Reevaluation of the expanded indications in undifferentiated early gastric cancer for endoscopic submucosal dissection  

作　　者：Jiyoung Yoon Seung-Yeon Yoo Young Soo Park Kee Don Choi Beom Su Kim Moon-Won Yoo In Seob Lee Jeong Hwan Yook Ga Hee Kim Hee Kyong Na Ji Yong Ahn Jeong Hoon Lee Kee Wook Jung Do Hoon Kim Ho June Song Gin Hyug Lee Hwoon-Yong Jung 

机构地区：[1]Department of Gastroenterology,Asan Medical Center,University of Ulsan College of Medicine,Seoul 05505,South Korea [2]Department of Pathology,Asan Medical Center,University of Ulsan College of Medicine,Seoul 05505,South Korea [3]Department of Surgery,Asan Medical Center,University of Ulsan College of Medicine,Seoul 05505,South Korea

出　　处：《World Journal of Gastroenterology》2022年第15期1548-1562,共15页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Although the criteria for the indication of endoscopic submucosal dissection(ESD)for undifferentiated early gastric cancer(UD-EGC)have been recently proposed,accumulating reports on the non-negligible rate of lymph node metastasis(LNM)after indicated ESD raise questions on the reliability of the current criteria.AIM To investigate the prevalence and risk factors of LNM in UD-EGC cases meeting the expanded indication for ESD.METHODS We retrospectively reviewed 4780 UD-EGC cases that underwent surgical resection between January 2008 and February 2019 at Asan Medical Center,a tertiary university hospital in Korea.To identify the risk factors of LNM of UDEGC meeting the expanded criteria for ESD,we performed a case-control study by matching the cases with LNM to those without at a ratio of 1:4.We reviewed the clinical,endoscopic,and histologic features of the cases to identify features with a significant difference according to the presence of LNM.Univariate and multivariate logistic regression analyses were performed to estimate the odds ratios(ORs).RESULTS Of the 4780 UD-EGC cases,1240(25.9%)were identified to meet the expanded indication for ESD.Of the 1240 cases,14(1.1%)cases had LNM.Among the various clinical,endoscopic,and histopathological features that were evaluated,mixed histology(tumors consisting of 10%-90%of signet ring cells)had a marginally significant association(P=0.059)with the risk of LNM.Moreover,diffuse blurring of the muscularis mucosae(MM)underneath the tumorous epithelium,a previously unrecognized histologic feature,had a significant association with the absence of LNM(P=0.028).Multivariate logistic regression analysis showed that the blurring of MM was the only explanatory variable significantly associated with a reduced risk of LNM(OR:0.12,95%CI:0.02-0.95;P=0.045).CONCLUSION The risk of LNM is higher than expected when using the current expanded indication for UDEGC.Histological evaluation could provide useful clues for reducing the risk of LNM.

关 键 词：Gastric cancer Undifferentiated carcinoma Endoscopic submucosal dissection Lymph node metastasis 

分 类 号：R735.2[医药卫生—肿瘤]