title: Risk factors for submucosal and lymphovascular invasion in gastric cancer looking indicative for endoscopic submucosal dissection.
abstract: BACKGROUND
  Submucosal and lymphovascular (SM/LV) invasions of early gastric cancer (EGC) are difficult to diagnose accurately prior to endoscopic submucosal dissection (ESD), and are occasionally found in resected specimens, requiring additional gastrectomy and lymph node dissection. We performed a retrospective study to determine the risk factors for SM/LV invasions.
  
  
  METHODS
  We analyzed clinicopathological data (age, sex, cancer location, gross morphology, multifocality, tumor size, histological differentiation, depth of invasion, and the presence or absence of lymphovascular invasion) in patients receiving ESD between 2007 and 2012 and presenting with EGC of 2.0 cm or smaller in size, a differentiated-type adenocarcinoma, and without ulceration.
  
  
  RESULTS
  Of 208 lesions consecutively resected by ESD, 143 lesions in 132 patients were included in this study. Submucosal and lymphovascular invasions were detected in 16 lesions. Multivariate analysis revealed three independent risk factors for SM/LV invasions: dominant histology of moderately-differentiated or papillary adenocarcinoma, gross type of 0-IIa + IIc or IIc + IIa, and tumor size of ≥1.5 cm. Lesions exhibiting more than two of these three risk factors were associated with having a 47 % increased incidence of SM/LV invasion (odds ratio 15; 95 % confidence interval 4.6-49.0; P < 0.0001).
  
  
  CONCLUSIONS
  Moderately-differentiated or papillary adenocarcinoma, 0-IIa + IIc or IIc + IIa, and a tumor size of ≥1.5 cm were identified as independent risk factors for SM/LV invasion among EGCs which appeared to be an endoscopically good indication for ESD. Careful surveillances including endoscopic ultrasonography or enhanced computed tomography might be needed for high risk patients before ESD.
authors: Division of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan, yamatake@jade.plala.or.jp.
authors: Takeshi
authors: T
authors: Yamada
authors: Hiroaki
authors: H
authors: Sugiyama
authors: Daisuke
authors: D
authors: Ochi
authors: Daisuke
authors: D
authors: Akutsu
authors: Hideo
authors: H
authors: Suzuki
authors: Toshiaki
authors: T
authors: Narasaka
authors: Toshikazu
authors: T
authors: Moriwaki
authors: Shinji
authors: S
authors: Endo
authors: Tsuyoshi
authors: T
authors: Kaneko
authors: Kaishi
authors: K
authors: Satomi
authors: Kazuto
authors: K
authors: Ikezawa
authors: Yuji
authors: Y
authors: Mizokami
authors: Ichinosuke
authors: I
authors: Hyodo
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery