title: Feasibility study on expanded indication for endoscopic submucosal dissection of intramucosal poorly differentiated early gastric cancer.
abstract: OBJECTIVE
  To identify clinicopathological factors predictive of lymph node metastasis (LNM) in intramucosal poorly differentiated early gastric cancer (EGC), and further to expand the possibility of using endoscopic submucosal dissection (ESD) for the treatment of intramucosal poorly differentiated EGC.
  
  
  METHODS
  Data for 81 surgically treated patients with intramucosal poorly differentiated EGC were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Several clinicopathologic factors were investigated to identify predictive factors for lymph nodes metastasis, including gender, age, family history of gastric cancer, number of tumors, tumor location, ulceration, tumor size, macroscopic type, lymphatic vessel involvement, and signet-ring-cell component.
  
  
  RESULTS
  Tumor size (OR = 7.273, 95%CI: 1.246-29.918, P = 0.042), lymphatic vessel involvement (OR = 42.219, 95%CI: 1.923-97.052, P = 0.018) and signet-ring-cell component (OR = 17.513, 95%CI: 1.647-77.469, P = 0.034) that were significantly associated with LNM by univariate analysis, were found to be significant and independent risk factors for LNM by multivariate analysis. However, gender, age, family history of gastric cancer, number, location, ulceration and macroscopic type of tumor were found not to be associated with LNM. Of these 81 patients diagnosed with intramucosal poorly differentiated EGC, 7 (8.6%) had LNM. The LNM rates were 9.1%, 22.2% and 57.1%, respectively, in cases with one, two and three of the risk factors. There was no LNM in 54 patients without the three risk clinicopathological factors.
  
  
  CONCLUSIONS
  Tumor size, lymphatic vessel involvement and signet-ring-cell component are independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Thus, these three risk factors may be used as a simple criterion to expand the possibility of using ESD for the treatment of intramucosal poorly differentiated EGC.
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Zhi-Bin
authors.initials: ZB
authors.lastname: Huo
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Shu-Bo
authors.initials: SB
authors.lastname: Chen
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Dian-Chao
authors.initials: DC
authors.lastname: Wu
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Tong-Shan
authors.initials: TS
authors.lastname: Zhai
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Qi-Hai
authors.initials: QH
authors.lastname: Xiao
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Wang
authors.affiliation: Hua Li, Zhi-Bin Huo, Dian-Chao Wu, Tong-Shan Zhai, Qi-Hai Xiao, Shu-Xia Wang, Li-Li Zhang, Department of Surgical Oncology, Affiliated Xingtai People's Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Clinicopathological characteristics; Early gastric cancer; Endoscopic submucosal dissection; Intramucosal poorly differentiated early gastric cancer; Lymph node metastasis