Risk factors for lymph node metastasis in mucosal gastric cancer and re-evaluation of endoscopic submucosal dissection.
OBJECTIVE
The selection of the appropriate treatment strategy for patients with mucosal gastric cancer (MGC) remains controversial. In the present study, we aimed to determine the risk factors for lymph node (LN) metastasis in MGC and reassess the role of endoscopic submucosal dissection (ESD).


METHODS
We examined 1,191 MGC patients who underwent curative gastrectomy between January 2005 and December 2014. We determined the clinicopathologic risk factors for LN metastasis among the MGC patients.


RESULTS
Among 1,191 patients with MGC, 42 patients (3.5%) had LN metastasis. Univariate analysis indicated that age ≤ 50 years (P = 0.045), tumor invasion to the muscularis mucosa (P < 0.001), tumor size > 2 cm (P = 0.014), presence of ulceration (P = 0.01), diffuse type as per Lauren classification (P = 0.005), and undifferentiated-type histology (P = 0.001) were associated with LN metastasis. Moreover, multivariate analysis indicated that tumor invasion to the muscularis mucosa (P = 0.001; odds ratio [OR], 4.909), presence of ulceration (P = 0.036; OR, 1.982), and undifferentiated-type histology (P = 0.025; OR, 4.233) were independent risk factors for LN metastasis. In particular, LN metastasis was observed in some MGC cases with indications for ESD, including absolute indications (1 of 179, 0.6%) and expanded indications (9 of 493, 1.8%).


CONCLUSIONS
Although MGC patients can be treated via ESD, we recommend that they undergo a more aggressive treatment strategy if they have tumor invasion to the muscularis mucosa, ulceration, or undifferentiated-type histology in the final pathology report.
Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Si-Hak
SH
Lee
Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
Cheol Woong
CW
Choi
Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
Su Jin
SJ
Kim
Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea.
Chang In
CI
Choi
Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea.
Dae-Hwan
DH
Kim
Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea.
Tae-Yong
TY
Jeon
Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea.
Dong-Heon
DH
Kim
Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Hyun Jung
HJ
Lee
Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
Ki-Hyun
KH
Kim
Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Sun-Hwi
SH
Hwang
Lymph nodes; Neoplasm metastasis; Risk factors; Stomach neoplasms