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Cited 2 time in webofscience Cited 3 time in scopus
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Risk factors of lymph node metastasis after non-curative endoscopic resection of undifferentiated-type early gastric cancer

Authors
Yang, Hyo-JoonJang, Jae-YoungKim, Sang GyunAhn, Ji YongNam, Su YounKim, Jie-HyunMin, Byung-HoonLee, Wan-SikLee, Bong EunJoo, Moon KyungPark, Jae MyungShin, Woon GeonLee, Hang LakGweon, Tae-GeunPark, Moo InChoi, JeongminTae, Chung HyunKim, Young-IlChoi, Il Ju
Issue Date
Jan-2021
Publisher
SPRINGER
Keywords
Stomach neoplasms; Undifferentiated-type histology; Non-curative resection; Lymph node Metastasis; Risk factors
Citation
Gastric Cancer, v.24, no.1, pp.168 - 178
Indexed
SCIE
SCOPUS
Journal Title
Gastric Cancer
Volume
24
Number
1
Start Page
168
End Page
178
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/33912
DOI
10.1007/s10120-020-01103-2
ISSN
1436-3291
Abstract
Background This study aimed to investigate risk factors for lymph node (LN) or distant metastasis after non-curative endoscopic resection (ER) of undifferentiated-type early gastric cancer (EGC). Methods Of 1124 patients who underwent ER for undifferentiated-type gastric cancer at 18 tertiary hospitals across six geographic areas in Korea between 2005 and 2014, 634 with non-curative ER beyond the expanded criteria were retrospectively enrolled. According to the treatment after ER, patients were divided into additional surgery (n = 270) and follow-up (n = 364) groups. The median follow-up duration was 59 months for recurrence and 84 months for mortality. Results LN metastasis was found in 6.7% (18/270) of patients at surgery. Ulcer [odds ratio (OR) 3.83; 95% confidence interval (CI) 1.21–12.13; p = 0.022] and submucosal invasion (OR 10.35; 95% CI 1.35–79.48; p = 0.025) were independent risk factors. In the follow-up group, seven patients (1.9%) developed LN or distant recurrence. Ulcer [hazard ratio (HR) 7.60; 95% CI 1.39–35.74; p = 0.018], LVI (HR 6.80; 95% CI 1.07–42.99; p = 0.042), and positive vertical margin (HR 6.71; 95% CI 1.28–35.19; p = 0.024) were independent risk factors. In the overall cohort, LN metastasis rates were 9.6% in patients with two or more risk factors and 1.2% in those with no or one risk factor. Conclusions LVI, ulcer, submucosal invasion, and positive vertical margin are independently associated with LN or distant metastasis after non-curative ER of undifferentiated-type EGC. Surgical resection is strongly recommended for patients with two or more risk factors.
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Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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