Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Scoring Model Based on Nodal Metastasis Prediction Suggesting an Alternative Treatment to Total Gastrectomy in Proximal Early Gastric Cancer

  • So, Seol (Department of Gastroenterology, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Noh, Jin Hee (Department of Gastroenterology, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Ahn, Ji Yong (Department of Gastroenterology, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Lee, In-Seob (Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Lee, Jung Bok (Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jung, Hwoon-Yong (Department of Gastroenterology, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Yook, Jeong-Hwan (Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Kim, Byung-Sik (Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center)
  • Received : 2021.11.13
  • Accepted : 2022.02.04
  • Published : 2022.03.31
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Abstract

Purpose: Total gastrectomy (TG) with lymph node (LN) dissection is recommended for early gastric cancer (EGC) but is not indicated for endoscopic resection (ER). We aimed to identify patients who could avoid TG by establishing a scoring system for predicting lymph node metastasis (LNM) in proximal EGCs. Materials and Methods: Between January 2003 and December 2017, a total of 1,025 proximal EGC patients who underwent TG with LN dissection were enrolled. Patients who met the absolute ER criteria based on pathological examination were excluded. The pathological risk factors for LNM were determined using univariate and multivariate logistic regression analyses. A scoring system for predicting LNM was developed and applied to the validation group. Results: Of the 1,025 cases, 100 (9.8%) showed positive LNM. Multivariate analysis confirmed the following independent risk factors for LNM: tumor size >2 cm, submucosal invasion, lymphovascular invasion (LVI), and perineural invasion (PNI). A scoring system was created using the four aforementioned variables, and the areas under the receiver operating characteristic curves in both the training (0.85) and validation (0.84) groups indicated excellent discrimination. The probability of LNM in mucosal cancers without LVI or PNI, regardless of size, was <2.9%. Conclusions: Our scoring system involving four variables can predict the probability of LNM in proximal EGC and might be helpful in determining additional treatment plans after ER, functioning as a good indicator of the adequacy of treatments other than TG in high surgical risk patients.

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References

  1. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007;10:1-11. https://doi.org/10.1007/s10120-006-0408-1
  2. Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 2011;74:485-493. https://doi.org/10.1016/j.gie.2011.04.038
  3. Goto O, Fujishiro M, Kodashima S, Ono S, Omata M. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 2009;41:118-122. https://doi.org/10.1055/s-0028-1119452
  4. Ahn JY, Park HJ, Park YS, Lee JH, Choi KS, Jeong KW, et al. Endoscopic resection for undifferentiated-type early gastric cancer: Immediate endoscopic outcomes and long-term survivals. Dig Dis Sci 2016;61:1158-1164. https://doi.org/10.1007/s10620-015-3988-y
  5. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017;20:1-19. https://doi.org/10.1007/s10120-016-0622-4
  6. Kim EM, Jeong HY, Lee ES, Moon HS, Sung JK, Kim SH, et al. Comparision between proximal gastrectomy and total gastrectomy in early gastric cancer. Korean J Gastroenterol 2009;54:212-219. https://doi.org/10.4166/kjg.2009.54.4.212
  7. Lee MS, Lee JH, Park DJ, Lee HJ, Kim HH, Yang HK. Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc 2013;27:2598-2605. https://doi.org/10.1007/s00464-013-2796-8
  8. An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 2008;196:587-591. https://doi.org/10.1016/j.amjsurg.2007.09.040
  9. Topal B, Leys E, Ectors N, Aerts R, Penninckx F. Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 2008;22:980-984. https://doi.org/10.1007/s00464-007-9549-5
  10. Kim HS, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A 2013;23:323-331. https://doi.org/10.1089/lap.2012.0389
  11. Adachi Y, Inoue T, Hagino Y, Shiraishi N, Shimoda K, Kitano S. Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction. Gastric Cancer 1999;2:40-45. https://doi.org/10.1007/s101200050019
  12. Shinohara T, Ohyama S, Muto T, Kato Y, Yanaga K, Yamaguchi T. Clinical outcome of high segmental gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 2006;93:975-980. https://doi.org/10.1002/bjs.5388
  13. Ohwada S, Nakamura S, Ogawa T, Izumi M, Tanahashi Y, Sato Y, et al. Segmental gastrectomy for early cancer in the mid-stomach. Hepatogastroenterology 1999;46:1229-1233.
  14. Kitamura K, Yamaguchi T, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 1997;64:42-47. https://doi.org/10.1002/(SICI)1096-9098(199701)64:1<42::AID-JSO9>3.0.CO;2-P
  15. Seto Y, Nagawa H, Muto Y, Kaizaki S, Kitayama J, Muto T. Preliminary report on local resection with lymphadenectomy for early gastric cancer. Br J Surg 1999;86:526-528. https://doi.org/10.1046/j.1365-2168.1999.01069.x
  16. Seto Y, Yamaguchi H, Shimoyama S, Shimizu N, Aoki F, Kaminishi M. Results of local resection with regional lymphadenectomy for early gastric cancer. Am J Surg 2001;182:498-501. https://doi.org/10.1016/S0002-9610(01)00747-4
  17. Lips DJ, Schutte HW, van der Linden RL, Dassen AE, Voogd AC, Bosscha K. Sentinel lymph node biopsy to direct treatment in gastric cancer. A systematic review of the literature. Eur J Surg Oncol 2011;37:655-661. https://doi.org/10.1016/j.ejso.2011.05.001
  18. Cho WY, Kim YJ, Cho JY, Bok GH, Jin SY, Lee TH, et al. Hybrid natural orifice transluminal endoscopic surgery: endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection--14 human cases. Endoscopy 2011;43:134-139. https://doi.org/10.1055/s-0030-1255955
  19. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112. https://doi.org/10.1007/s10120-011-0041-5
  20. Lee S, Choi KD, Han M, Na HK, Ahn JY, Jung KW, et al. Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors: a criteria-based analysis. Gastric Cancer 2018;21:490-499. https://doi.org/10.1007/s10120-017-0772-z
  21. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. 4th ed. Lyon: IARC Press, 2010.
  22. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L, et al. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Ann Surg 1999;230:170-178. https://doi.org/10.1097/00000658-199908000-00006
  23. Jentschura D, Winkler M, Strohmeier N, Rumstadt B, Hagmuller E. Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection. Hepatogastroenterology 1997;44:1137-1142.
  24. Davies J, Johnston D, Sue-Ling H, Young S, May J, Griffith J, et al. Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World J Surg 1998;22:1048-1055. https://doi.org/10.1007/s002689900515
  25. Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 2009;12:148-152. https://doi.org/10.1007/s10120-009-0515-x
  26. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000;3:219-225. https://doi.org/10.1007/PL00011720
  27. Tran TB, Worhunsky DJ, Squires MH, Jin LX, Spolverato G, Votanopoulos KI, et al. Clinicopathologic score predicting lymph node metastasis in T1 gastric cancer. Surgery 2018;163:889-893. https://doi.org/10.1016/j.surg.2017.09.021
  28. Gu L, Chen M, Khadaroo PA, Ma X, Kong L, Li X, et al. A risk-scoring model for predicting lymph node metastasis in early gastric cancer patients: a retrospective study and external validation. J Gastrointest Surg 2018;22:1508-1515. https://doi.org/10.1007/s11605-018-3816-8
  29. Kim JY, Kim WG, Jeon TY, Kim GH, Jeong EH, Kim DH, et al. Lymph node metastasis in early gastric cancer: evaluation of a novel method for measuring submucosal invasion and development of a nodal predicting index. Hum Pathol 2013;44:2829-2836. https://doi.org/10.1016/j.humpath.2013.07.037
  30. Zheng Z, Zhang Y, Zhang L, Li Z, Wu X, Liu Y, et al. A nomogram for predicting the likelihood of lymph node metastasis in early gastric patients. BMC Cancer 2016;16:92. https://doi.org/10.1186/s12885-016-2132-5
  31. Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, et al. A scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer: "eCura system". Am J Gastroenterol 2017;112:874-881. https://doi.org/10.1038/ajg.2017.95