疗的黏膜未分化型 EGC 患者。LNM 与年龄、肿瘤大小、部位和大体类型无关（均 P>0.05），但与淋巴管血管侵犯（LVI，P<0.001）显著相关。逻辑回归分析显示，LVI 是 LNM 的唯一显著危险因素（OR：0.34，95%CI：0.06-0.204；P<0.001）。在符合 ESD 扩大适应证的 44 例黏膜未分化型 EGC 患者中，3 例（6.8%）患者出现 LN 转移，均为未分化癌且无溃疡，肿瘤大小<2.0cm。
由于符合 ESD 扩大适应证的黏膜未分化型 EGC 患者存在 LNM，ESD 不能被认为是所有未分化型 EGC 患者的首选治疗方法。LVI 是黏膜未分化型 EGC 患者发生 LNM 的显著危险因素。
