title: Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 ≥500 µm 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea.
authors.forename: Hyo-Joon
authors.initials: HJ
authors.lastname: Yang
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Joo Hyun
authors.initials: JH
authors.lastname: Lim
authors.forename: Jeongmin
authors.initials: J
authors.lastname: Choi
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Im
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Woo Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*