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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (6): 1093-1097. doi: 10.19723/j.issn.1671-167X.2020.06.017

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Characteristics of lymph node metastasis and evaluating the efficacy of endoscopic submucosal dissection in early gastric cancer

Ying-chao WU1,Yun-long CAI2,Long RONG2,Ji-xin ZHANG3,Jin LIU1,Xin WANG1,△()   

  1. 1. Department of General Surgery, Peking University First Hospital, Beijing 100034, China
    2. Department of Endoscopy, Peking University First Hospital, Beijing 100034, China
    3. Department of Pathology, Peking University First Hospital, Beijing 100034, China
  • Received:2020-05-20 Online:2020-12-18 Published:2020-12-13
  • Contact: Xin WANG E-mail:wangxin_guo@hotmail.com

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Abstract:

Objective: To investigate the correlation between clinicopathological features and lymph node metastasis, and to evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) by comparing with surgery treatment. Methods: The clinicopathological data of 320 patients with EGC who were treated in Peking University First Hospital between January 2010 and December 2017 were retrospectively reviewed, in which there were 198 cases of surgical procedure and 122 cases of ESD. Characteristics of lymph node metastasis in EGC were analyzed, and lymph node metastasis of EGC with ESD absolute and expanded indications were summarized. The long-term efficacy of ESD and surgical treatment of EGC were compared to evaluate the rationality of absolute and expanded indications of ESD. Results: Lymph node metastasis was detected in 22 (11.1%) of 198 patients. Univariate analysis showed a positive relationship between tumor size (χ2=5.525, P=0.019), depth of invasion(χ2=8.235, P=0.004), histological type (χ2=6.323, P=0.012), lymphovascular invasion (χ2=12.273, P<0.001) and lymph node metastasis in EGC. Multivariate analysis revealed that depth of invasion(Wald=7.575, P=0.006) and histological type (Wald=6.317, P=0.012) were independent relative factors of lymph node metastasis in EGC. The lymph node metastasis rates of the patients with absolute and expanded ESD indications were both 0%. The 5-year survival rates of the patients who met ESD absolute indication receiving surgery treatment and ESD were 97.6% and 97.9% respectively, and the difference between the two groups was not statistically significant(χ2=0.014, P=0.907).The 5-year survival rates of the patients who met ESD expanded indication receiving surgery treatment and ESD were 96.5% and 91.7% respectively, the difference between the two groups was not statistically significant(χ2=1.061, P=0.303). Conclusion: Lymph node metastasis in EGC is mainly correlated with depth of invasion and histological type. Our data indicate that ESD procedure for EGC is comparable to surgery in terms of long-term efficacy in both absolute and expanded indications. However, some studies of a large sample size are still needed for more confirmation.

Key words: Stomach neoplasms, early, Lymphatic metastasis, Endoscopic submucosal dissection

CLC Number: 

  • R735.2

Table 1

Univariate analysis of lymph node metastasis factors in patients with early gastric cancer"

Variable n Lymph node metastasis rate/% χ2 P
Gender 0.108 0.743
Male 138 11.6
Female 60 10.0
Age/years 0.650 0.420
≤60 92 13.0
>60 106 9.4
Tumor location 1.354 0.508
Upper 1/3 24 8.3
Middle 1/3 22 18.2
Lower 1/3 152 10.5
Tumor size/cm 5.525 0.019
≤2 126 7.1
>2 72 18.1
Macroscopic type 2.920 0.232
Protruded 14 7.1
Flat 83 7.2
Ulcerative 101 14.9
Operation 0.549 0.760
Proximal gastrectomy 4 0
Distal gastrectomy 153 11.1
Total gastrectomy 41 12.2
Lymph node dissection 1.737 0.188
D1 or D1+ 27 3.7
D2 or D2+ 171 12.3
Invasive depth 8.235 0.004
Mucosa 93 4.3
Submucosa 105 17.1
Differentiated degree 6.323 0.012
Differentiated 95 5.3
Undifferentiated 103 16.5
Perineural invasion 0.797 0.372
No 194 10.8
Yes 4 25.0
Lymphovascular invasion 12.273 0.000
No 182 8.8
Yes 16 37.5

Table 2

Multivariate analysis of lymph node metastasis factors in patients with early gastric cancer"

Variable B S.E. Wald df P Exp(B) 95%CI
Invasive depth 1.619 0.588 7.575 1 0.006 5.047 1.594-15.983
Differentiated degree 1.379 0.549 6.317 1 0.012 3.970 1.355-11.636

Figure 1

Survival curves of patients for absolute ESD indication ESD, endoscopic submucosal dissection."

Figure 2

Survival curves of patients for expanded ESD indication ESD, endoscopic submucosal dissection."

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