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Abstract
Background/AimThe current indication for endoscopic resection in early gastric cancer (EGC) with minute (< 500 µm) submucosal invasion is based on tumor diameter, which may be insufficient to predict lymph node metastasis (LNM). We investigated whether tumor volume might more accurately predict LNM in EGC with minute submucosal invasion.Materials and MethodsAmong patients who underwent gastrectomy for gastric cancer, 346 with well/moderately differentiated EGC with submucosal invasion <500 µm were evaluated. Three-dimensional tumor volume was calculated using an endoscopically resected specimen and compared with 1-dimensional tumor diameter. Predictive ability of tumor diameter or volume for LNM was evaluated using receiver operating characteristic curve analysis.ResultsTumor diameter and volume predicted LNM with an area under the curve (AUC) of 0.567 and 0.589, respectively. AUC, sensitivity, specificity, positive and negative predictive values, and accuracy of the 2 models were not significantly different. Tumor diameter ≥ 3 cm showed a significant association with LNM (odds ratio [OR], 2.57; 95% confidence interval [CI], 1.01–6.57; P = 0.049), whereas a tumor volume cutoff value of 752.8 cm3 showed no significant association with LNM (OR, 1.52; 95% CI, 0.59–3.88; P = 0.385).ConclusionsTumor volume had no advantage over diameter for predicting LNM in well/moderately differentiated EGC with minute submucosal invasion.
Highlights
Endoscopic resection is considered to be the optimal treatment in select patients with early gastric cancer (EGC) [1, 2]
Background/Aim: The current indication for endoscopic resection in early gastric cancer (EGC) with minute (< 500 μm) submucosal invasion is based on tumor diameter, which may be insufficient to predict lymph node metastasis (LNM)
We investigated whether tumor volume might more accurately predict LNM in EGC with minute submucosal invasion
Summary
Endoscopic resection is considered to be the optimal treatment in select patients with early gastric cancer (EGC) [1, 2]. The criteria for patient selection are based on the Japanese treatment guideline [3]. Patients with gastric cancer with submucosal invasion have considerably high incidence of LNM (10%–20%) [4, 5], and as such, have been excluded from endoscopic resection. Gotoda [4] proposed an expanded indication for endoscopic submucosal dissection (ESD). Recent studies have reported high incidence of LNM in tumors satisfying these criteria, and the validity of the expanded indication remains controversial [6, 7]
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