Title |
Risk factors for lymph node metastasis and long-term outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection
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Published in |
Surgical Endoscopy, August 2016
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DOI | 10.1007/s00464-016-5148-7 |
Pubmed ID | |
Authors |
Noboru Kawata, Naomi Kakushima, Kohei Takizawa, Masaki Tanaka, Rie Makuuchi, Masanori Tokunaga, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Takashi Sugino, Kimihide Kusafuka, Tadakazu Shimoda, Takashi Nakajima, Masanori Terashima, Hiroyuki Ono |
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. |
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Unknown | 1 | 100% |
Demographic breakdown
Type | Count | As % |
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Science communicators (journalists, bloggers, editors) | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 32 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Other | 4 | 13% |
Researcher | 4 | 13% |
Student > Postgraduate | 4 | 13% |
Professor > Associate Professor | 2 | 6% |
Student > Doctoral Student | 1 | 3% |
Other | 7 | 22% |
Unknown | 10 | 31% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 18 | 56% |
Agricultural and Biological Sciences | 1 | 3% |
Unspecified | 1 | 3% |
Unknown | 12 | 38% |