Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2016; 22(29): 6736-6741
Published online Aug 7, 2016. doi: 10.3748/wjg.v22.i29.6736
Feasibility study on expanded indication for endoscopic submucosal dissection of intramucosal poorly differentiated early gastric cancer
Hua Li, Zhi-Bin Huo, Shu-Bo Chen, Hui Li, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang
Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People’s Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China
Shu-Bo Chen, Department of Surgical Urology, Affiliated Xingtai People’s Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China
Hui Li, Department of Hepatobiliary Surgery, Affiliated Xingtai People’s Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China
Author contributions: Li H and Huo ZB designed the research; Li H analyzed the data and drafted the manuscript; Chen SB and Li Hui revised the manuscript critically for important intellectual content and contributed to the data analysis; Wu DC, Xiao QH, Wang SX and Zhang LL helped draft the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Hebei Medical University. Because of the retrospective design, ethics committee approval was not always required.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest was declared by the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Zhi-Bin Huo, Department of Surgical Oncology, Affiliated Xingtai People’s Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China. huozhibinxt@126.com
Telephone: +86-319-3286154 Fax: +86-319-3286153
Received: April 14, 2016
Peer-review started: April 15, 2016
First decision: May 12, 2016
Revised: May 20, 2016
Accepted: June 29, 2016
Article in press: June 29, 2016
Published online: August 7, 2016
Processing time: 105 Days and 22.9 Hours
Abstract

AIM: To identify clinicopathological factors predictive of lymph node metastasis (LNM) in intramucosal poorly differentiated early gastric cancer (EGC), and further to expand the possibility of using endoscopic submucosal dissection (ESD) for the treatment of intramucosal poorly differentiated EGC.

METHODS: Data for 81 surgically treated patients with intramucosal poorly differentiated EGC were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Several clinicopathologic factors were investigated to identify predictive factors for lymph nodes metastasis, including gender, age, family history of gastric cancer, number of tumors, tumor location, ulceration, tumor size, macroscopic type, lymphatic vessel involvement, and signet-ring-cell component.

RESULTS: Tumor size (OR = 7.273, 95%CI: 1.246-29.918, P = 0.042), lymphatic vessel involvement (OR = 42.219, 95%CI: 1.923-97.052, P = 0.018) and signet-ring-cell component (OR = 17.513, 95%CI: 1.647-77.469, P = 0.034) that were significantly associated with LNM by univariate analysis, were found to be significant and independent risk factors for LNM by multivariate analysis. However, gender, age, family history of gastric cancer, number, location, ulceration and macroscopic type of tumor were found not to be associated with LNM. Of these 81 patients diagnosed with intramucosal poorly differentiated EGC, 7 (8.6%) had LNM. The LNM rates were 9.1%, 22.2% and 57.1%, respectively, in cases with one, two and three of the risk factors. There was no LNM in 54 patients without the three risk clinicopathological factors.

CONCLUSION: Tumor size, lymphatic vessel involvement and signet-ring-cell component are independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Thus, these three risk factors may be used as a simple criterion to expand the possibility of using ESD for the treatment of intramucosal poorly differentiated EGC.

Keywords: Intramucosal poorly differentiated early gastric cancer; Early gastric cancer; Clinicopathological characteristics; Lymph node metastasis; Endoscopic submucosal dissection

Core tip: Endoscopic submucosal dissection (ESD) has recently been practiced on a differentiated type of early gastric cancer (EGC). However, there is no clear evidence for endoscopic treatment of intramucosal poorly differentiated EGC. We carried out this retrospectively study to determine the clinicopathological factors that are predictive of lymph node metastasis in intramucosal poorly differentiated EGC, and to guide the individual application of ESD in a suitable subgroup of patients with intramucosal poorly differentiated EGC.