Abstract
Background and AimEndoscopic submucosal dissection (ESD) for undifferentiated type early gastric cancer is regarded as an investigational treatment. Few studies have tried to identify the risk factors that predict lymph-node metastasis (LNM) in intramucosal poorly differentiated adenocarcinomas (PDC). This study was designed to develop a risk scoring system (RSS) for predicting LNM in intramucosal PDC.MethodsFrom January 2002 to July 2015, patients diagnosed with mucosa-confined PDC, among those who underwent curative gastrectomy with lymph node dissection were reviewed. A risk model based on independent predicting factors of LNM was developed, and its performance was internally validated using a split sample approach.ResultsOverall, LNM was observed in 5.2% (61) of 1169 patients. Four risk factors [Female sex, tumor size ≥ 3.2 cm, muscularis mucosa (M3) invasion, and lymphatic-vascular involvement] were significantly associated with LNM, which were incorporated into the RSS. The area under the receiver operating characteristic curve for predicting LNM after internal validation was 0.69 [95% confidence interval (CI), 0.59–0.79]. A total score of 2 points corresponded to the optimal RSS threshold with a discrimination of 0.75 (95% CI 0.69–0.81). The LNM rates were 1.6% for low risk (<2 points) and 8.9% for high-risk (≥2 points) patients, with a negative predictive value of 98.6% (95% CI 0.98–1.00).ConclusionsA RSS could be useful in clinical practice to determine which patients with intramucosal PDC have low risk of LNM.
Highlights
Endoscopic resection for early gastric cancer (EGC) is one of the most advanced and representative techniques in the field of therapeutic endoscopy and is increasingly used worldwide [1,2]
Four risk factors [Female sex, tumor size 3.2 cm, muscularis mucosa (M3) invasion, and lymphatic-vascular involvement] were significantly associated with lymph node metastasis (LNM), which were incorporated into the risk scoring system (RSS)
A total score of 2 points corresponded to the optimal RSS threshold with a discrimination of 0.75
Summary
Endoscopic resection for early gastric cancer (EGC) is one of the most advanced and representative techniques in the field of therapeutic endoscopy and is increasingly used worldwide [1,2]. We previously developed an LNM risk-prediction model for signet ring cell-type intramucosal gastric cancer [18]. Even among undifferentiatedtype EGCs, poorly differentiated EGC has clinicopathological features that are less amenable to endoscopic treatment than are those of signet ring cell EGC [13]. These two types of EGCs should be managed separately when planning endoscopic treatment, and not as a single type of tumor with undifferentiated histology. Endoscopic submucosal dissection (ESD) for undifferentiated type early gastric cancer is regarded as an investigational treatment. Few studies have tried to identify the risk factors that predict lymph-node metastasis (LNM) in intramucosal poorly differentiated adenocarcinomas (PDC). This study was designed to develop a risk scoring system (RSS) for predicting LNM in intramucosal PDC
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