title: Expanded endoscopic therapy criteria should be cautiously used in intramucosal gastric cancer.
abstract: OBJECTIVE
  Accurate estimation of lymph node metastasis (LNM) in intramucosal gastric cancer is essential to select less invasive treatment options and even avoid surgery. The aim of this study was to evaluate combined clinicopathological features to predict the presence of LNM.
  
  
  METHODS
  A retrospective review of data from 386 intramucosal gastric cancer patients who underwent gastrectomy with extended lymphadenectomy from 2003 to 2010 was conducted. The mutual relation between clinicopathological characteristics and LNM was analyzed.
  
  
  RESULTS
  LNM was detected in 40 (10.4%) of the 386 patients. Histological type and vascular or lymphatic invasion presence showed a positive correlation with LNM occurrence by univariate analysis. Multivariate analysis revealed that histological type was the only factor associated with LNM. Combined clinicopathologic characteristics would be more predictable for LNM. We found no LNM when we used combined clinicopathological characteristics conforming to Japanese absolute indications for endoscopic therapy. The LNM rate was as high as 8.7% when Japanese expanded criteria were used. Univariate analysis in cancer conformity to expand endoscopic submucosal dissection (ESD) indication also revealed that the undifferential type was the only significant factor for LNM.
  
  
  CONCLUSIONS
  It was possible to predict intramucosal gastric cancer cases without LNM using combined clinicopathological characteristic analysis. Extended indication for ESD should be cautiously used for intramucosal gastric cancer patients.
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Hongshan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Xuefei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Fenglin
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Kuntang
authors.initials: K
authors.lastname: Shen
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Qin
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Zhenbin
authors.initials: Z
authors.lastname: Shen
authors.affiliation: Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China.
authors.forename: Yihong
authors.initials: Y
authors.lastname: Sun
keywords: Lymph node metastasis; early gastric cancer; endoscopic therapy; intramucosal cancer