Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer
Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer
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DOI：
10.1007/s00464-014-3780-7
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发表时间：
2015-05-01
影响因子：
3.1
通讯作者：
Jung, Hyun Chae
中科院分区：
文献类型：
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作者：
Yang, Hyo-Joon;Kim, Sang Gyun;Jung, Hyun Chae
虽然早期胃癌（EGC）的非治愈性内镜切除术建议手术治疗，但只有部分患者发现淋巴结（LN）转移。本研究旨在确定非治愈性内镜切除患者淋巴结转移的预测因素。2005年4月至2013年7月，连续在一家三级医院回顾性纳入接受非治愈性内镜切除术，然后接受胃切除术和淋巴结清扫术或至少1年腹部计算机断层扫描的患者。非治愈性切除被定义为超出病理定位扩展标准的切除。通过拟合多变量逻辑回归模型确定了 LN 转移的预测因素。 在连续 1783 名接受内镜下 EGC 切除的患者中，有 323 名 (18.1%) 患者进行了非治愈性切除。其中，共有267例患者入组，淋巴结转移率为6.7%（18/267）。在多变量分析中，静脉侵犯[比值比 (OR)，7.83； 95% 置信区间 (CI) 2.20-27.86； p = 0.001]、sm2 侵袭（肿瘤侵入粘膜下层每千分之一 500 A μm；OR 4.98；95 % CI 1.34-18.47；p = 0.016）或胃窦肿瘤位置（OR 12.65；95 % CI 1.57-102.00；p = 0.017）是独立预测因素淋巴结转移。对于具有一种或无预测因子的患者，LN 转移率为 1.1 % (95 % CI 0-2.7)；对于具有两种或多种预测因子的患者，LN 转移率为 17.8 % (95 % CI 9.7-25.8)。对于具有两种或两种以上确定的预测因子的患者，建议在非治愈性内镜切除 EGC 后进行额外的胃切除术和淋巴结切除术。然而，对于只有一种或没有预测因子的患者，可以谨慎考虑不立即手术的密切随访。
Although surgery is recommend for non-curative endoscopic resection of early gastric cancer (EGC), only a part of patients are found to have lymph node (LN) metastasis. This study aimed to identify the predictors of LN metastasis in patients with non-curative endoscopic resection.Between April 2005 and July 2013, consecutive patients who received non-curative endoscopic resection and then underwent gastrectomy with lymphadenectomy or followed at least 1 year with abdominal computed tomography were retrospectively enrolled at a single tertiary hospital. Non-curative resection was defined as a resection beyond the expanded criteria in pathologic mapping. The predictors for LN metastasis were identified by fitting a multivariate logistic regression model.Among the 1783 consecutive patients who received endoscopic resection of EGC, non-curative resection was performed in 323 (18.1 %) patients. Of these patients, a total of 267 patients were enrolled, and the rate of LN metastasis was 6.7 % (18/267). In multivariate analysis, venous invasion [odds ratio (OR), 7.83; 95 % confidence interval (CI) 2.20-27.86; p = 0.001], sm2 invasion (tumor invasion a parts per thousand yen500 A mu m into submucosa; OR 4.98; 95 % CI 1.34-18.47; p = 0.016), or antral tumor location (OR 12.65; 95 % CI 1.57-102.00; p = 0.017) were independent predictors for LN metastasis. The rates of LN metastasis were 1.1 % (95 % CI 0-2.7) for patients with one or no predictor and 17.8 % (95 % CI 9.7-25.8) for those with two or more predictors.Additional gastrectomy with lymphadenectomy after non-curative endoscopic resection of EGC is recommended for the patients with two or more identified predictors. However, close follow-up without immediate surgery might be considered cautiously for those with only one or no predictor.