|
1
|
Yu W, Xu Z, Li B, Zi M, Ren J, Wang W, Sun Q, Zhang Q, Wang D. Nomogram for pre-procedural prediction of lymph node metastasis in patients with submucosal early gastric cancer. Surg Endosc 2025; 39:1661-1671. [PMID: 39786464 DOI: 10.1007/s00464-024-11517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 12/30/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND The treatment of early gastric cancer (EGC) is contingent upon the status of lymph node metastasis (LNM). Accurate preoperative prediction of LNM is critical for reducing unnecessary surgeries. This study seeks to evaluate the risk factors for LNM in submucosal EGC and develop a predictive model to optimize therapeutic decision-making. METHODS A retrospective analysis was performed on clinical data from 389 patients with T1b-stage EGC who underwent radical gastrectomy. Univariate and multivariate analyses were conducted to identify independent risk factors, followed by the development of a nomogram to predict LNM. The model's efficacy was validated through receiver operating characteristic curves, calibration curves, and decision curve analysis. RESULTS Of the 389 patients, 77 had LNM. Logistic regression analysis identified gender, CA199 levels, tumor location, degree of differentiation, presence of ulcers, and lymph node enlargement on CT as independent risk factors for LNM. A nomogram was constructed to assess the risk of LNM, demonstrating strong predictive accuracy with an area under the curve of 0.82 in the training set and 0.74 in the validation set, along with good sensitivity and positive predictive value. CONCLUSIONS This study presents a reliable preoperative nomogram to estimate the likelihood of LNM in submucosal EGC, providing valuable guidance for determining the most effective treatment strategies for patients.
Collapse
Affiliation(s)
- Wenhao Yu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Zijie Xu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Ben Li
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Mengli Zi
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Wei Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Qiannan Sun
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
| |
Collapse
|
|
2
|
Fretwell VL, Kane EG, MacPherson S, Skaife P. Metastases from gastric cancer presenting as colorectal lesions: a report of two cases and systematic review. Ann R Coll Surg Engl 2025; 107:76-82. [PMID: 37218659 PMCID: PMC11658880 DOI: 10.1308/rcsann.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/24/2023] Open
Abstract
Gastric cancer is common with well-established routes of spread. Metastasis to the colon or rectum is rare; however, we have recently managed two patients with this clinical picture. We present these cases together with a literature review of current practice. A systematic review in PubMed using the terms 'gastric cancer' and 'colorectal metastasis' was performed. The identified papers were screened for relevance and the reference lists of relevant papers were also reviewed to ensure capture of all relevant reports. Twenty-four papers containing 26 cases of gastric cancer with metastasis to the colon or rectum were found. There was wide variation in presentation and practice in these cases, which tended to be in patients with poor histopathological features. Diagnosis is often challenging owing to the unusual radiological appearance and submucosal nature of the metastatic lesions. Treatment ranges from palliative care to radical resection. Colorectal metastases from gastric primary cancer are rare, but cases are reported and should be part of the index of suspicion during the work-up of patients with lower gastrointestinal symptoms and a history of gastric cancer. Treatment options range from aggressive surgical resection to palliative care and should be centred on the patient's fitness and wishes.
Collapse
Affiliation(s)
- VL Fretwell
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - EG Kane
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - S MacPherson
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - P Skaife
- Liverpool University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
|
3
|
Kim IH, Kang SJ, Choi W, Seo AN, Eom BW, Kang B, Kim BJ, Min BH, Tae CH, Choi CI, Lee CK, An HJ, Byun HK, Im HS, Kim HD, Cho JH, Pak K, Kim JJ, Bae JS, Yu JI, Lee JW, Choi J, Kim JH, Choi M, Jung MR, Seo N, Eom SS, Ahn S, Kim SJ, Lee SH, Lim SH, Kim TH, Han HS. Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline). J Gastric Cancer 2025; 25:5-114. [PMID: 39822170 PMCID: PMC11739648 DOI: 10.5230/jgc.2025.25.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 12/24/2024] [Indexed: 01/19/2025] Open
Abstract
Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area. Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version. Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.
Collapse
Affiliation(s)
- In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Wonyoung Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bum Jun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Jung An
- Division of Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Ho Cho
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Joon Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jungyoon Choi
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jwa Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Soo Eom
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Soomin Ahn
- Department of Pathology and Translational Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hee Lim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| |
Collapse
|
|
4
|
Oh Y, Bae GE, Kim KH, Yeo MK, Ye JC. Multi-Scale Hybrid Vision Transformer for Learning Gastric Histology: AI-Based Decision Support System for Gastric Cancer Treatment. IEEE J Biomed Health Inform 2023; 27:4143-4153. [PMID: 37192031 DOI: 10.1109/jbhi.2023.3276778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Gastric endoscopic screening is an effective way to decide appropriate gastric cancer treatment at an early stage, reducing gastric cancer-associated mortality rate. Although artificial intelligence has brought a great promise to assist pathologist to screen digitalized endoscopic biopsies, existing artificial intelligence systems are limited to be utilized in planning gastric cancer treatment. We propose a practical artificial intelligence-based decision support system that enables five subclassifications of gastric cancer pathology, which can be directly matched to general gastric cancer treatment guidance. The proposed framework is designed to efficiently differentiate multi-classes of gastric cancer through multiscale self-attention mechanism using 2-stage hybrid vision transformer networks, by mimicking the way how human pathologists understand histology. The proposed system demonstrates its reliable diagnostic performance by achieving class-average sensitivity of above 0.85 for multicentric cohort tests. Moreover, the proposed system demonstrates its great generalization capability on gastrointestinal track organ cancer by achieving the best class-average sensitivity among contemporary networks. Furthermore, in the observational study, artificial intelligence-assisted pathologists show significantly improved diagnostic sensitivity within saved screening time compared to human pathologists. Our results demonstrate that the proposed artificial intelligence system has a great potential for providing presumptive pathologic opinion and supporting decision of appropriate gastric cancer treatment in practical clinical settings.
Collapse
|
|
5
|
Paredes O, Baca C, Cruz R, Paredes K, Luque-Vasquez C, Chavez I, Taxa L, Ruiz E, Berrospi F, Payet E. Predictive factors of lymphatic metastasis and evaluation of the Japanese treatment guidelines for endoscopic resection of early gastric cancer in a high-volume center in Perú. Heliyon 2023; 9:e16293. [PMID: 37251889 PMCID: PMC10209413 DOI: 10.1016/j.heliyon.2023.e16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose This study aimed to identify the predictive factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) and to evaluate the applicability of the Japanese treatment guidelines for endoscopic resection in the western population. Methods Five hundred-one patients with pathological diagnoses of EGC were included. Univariate and multivariate analyses were conducted to identify the predictive factors of LNM. EGC patients were distributed according to the indications for endoscopic resection of the Eastern guidelines. The incidence of LNM was evaluated in each group. Results From 501 patients with EGC, 96 (19.2%) presented LNM. In 279 patients with tumors with submucosal infiltration (T1b), 83 (30%) patients had LNM. Among 219 patients who presented tumors > 3 cm, 63 (29%) patients had LNM. Thirty-one percent of patients with ulcerated tumors presented LMN (33 out of 105). In 76 patients and 24 patients with lymphovascular and perineural invasion, the percentage of LMN was 84% and 87%, respectively. In the multivariate analysis, a tumor diameter >3 cm, submucosal invasion, lymphovascular, and perineural invasion were independent predictors of LMN in EGC. No patient with differentiated, non-ulcerated mucosal tumors presented LNM regardless of tumor size. Three of 17 patients (18%) with differentiated, ulcerated mucosal tumors and ≤ 3 cm presented LNM. No LNM was evidenced in patients with undifferentiated mucosal tumors and ≤ 2 cm. Conclusions The presence of LNM in Western EGC patients was independently related to larger tumors (>3 cm), submucosal invasion, lymphovascular and perineural invasion. The Japanese absolute indications for EMR are safe in the Western population. Likewise, Western patients with differentiated, non-ulcerated mucosal tumors, and larger than 2 cm are susceptible to endoscopic resection. Patients with undifferentiated mucosal tumors smaller than 2 cm presented encouraging results and ESD could be recommended only for selected cases.
Collapse
Affiliation(s)
- Oscar Paredes
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Carlos Baca
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Renier Cruz
- Department of Pathology, National Institute of Neoplastic Disease INEN, Lima, Peru
| | - Kori Paredes
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Carlos Luque-Vasquez
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Iván Chavez
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Luis Taxa
- Department of Pathology, National Institute of Neoplastic Disease INEN, Lima, Peru
| | - Eloy Ruiz
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Francisco Berrospi
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| | - Eduardo Payet
- Department of Abdominal Surgery, National Institute of Neoplastic Diseases INEN, Lima, Peru
| |
Collapse
|
|
6
|
Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, Kim BJ, Min BH, Choi CI, Shin CM, Tae CH, Gong CS, Kim DJ, Cho AEH, Gong EJ, Song GJ, Im HS, Ahn HS, Lim H, Kim HD, Kim JJ, Yu JI, Lee JW, Park JY, Kim JH, Song KD, Jung M, Jung MR, Son SY, Park SH, Kim SJ, Lee SH, Kim TY, Bae WK, Koom WS, Jee Y, Kim YM, Kwak Y, Park YS, Han HS, Nam SY, Kong SH. Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach. J Gastric Cancer 2023; 23:3-106. [PMID: 36750993 PMCID: PMC9911619 DOI: 10.5230/jgc.2023.23.e11] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
Collapse
Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center Seoul, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seungnam, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, Korea
| | - Chung Sik Gong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University, Cheonan, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Lim
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jwa Hoon Kim
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeseob Jee
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Yoo Min Kim
- Department of Surgery, Severance Hospital, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Su Youn Nam
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
| |
Collapse
|
|
7
|
Lee JH, Oh JY, Kim YI, Lee JY, Kim CG, Choi IJ, Ryu KW, Kim YW, Cho SJ. Endoscopic submucosal dissection for papillary early gastric carcinoma: Insights from a large-scale analysis of post-gastrectomy pathology specimens. Medicine (Baltimore) 2022; 101:e32085. [PMID: 36550814 PMCID: PMC9771273 DOI: 10.1097/md.0000000000032085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Gastric papillary adenocarcinoma is considered a differentiated adenocarcinoma in the current endoscopic submucosal dissection indication guidelines. However, the safety of endoscopic submucosal dissection remains controversial. Currently, data regarding which papillary early gastric cancer should be considered for endoscopic submucosal dissection are unavailable. Thus, the aim of this study was to investigate lymph node metastasis and the safety of endoscopic submucosal dissection in patients with papillary early gastric cancer. This observational study recruited 4264 consecutive patients with early gastric cancer who underwent curative gastrectomy between October 2000 and December 2017 at the National Cancer Center, Korea. Of these, 45 had pathologically confirmed papillary early gastric cancer, 2106 had differentiated non-papillary early gastric cancer, and 2113 had undifferentiated early gastric cancer. Logistic regression analysis was performed to identify risk factors for lymph node metastasis. Mucosal tumors were less common in papillary early gastric cancer (37.9%) than in differentiated non-papillary early gastric cancer (48.8%) and undifferentiated early gastric cancer (60.4%) (both P < .001). Lymph node metastasis was more common in papillary early gastric cancer (20.0%) than in differentiated non-papillary early gastric cancer (9.2%) and undifferentiated early gastric cancer (11.7%; both P < .001). In multivariate analysis, non-mixed-type papillary early gastric cancer showed marginally increased odds of lymph node metastasis than differentiated early gastric cancer (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.0-6.3). Rates of lymph node metastasis (1/10, 10%) and angiolymphatic invasion (2/10, 20%) for papillary early gastric cancer meeting expanded criteria were higher than those for other histology types meeting endoscopic submucosal dissection absolute or expanded criteria (P = .03 and P < .001, respectively). Endoscopic submucosal dissection should be considered carefully for papillary early gastric cancer, especially if it meets expanded endoscopic submucosal dissection indications since it is associated with high rates of submucosal invasion and lymph node metastasis.
Collapse
Affiliation(s)
- Jung Hwan Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Ju Yeon Oh
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Il Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Soo-Jeong Cho
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Korea
| |
Collapse
|
|
8
|
Jang HJ, Song IH, Lee SH. Deep Learning for Automatic Subclassification of Gastric Carcinoma Using Whole-Slide Histopathology Images. Cancers (Basel) 2021; 13:3811. [PMID: 34359712 PMCID: PMC8345042 DOI: 10.3390/cancers13153811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/12/2022] Open
Abstract
Histomorphologic types of gastric cancer (GC) have significant prognostic values that should be considered during treatment planning. Because the thorough quantitative review of a tissue slide is a laborious task for pathologists, deep learning (DL) can be a useful tool to support pathologic workflow. In the present study, a fully automated approach was applied to distinguish differentiated/undifferentiated and non-mucinous/mucinous tumor types in GC tissue whole-slide images from The Cancer Genome Atlas (TCGA) stomach adenocarcinoma dataset (TCGA-STAD). By classifying small patches of tissue images into differentiated/undifferentiated and non-mucinous/mucinous tumor tissues, the relative proportion of GC tissue subtypes can be easily quantified. Furthermore, the distribution of different tissue subtypes can be clearly visualized. The patch-level areas under the curves for the receiver operating characteristic curves for the differentiated/undifferentiated and non-mucinous/mucinous classifiers were 0.932 and 0.979, respectively. We also validated the classifiers on our own GC datasets and confirmed that the generalizability of the classifiers is excellent. The results indicate that the DL-based tissue classifier could be a useful tool for the quantitative analysis of cancer tissue slides. By combining DL-based classifiers for various molecular and morphologic variations in tissue slides, the heterogeneity of tumor tissues can be unveiled more efficiently.
Collapse
Affiliation(s)
- Hyun-Jong Jang
- Catholic Big Data Integration Center, Department of Physiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - In-Hye Song
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Sung-Hak Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| |
Collapse
|
|
9
|
García AM, Sánchez W. Adenocarcinoma indiferenciado como factor predictor de metástasis ganglionares en cáncer gástrico. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El grado de diferenciación celular en el estudio histopatológico del adenocarcinoma gástrico está descrito como un factor pronóstico determinante en el comportamiento clínico del tumor. El adenocarcinoma gástrico indiferenciado es considerado una variante agresiva de mal pronóstico, que se correlaciona con una alta tasa de metástasis ganglionares.
Métodos. Estudio prospectivo descriptivo de una serie de casos en el cual se analizan los pacientes con adenocarcinoma gástrico indiferenciado, que fueron llevados a cirugía radical con gastrectomía y linfadenectomía DII y su correlación con la presencia de metástasis ganglionares en un período de dos años.
Resultados. De enero de 2018 a enero de 2020 se recolectaron en la base de datos 113 pacientes con adenocarcinoma gástrico a quienes se les practicó gastrectomía total, disección ganglionar DII y reconstrucción esofagoyeyunal terminolateral con técnica de Orr más Y de Roux. Fueron clasificados histológicamente como adenocarcinoma gástrico indiferenciado 41 pacientes (36,3 %). La edad promedio de este grupo fue de 56 años con un rango entre 28-92 años. De ellos 30 fueron hombres (73 %) y 11 mujeres (27 %). El número promedio de ganglios linfáticos analizados por espécimen fue de 24. De los 41 pacientes con adenocarcinoma gástrico indiferenciado, 35 (85 %) tuvieron metástasis ganglionares, con 382 ganglios positivos en total, con un rango entre 1-38 y un promedio de 11 ganglios linfáticos positivos por espécimen.
Discusión. En esta serie el adenocarcinoma gástrico indiferenciado se presentó en el 36,3 % de los casos y se correlacionó con un 85 % de presencia de metástasis ganglionares en estadios T3-T4.
Collapse
|
|
10
|
Lee A, Chung H, Lee HJ, Cho SJ, Kim JL, Ahn HS, Suh YS, Kong SH, Choe HN, Yang HK, Kim SG. Impact of the Interval between Previous Endoscopic Exam and Diagnosis on the Mortality and Treatment Modality of Undifferentiated-Type Gastric Cancer. J Gastric Cancer 2021; 21:203-212. [PMID: 34234981 PMCID: PMC8255304 DOI: 10.5230/jgc.2021.21.e19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose The impact of the interval between previous endoscopy and diagnosis on the treatment modality or mortality of undifferentiated (UD)-type gastric cancer is unclear. This study aimed to investigate the effect of endoscopic screening interval on the stage, cancer-related mortality, and treatment methods of UD-type gastric cancer. Materials and Methods We reviewed the medical records of newly diagnosed patients with UD gastric cancer in 2013, in whom the interval between previous endoscopy and diagnosis could be determined. The patients were classified into different groups according to the period from the previous endoscopy to diagnosis (<12 months, 12–23 months, 24–35 months, ≥36 months, and no history of endoscopy), and the outcomes were compared between the groups. In addition, patients who underwent endoscopic and surgical treatment were reclassified based on the final treatment results. Results The number of enrolled patients was 440, with males representing 64.1% of the study population; 11.8% of the participants reported that they had undergone endoscopy for the first time in their cancer diagnosis. The percentage of stage I cancer at diagnosis significantly decreased as the interval from the previous endoscopy to diagnosis increased (65.4%, 63.2%, 64.2%, 45.9%, and 35.2% for intervals of <12 months, 12–23 months, 24–35 months, ≥36 months, and no previous endoscopy, respectively, P<0.01). Cancer-related mortality was significantly lower for a 3-year interval of endoscopy (P<0.001). Conclusions A 3-year interval of endoscopic screening reduces gastric-cancer-related mortality, particularly in cases of UD histology.
Collapse
Affiliation(s)
- Ayoung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Gastric Cancer Center, Seoul National University Cancer Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jue Lie Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Seong Ahn
- Department of Surgery, Gastric Cancer Center, Seoul National University Cancer Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yun-Suhk Suh
- Department of Surgery, Gastric Cancer Center, Seoul National University Cancer Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Gastric Cancer Center, Seoul National University Cancer Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hwi Nyeong Choe
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery and Cancer Research Institute, Gastric Cancer Center, Seoul National University Cancer Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
|
11
|
Fang C, Chen C, Yang Y, Li K, Gao R, Xu D, Huang Y, Chen Z, Liu Z, Chen S, Yu X, Li Y, Zeng C. Physalin B inhibits cell proliferation and induces apoptosis in undifferentiated human gastric cancer HGC-27 cells. Asia Pac J Clin Oncol 2021; 18:224-231. [PMID: 34161670 DOI: 10.1111/ajco.13593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Physalin B (PB) from Physalis angulata L. (Solanaceae) is a naturally occurring secosteroid with multiple biological activities, including anti-inflammatory and anticancer activity. However, PB's effects and mechanisms in human gastric cancer (GC) cells are not well characterized. METHODS The undifferentiated GC cell line HGC-27 and semi-differentiated GC cell line SGC-7901 were treated with PB. Cell counting kit-8 (CCK-8) and colony formation assays were performed to evaluate cell viability. Apoptosis and the cell cycle were assessed by Annexin V/PI and PI/RNase DNA staining assays, respectively, and Western blotting was used to evaluate the expression of a protein. RESULTS PB significantly inhibited the proliferation of HGC-27 cells in a dose- and time-dependent manner. Moreover, PB induced G0/G1 cycle arrest and caspase-dependent apoptosis of HGC-27 cells. Cleaved caspases 8, 3, and 7, poly(ADP)-ribose polymerase (PARP), and the cyclin-dependent kinase (CDK) inhibitor p-Chk2 was induced by PB in HGC-27 cells, while the cell cycle-related proteins cyclin D1, cyclin D3, CDK4, CDK6, cyclin E, and phosphorylated retinoblastoma tumor suppressor protein (p-Rb) were downregulated in a dose-dependent manner. CONCLUSIONS PB inhibits proliferation via cyclin-dependent kinase and induces caspase-dependent apoptosis in HGC-27 cells, suggesting that PB might be a novel and effective agent for undifferentiated GC therapy.
Collapse
Affiliation(s)
- Chunsheng Fang
- Guangdong Food and Drug Vocational College, Guangzhou, China.,Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Cunte Chen
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Yanjun Yang
- Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Kehan Li
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Rili Gao
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Dandan Xu
- Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Youxue Huang
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Zheng Chen
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Zhuandi Liu
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Shaohua Chen
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Xibao Yu
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Yangqiu Li
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Chengwu Zeng
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| |
Collapse
|
|
12
|
Qiu J, Xin Y. Incidence and prognosis of undifferentiated cancers of the digestive system: a population-based cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:15. [PMID: 33553308 PMCID: PMC7859808 DOI: 10.21037/atm-20-1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cases of undifferentiated cancers of the digestive system (UCDS) are occasionally encountered in clinical practice; however, no large-scale studies have described their characteristics. This study aimed to investigate the incidence, prognosis, and treatment strategies of UCDS. Methods We used the data from the Surveillance, Epidemiology, and End Results database to evaluate clinical characteristics in UCDS patients. A cohort of 1,372 patients was included to estimate UCDS incidence; another cohort of 1,816 patients was followed up until December 31, 2017 to evaluate treatment and prognosis. The incidence, trends, treatments, overall survival, and cause-specific survival were assessed. Results The estimated incidence of UCDS was 0.136 per 100,000 people-years [95% confidence interval (CI): 0.129-0.143] from 1975 to 2016 with respect to sex, age, year of diagnosis, race, region, site, income, and education. The age-adjusted rates of UCDS dropped from 0.567 per 100,000 people-years in 1978 to 0.031 per 100,000 people-years in 2016. The rates of surgery, beam radiation, and chemotherapy in patients with UCDS were 37.3%, 17.3%, and 30.7%, respectively. Overall, the 5-year cause-specific survival rate was 18%, with a median cause-specific survival of 4 months. Patient prognosis improved significantly over the decades; stage, site, year of diagnosis, surgery, beam radiation, and chemotherapy were independent prognostic factors for UCDS mortality. Conclusions The incidence of UCDS has decreased in the United States over the past 40 years. Patients benefited from surgery, beam radiation, and chemotherapy. The survival of patients with UCDS has improved. Further research on developing decision-making recommendations for UCDS treatment is crucial.
Collapse
Affiliation(s)
- Jingping Qiu
- Department of Radiation oncology, The First Hospital of China Medical University, Shenyang, China.,Laboratory of Gastrointestinal Onco-Pathology, Cancer Institute and General Surgery Institute, The First Hospital of China Medical University, Shenyang, China
| | - Yan Xin
- Laboratory of Gastrointestinal Onco-Pathology, Cancer Institute and General Surgery Institute, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
|
13
|
Ryu ES, Chang SJ, An J, Yang JY, Chung JW, Kim YJ, Kim KO, Park DK, Kwon KA, Nam S, Lee WK, Kim JH. Sex-specific differences in risk factors of lymph node metastasis in patients with early gastric cancer. PLoS One 2019; 14:e0224019. [PMID: 31626653 PMCID: PMC6799917 DOI: 10.1371/journal.pone.0224019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023] Open
Abstract
Accurate prediction of lymph node status is of crucial importance in the appropriate treatment planning for patients with early gastric cancer (EGC). Some studies have examined factors predicting lymph node metastasis (LNM) in EGC; however, these studies did not consider sex-specific differences. This study aimed to investigate sex-specific differences in predictive risk factors of LNM in EGC based on surgical specimens. Patients who underwent surgical treatment for EGC between January 2003 and February 2016 were retrospectively evaluated. Patients who underwent previous gastric surgery or treatment for gastric neoplasms were excluded. Finally, 1076 patients treated for EGC were included in the analysis. We analyzed risk factors of LNM by dividing patients into male and female groups. Of 1076 patients (mean age 59.6 years), 69% were men. The overall LNM rate was 9.4%. The LNM rate was lower in men (7.8%) than in women (12.9%). Multivariate analysis showed that elevated type (odds ratio [OR], 2.084; 95% confidence interval [CI]: 1.053–4.125; P = 0.035), submucosal invasion (OR, 2.162; 95% CI: 1.018–4.595; P = 0.045), undifferentiated type (OR, 2.044; 95% CI: 1.107–3.772; P = 0.022), and lymphovascular invasion (LVI) (OR, 7.210; 95% CI: 3.835–13.554; P<0.001) were independent predictive risk factors of LNM in EGC in men. However, only submucosal invasion (OR, 8.772; 95% CI: 2.823–27.259; P<0.001) and LVI (OR, 8.877; 95% CI: 3.861–20.410; P<0.001) were independent predictive risk factors of LNM in EGC in women. Submucosal invasion and LVI were risk factors of LNM in both men and women. However, elevated and undifferentiated types were risk factors in men but not in women. Clinicians should consider these sex-specific differences with regard to individualized management.
Collapse
Affiliation(s)
- Eun Sook Ryu
- College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Seung Jun Chang
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jungsuk An
- Department of Pathology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jun-Young Yang
- Department of Life Sciences, Gachon Advanced Institute of Health Sciences & Technology, Gachon University, Incheon, Republic of Korea
| | - Jun-Won Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Yoon Jae Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Kyoung Oh Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Dong Kyun Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Kwang An Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Seungyoon Nam
- College of Medicine, Gachon University, Incheon, Republic of Korea
- Department of Life Sciences, Gachon Advanced Institute of Health Sciences & Technology, Gachon University, Incheon, Republic of Korea
- Gachon Institute of Genome Medicine and Science, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Woon Kee Lee
- Department of Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
- * E-mail: (JHK); (WKL)
| | - Jung Ho Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
- Gachon Medical Research Institute, Gachon University Gil Medical Center, Incheon, Republic of Korea
- * E-mail: (JHK); (WKL)
| |
Collapse
|
|
14
|
Chu YN, Yu YN, Jing X, Mao T, Chen YQ, Zhou XB, Song W, Zhao XZ, Tian ZB. Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer. World J Gastroenterol 2019; 25:5344-5355. [PMID: 31558878 PMCID: PMC6761234 DOI: 10.3748/wjg.v25.i35.5344] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection. The indications for ESD have been recently expanded to include larger, ulcerated, and undifferentiated mucosal lesions, and differentiated lesions with slight submucosal invasion. The risk of lymph node metastasis (LNM) is the most important consideration when deciding on a treatment strategy for EGC. Despite the advantages over surgical procedures, lymph nodes cannot be removed by ESD. In addition, whether patients who meet the expanded indications for ESD can be managed safely remains controversial.
AIM To determine whether the ESD indications are applicable to Chinese patients and to investigate the predictors of LNM in EGC.
METHODS We retrospectively analyzed 12552 patients who underwent surgery for gastric cancer between June 2007 and December 2018 at the Affiliated Hospital of Qingdao University. A total of 1262 (10.1%) EGC patients were eligible for inclusion in this study. Data on the patients’ clinical, endoscopic, and histopathological characteristics were collected. The absolute and expanded indications for ESD were validated by regrouping the enrolled patients and determining the positive LNM results in each subgroup. Predictors of LNM in patients were evaluated by univariate and multivariate analyses.
RESULTS LNM was observed in 182 (14.4%) patients. No LNM was detected in the patients who met the absolute indications (0/90). LNM occurred in 4/311 (1.3%) patients who met the expanded indications. According to univariate analysis, LNM was significantly associated with positive tumor marker status, medium (20-30 mm) and large (>30 mm) lesion sizes, excavated macroscopic-type tumors, ulcer presence, submucosal invasion (SM1 and SM2), poor differentiation, lymphovascular invasion (LVI), perineural invasion, and diffuse and mixed Lauren’s types. Multivariate analysis demonstrated SM1 invasion (odds ration [OR] = 2.285, P = 0.03), SM2 invasion (OR = 3.230, P < 0.001), LVI (OR = 15.702, P < 0.001), mucinous adenocarcinoma (OR = 2.823, P = 0.015), and large lesion size (OR = 1.900, P = 0.006) to be independent risk factors.
CONCLUSION The absolute indications for ESD are reasonable, and the feasibility of expanding the indications for ESD requires further investigation. The predictors of LNM include invasion depth, LVI, mucinous adenocarcinoma, and lesion size.
Collapse
Affiliation(s)
- Yu-Ning Chu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Ya-Nan Yu
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xue Jing
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Tao Mao
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Yun-Qing Chen
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xiao-Bin Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao 266021, Shandong Province, China
| | - Wen Song
- Endoscopy Center, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xian-Zhi Zhao
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Zi-Bin Tian
- Department of Gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| |
Collapse
|