Skip to main content
Top

25-04-2024 | Gastric Cancer | Original Article

Identification of maximal tumor size associated with negligible lymph node metastasis for endoscopic submucosal dissection of undifferentiated-type early gastric cancer

Authors: Sung Eun Oh, Soomin Ahn, Kyoung-Mee Kim, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Ji Yeong An

Published in: Gastric Cancer

Login to get access

Abstract

Background and aims

When treating undifferentiated-type early gastric cancer (UD-EGC) that is limited to the mucosa (clinically T1a), endoscopic submucosal dissection (ESD) can be considered if the tumor is 2 cm or less and is not ulcerated. However, there is insufficient evidence to determine the relationships between tumor size and oncological safety of ESD in UD-EGC.

Methods

The pathology reports of Korean patients who were diagnosed with UD-EGC (n = 5286) were retrospectively reviewed. The cumulative incidence of lymph node metastasis (LNM) according to tumor size was evaluated in subgroups. The tumor-size cut-off was identified as the upper limit of the 95% confidence interval (CI) of cumulative LNM incidence that did not exceed 1.0%.

Results

We identified 1516 patients with non-ulcerated T1a tumors ≤2 cm in size. Among patients without lymphatic invasion, 1.5% (95% CI 0.912.16%) had LNM. In patients with poorly differentiated tubular adenocarcinoma (PD), LNM increased from 0 to 0.74% based on a tumor size of 1.0 cm. Regardless of tumor size, smaller percentages of undifferentiated-type (UD) and poorly cohesive carcinoma (PCC) patients experienced LNM than did those with PD. In non-ulcerated mucosal cancer without lymphatic invasion and tumor size ≤0.9 cm, no LNM was observed in patients with UD (95% CI 00.53%), PCC (95% CI 00.59%), or PD (95% CI 00.86%) histologic type.

Conclusion

In patients diagnosed with non-ulcerated T1a UD-EGC, ESD can be performed if the tumor size is 0.9 cm or less, regardless of histologic type.
Appendix
Available only for authorised users
Literature
1.
go back to reference Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1:505–27. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1:505–27.
2.
go back to reference Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev. 2014;23:700–13.CrossRefPubMedPubMedCentral Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev. 2014;23:700–13.CrossRefPubMedPubMedCentral
3.
go back to reference Kim YG, Kong SH, Oh SY, Lee KG, Suh YS, Yang JY, et al. Effects of screening on gastric cancer management: comparative analysis of the results in 2006 and in 2011. J Gastric Cancer. 2014;14:129–34.CrossRefPubMedPubMedCentral Kim YG, Kong SH, Oh SY, Lee KG, Suh YS, Yang JY, et al. Effects of screening on gastric cancer management: comparative analysis of the results in 2006 and in 2011. J Gastric Cancer. 2014;14:129–34.CrossRefPubMedPubMedCentral
4.
go back to reference Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.
5.
go back to reference Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/ endoscopic submucosal dissection) for early gastric cancer. Dig Endosc. 2013;25(Suppl 1):55–63.CrossRefPubMed Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/ endoscopic submucosal dissection) for early gastric cancer. Dig Endosc. 2013;25(Suppl 1):55–63.CrossRefPubMed
6.
go back to reference Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2021, 6th ed. Gastric Cancer. 2023;26:1–25. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2021, 6th ed. Gastric Cancer. 2023;26:1–25.
7.
go back to reference Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009;12:148–52.CrossRefPubMed Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009;12:148–52.CrossRefPubMed
8.
go back to reference Oh SY, Lee KG, Suh YS, Kim MA, Kong SH, Lee HJ, et al. Lymph node metastasis in mucosal gastric cancer: reappraisal of expanded indication of endoscopic submucosal dissection. Ann Surg. 2017;265:137–42.CrossRefPubMed Oh SY, Lee KG, Suh YS, Kim MA, Kong SH, Lee HJ, et al. Lymph node metastasis in mucosal gastric cancer: reappraisal of expanded indication of endoscopic submucosal dissection. Ann Surg. 2017;265:137–42.CrossRefPubMed
9.
go back to reference Chung JW, Jung HY, Choi KD, Song HJ, Lee GH, Jang SJ, et al. Extended indication of endoscopic resection for mucosal early gastric cancer: analysis of a single center experience. J Gastroenterol Hepatol. 2011;26:884–7.CrossRefPubMed Chung JW, Jung HY, Choi KD, Song HJ, Lee GH, Jang SJ, et al. Extended indication of endoscopic resection for mucosal early gastric cancer: analysis of a single center experience. J Gastroenterol Hepatol. 2011;26:884–7.CrossRefPubMed
10.
go back to reference Zhao X, Cai A, Xi H, Chen L, Peng Z, Li P, et al. Predictive factors for lymph node metastasis in undifferentiated early gastric cancer: a systematic review and meta-analysis. J Gastrointest Surg. 2017;21:700–11.CrossRefPubMed Zhao X, Cai A, Xi H, Chen L, Peng Z, Li P, et al. Predictive factors for lymph node metastasis in undifferentiated early gastric cancer: a systematic review and meta-analysis. J Gastrointest Surg. 2017;21:700–11.CrossRefPubMed
11.
go back to reference WHO Classification of Tumours Editorial Board. WHO Classification of tumours: digestive system tumours. 5th ed. Lyon: IARC Press; 2019. WHO Classification of Tumours Editorial Board. WHO Classification of tumours: digestive system tumours. 5th ed. Lyon: IARC Press; 2019.
12.
go back to reference Guideline Committee of the Korean Gastric Cancer Association, Development Working Group, Panel R. Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer. 2019;19:1–48. Guideline Committee of the Korean Gastric Cancer Association, Development Working Group, Panel R. Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer. 2019;19:1–48.
13.
go back to reference Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, et al. Clinical practice guideline for endoscopic resection of early gastrointestinal cancer. Korean J Gastroenterol. 2020;75:264–91. Park CH, Yang DH, Kim JW, Kim JH, Kim JH, Min YW, et al. Clinical practice guideline for endoscopic resection of early gastrointestinal cancer. Korean J Gastroenterol. 2020;75:264–91.
14.
go back to reference Information Committee of the Korean Gastric Cancer Association. Korean gastric cancer association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer. 2021;21:221–35.CrossRef Information Committee of the Korean Gastric Cancer Association. Korean gastric cancer association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer. 2021;21:221–35.CrossRef
15.
go back to reference Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228–35.CrossRefPubMed Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228–35.CrossRefPubMed
16.
go back to reference Kim SG, Lyu DH, Park CM, Lee NR, Kim J, Cha Y, et al. Current status of endoscopic submucosal dissection for early gastric cancer in Korea: role and benefits. Korean J Intern Med. 2019;34:785–93.CrossRefPubMed Kim SG, Lyu DH, Park CM, Lee NR, Kim J, Cha Y, et al. Current status of endoscopic submucosal dissection for early gastric cancer in Korea: role and benefits. Korean J Intern Med. 2019;34:785–93.CrossRefPubMed
17.
go back to reference Lee HJ, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, et al. Morbidity and mortality after laparoscopy-assisted and open distal gastrectomy for stage I gastric cancer: results from a multicenter randomized controlled trial (KLASS-01). J Clin Oncol. 2015;33(3 Suppl):4. Lee HJ, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, et al. Morbidity and mortality after laparoscopy-assisted and open distal gastrectomy for stage I gastric cancer: results from a multicenter randomized controlled trial (KLASS-01). J Clin Oncol. 2015;33(3 Suppl):4.
18.
go back to reference Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ, et al. A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer. 2019;22:214–22.CrossRefPubMed Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ, et al. A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer. 2019;22:214–22.CrossRefPubMed
19.
go back to reference Lee J, Kim BW, Huh CW, Kim JS, Maeng LS. Endoscopic factors that can predict histological ulcerations in early gastric cancers. Clin Endosc. 2020;53:328–33.CrossRefPubMedPubMedCentral Lee J, Kim BW, Huh CW, Kim JS, Maeng LS. Endoscopic factors that can predict histological ulcerations in early gastric cancers. Clin Endosc. 2020;53:328–33.CrossRefPubMedPubMedCentral
20.
go back to reference Lee HL. Identification of ulceration in early gastric cancer before resection is not easy: need for a new guideline for endoscopic submucosal dissection indication based on endoscopic image. Clin Endosc. 2017;50:410–1.CrossRefPubMedPubMedCentral Lee HL. Identification of ulceration in early gastric cancer before resection is not easy: need for a new guideline for endoscopic submucosal dissection indication based on endoscopic image. Clin Endosc. 2017;50:410–1.CrossRefPubMedPubMedCentral
21.
go back to reference Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.CrossRefPubMed Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.CrossRefPubMed
Metadata
Title
Identification of maximal tumor size associated with negligible lymph node metastasis for endoscopic submucosal dissection of undifferentiated-type early gastric cancer
Authors
Sung Eun Oh
Soomin Ahn
Kyoung-Mee Kim
Min-Gew Choi
Jun Ho Lee
Tae Sung Sohn
Jae Moon Bae
Ji Yeong An
Publication date
25-04-2024
Publisher
Springer Nature Singapore
Published in
Gastric Cancer
Print ISSN: 1436-3291
Electronic ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-024-01498-2
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare