Feasibility of Endoscopic Resection in Early Gastric Cancer with Lymphovascular Invasion.

Abstract

Lymphovascular invasion (LVI) is associated with the risk of lymph node metastasis (LNM) and poor survival in gastric cancer patients; however, it is unclear whether LVI is a non-curative criteria component in all patients. We evaluated the risk factors of LNM in LVI-positive early gastric cancer (EGC) patients and identified a subgroup with a negligible LNM risk to assess the feasibility of endoscopic resection in these patients. The clinicopathologic and survival data of patients undergoing surgery for gastric cancer were reviewed; LVI-positive EGC patients were selected. Logistic regression analysis was used to test the associations of potential risk factors with LNM, and Kaplan-Meier analysis was used to compare survival curves. LVI was detected in 1243 (15.5%) patients. In the multivariate logistic analysis, larger tumor size (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.16-1.31; p<0.001), presence of ulcer (OR 1.80, 95% CI 1.15-2.82; p=0.010), undifferentiated histology (OR 1.64, 95% CI 1.25-2.16; p<0.001), submucosal invasion (OR 2.28, 95% CI 1.38-3.76; p=0.001), middle (OR 2.12, 95% CI 1.26-3.55; p=0.004) or lower third location (OR 2.28, 95% CI 1.32-3.60; p=0.002), and younger age (OR 0.98, 95% CI 0.97-0.99; p=0.002) independently predicted LNM in LVI-positive EGC patients. LVI-positive patients fulfilling the absolute endoscopic resection criteria did not have LNM and there was no significant difference in the overall (p=0.928) and disease-specific survival (p=0.821) between these patients and those with LVI-negative EGC. Additional surgery after endoscopic resection might be unnecessary in LVI-positive patients meeting the absolute criteria for endoscopic resection.