Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Additional Surgery
2.3. Analysis of Lymph Node Metastasis According to Risk Factors
2.4. Statistical Analysis
3. Results
3.1. Clinicopathological Features
3.2. Risk Factor Analysis for Lymph Node Metastasis
3.3. Modification of the eCura System
3.4. Survival Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Tumor Depth | Ulcer | Differentiated | Undifferentiated | ||
---|---|---|---|---|---|
pT1a | Negative | ≤20 mm | >20 mm | ≤20 mm | >20 mm |
endoscopic curability A †¶ | endoscopic curability A †¶ | endoscopic curability B †¶ | endoscopic curability C-2 ‡ | ||
Positive | ≤30 mm | >30 mm | |||
endoscopic curability A †¶ | endoscopic curability C-2 ‡ | endoscopic curability C-2 ‡ | endoscopic curability C-2 ‡ | ||
pT1b (SM1) | ≤30 mm | >30 mm | |||
endoscopic curability B †¶ | endoscopic curability C-2 ‡ | endoscopic curability C-2 ‡ | endoscopic curability C-2 ‡ |
Characteristic | Patients (n = 543) | LNM (n = 44) | Rate of LNM (%) (95% CI) | p-Value |
---|---|---|---|---|
Age | 0.713 | |||
≤60 years | 199 (36.6) | 15 | 7.5 (3.9–11.2) | |
>60 years | 344 (63.4) | 29 | 8.4 (5.5–11.4) | |
Sex | 0.079 | |||
Male | 389 (71.6) | 26 | 6.7 (4.2–9.2) | |
Female | 154 (28.4) | 18 | 11.7 (6.6–16.8) | |
Location | 0.444 | |||
Upper third | 74 (13.6) | 7 | 9.5 (2.8–16.1) | |
Middle third | 79 (14.5) | 8 | 10.1 (3.5–16.8) | |
Lower third | 390 (71.8) | 29 | 7.4 (4.8–10.0) | |
Size | 0.001 | |||
≤30 mm | 440 (81.0) | 27 | 6.1 (3.9–8.4) | |
>30 mm | 103 (19.0) | 17 | 16.5 (9.3–23.7) | |
Depth of invasion | 0.105 | |||
Mucosa/SM1 | 170 (31.3) | 9 | 5.3 (1.9–8.7) | |
SM2/SM3 | 373 (68.7) | 35 | 9.4 (6.4–12.3) | |
Histopathological type | 0.610 | |||
Differentiated | 441 (81.2) | 37 | 8.4 (5.8–11.0) | |
Undifferentiated | 102 (18.8) | 7 | 6.9 (2.0–11.8) | |
Vertical margin | 0.001 | |||
Negative | 389 (71.6) | 22 | 5.7 (3.4–8.0) | |
Positive | 154 (28.4) | 22 | 14.3 (8.8–19.8) | |
Lymphovascular invasion | <0.001 | |||
Negative | 251 (46.2) | 6 | 2.4 (0.5–4.3) | |
Positive | 292 (53.8) | 38 | 13.0 (9.2–16.9) |
Risk Factors | Odds Ratio | 95% CI | p-Value |
---|---|---|---|
Size | <0.001 | ||
≤30 mm | 1 | Reference | |
>30 mm | 3.772 | 1.867–7.624 | |
Depth of invasion | 0.334 | ||
Mucosa/SM1 | 1 | Reference | |
SM2/SM3 | 1.509 | 0.655–3.477 | |
Vertical margin | <0.001 | ||
Negative | 1 | Reference | |
Positive | 3.930 | 2.007–7.698 | |
Lymphovascular invasion | <0.001 | ||
Negative | 1 | Reference | |
Positive | 8.199 | 3.304–20.346 |
No. of Risk Factors | Risk Factors | Patients (n = 543) | LNM (n = 44) | Rate of LNM (%) (95% CI) |
---|---|---|---|---|
0 | None | 28 (5.2) | 1 | 3.6 (0–10.4) |
1 | Tumor size > 30 mm | 24 (4.4) | 1 | 4.2 (0–12.2) |
SM2/SM3 | 98 (18.0) | 1 | 1.0 (0–3.0) | |
Vertical margin (+) | 9 (1.7) | 1 | 11.1 (0–31.6) | |
LVI | 85 (15.7) | 2 | 2.4 (0–5.6) | |
2 | Without LVI | 82 (15.1) | 2 | 2.4 (0–5.8) |
With LVI | 122 (22.5) | 13 | 10.7 (5.2–16.1) | |
3 | Without LVI | 10 (1.8) | 0 | |
With LVI | 72 (13.3) | 15 | 20.8 (11.5–30.2) | |
4 | All risk factors | 13 (2.4) | 8 | 61.5 (35.1–88.0) |
Risk Group | Risk Factors | Patients (n = 543) | LNM (n = 44) |
---|---|---|---|
Low | without LVI or with LVI only | 336 (61.9) | 8 (2.4%; 95% CI: 0.8–4.0) |
High | with LVI and other risk factors | 207 (38.1) | 36 (17.4%; 95% CI: 12.2–22.6) |
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Lee, S.; Song, J.H.; Park, S.H.; Cho, M.; Kim, Y.M.; Kim, H.-I.; Hyung, W.J. Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System. Cancers 2021, 13, 5768. https://doi.org/10.3390/cancers13225768
Lee S, Song JH, Park SH, Cho M, Kim YM, Kim H-I, Hyung WJ. Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System. Cancers. 2021; 13(22):5768. https://doi.org/10.3390/cancers13225768
Chicago/Turabian StyleLee, Sejin, Jeong Ho Song, Sung Hyun Park, Minah Cho, Yoo Min Kim, Hyoung-Il Kim, and Woo Jin Hyung. 2021. "Determination of Additional Surgery after Non-Curative Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Practically Modified Application of the eCura System" Cancers 13, no. 22: 5768. https://doi.org/10.3390/cancers13225768