Hierarchical Analysis of Factors Associated with T Staging of Gastric Cancer by Endoscopic Ultrasound.

Abstract

Size, ulcer, differentiation, and location are known to be factors affecting the T stage accuracy of EUS in gastric cancer. However, whether an interaction exists among recognized variables is poorly understood. The aim of this study was to identify the combinatorial characteristics of group with high overestimation rate to determine which group should be considered carefully for EUS-based treatment plans. We retrospectively analyzed early gastric cancer patients who underwent EUS from 2005 to 2016. The accuracy of EUS T stage and factors affecting over-/underestimation were examined by using decision tree analysis, the CHAID method. The most significant factor affecting the accuracy of the EUS T stage was the size. The rate of overestimation was higher in lesions > 3cm (37.2% vs. 28.8% vs. 17.1%, p < 0.001). In lesions > 3cm, the rate of overestimation was higher in lesions with an ulcer (62.1% vs. 35.0%, p < 0.001). Moreover, for lesions ≤ 3cm, the accuracy of the EUS T stage was more affected by differentiation and location. The rate of overestimation was higher in undifferentiated-type lesions ≤ 2cm (24.5% vs. 13.9%, p < 0.001) and 2-3cm (33.3% vs. 25.7%, p = 0.011). In the differentiated type, the location affected the accuracy of the EUS T stage. In this hierarchical analysis, the rate of overestimation was higher in lesions > 3cm with ulcer, lesions > 3cm irrespective of ulcer, and undifferentiated-type lesions measuring 2-3cm.