Abstract
BackgroundThe presence of ulcer in early gastric cancer (EGC) is important for the feasibility of endoscopic resection, only a few studies have examined the clinicopathological implications of endoscopic ulcer in EGC.ObjectivesTo determine the role of endoscopic ulcer as a predictor of clinical behaviors in EGC.MethodsData of 3,270 patients with EGC who underwent surgery between January 2005 and December 2012 were reviewed. Clinicopathological characteristics were analyzed in relation to the presence and stage of ulcer in EGC. Based on endoscopic findings, the stage of ulcer was categorized as active, healing, or scar. Logistic regression analysis was performed to analyze factors associated with lymph node metastasis (LNM).Results2,343 (71.7%) patients had endoscopic findings of ulceration in EGC. Submucosal (SM) invasion, LNM, lymphovascular invasion (LVI), perineural invasion, and undifferentiated-type histology were significantly higher in ulcerative than non-ulcerative EGC. Comparison across different stages of ulcer revealed that SM invasion, LNM, and LVI were significantly associated with the active stage, and that these features exhibited significant stage-based differences, being most common at the active stage, and least common at the scar stage. The presence of endoscopic ulcer and active status of the ulcer were identified as independent risk factors for LNM.ConclusionsUlcerative EGC detected by endoscopy exhibited more aggressive behaviors than non-ulcerative EGC. Additionally, the endoscopic stage of ulcer may predict the clinicopathological behaviors of EGC. Therefore, the appearance of ulcers should be carefully evaluated to determine an adequate treatment strategy for EGC.
Highlights
Endoscopic resection (ER) has become a standard treatment for patients with early gastric cancer (EGC) without risk of lymph node metastasis (LNM)
Ulcerative EGC detected by endoscopy exhibited more aggressive behaviors than nonulcerative EGC
The endoscopic stage of ulcer may predict the clinicopathological behaviors of EGC
Summary
Endoscopic resection (ER) has become a standard treatment for patients with early gastric cancer (EGC) without risk of lymph node metastasis (LNM). It has the advantages of being less invasive and more effective than surgery [1, 2]. Studies have suggested that select patients with EGC can be considered candidates for ER with a low risk of LNM [4, 5]. The presence of ulcer in early gastric cancer (EGC) is important for the feasibility of endoscopic resection, only a few studies have examined the clinicopathological implications of endoscopic ulcer in EGC
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