title: Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection.
abstract: The long-term outcomes after non-curative gastric endoscopic submucosal dissection (ESD) are still unknown. We aimed to clarify the pathological risk factors for lymph node metastasis (LNM) of early gastric cancer (EGC) and the long-term outcomes among patients who were judged to have had non-curative ESD.
  
  
  
  From September 2002 to December 2012, 506 patients who were judged to have had non-curative gastric ESD were enrolled and classified into two groups: (1) those who subsequently underwent additional surgical resection (surgical group, n = 323) and (2) those followed up without additional surgical resection (nonsurgical group, n = 183). We analyzed pathological risk factors for LNM of EGC in the surgical group. Additionally, we compared long-term outcomes in the two groups.
  
  
  
  LNM was found pathologically in 9.3 % of the surgical group (30/323) at the additional surgical resection after non-curative ESD. In the multivariate logistic regression analysis, lymphovascular invasion (LVI) was an independent risk factor for LNM in the surgical group (odds ratio 8.57, 95 % confidence interval 2.76-38.14, P < 0.0001). The 5-year cause-specific survival rate was similar in the surgical and nonsurgical groups (98.7 and 96.5 %, respectively; log-rank test, P = 0.07). In contrast, the 5-year cause-specific survival rate of patients with LVI in the surgical group was better than that in the nonsurgical group (98.2 and 79.1 %, respectively; log-rank test, P < 0.0001).
  
  
  
  A detailed assessment of LVI is essential to the pathological evaluation of endoscopically resected specimens. An additional surgical resection should be strongly recommended for patients with LVI.
authors: Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan.
authors: Noboru
authors: N
authors: Kawata
authors: Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan. n.kakushima@scchr.jp.
authors: Naomi
authors: N
authors: Kakushima
authors: Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan.
authors: Kohei
authors: K
authors: Takizawa
authors: Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan.
authors: Masaki
authors: M
authors: Tanaka
authors: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Rie
authors: R
authors: Makuuchi
authors: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Masanori
authors: M
authors: Tokunaga
authors: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Yutaka
authors: Y
authors: Tanizawa
authors: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Etsuro
authors: E
authors: Bando
authors: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Taiichi
authors: T
authors: Kawamura
authors: Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Takashi
authors: T
authors: Sugino
authors: Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Kimihide
authors: K
authors: Kusafuka
authors: Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Tadakazu
authors: T
authors: Shimoda
authors: Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Takashi
authors: T
authors: Nakajima
authors: Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Masanori
authors: M
authors: Terashima
authors: Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan.
authors: Hiroyuki
authors: H
authors: Ono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Early gastric cancer; Endoscopic submucosal dissection; Long-term outcomes; Non-curative resection; Risk factors for lymph node metastasis