Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13325-13331
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13325
Feasible endoscopic therapy for early gastric cancer
Tian-Jiao Guo, Jin-Yu Qin, Lin-Lin Zhu, Jin Wang, Jin-Lin Yang, Yi-Ping Wang
Tian-Jiao Guo, Jin-Yu Qin, Lin-Lin Zhu, Jin Wang, Jin-Lin Yang, Yi-Ping Wang, Gastroenterology Department of West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Qin JY, Zhu LL and Wang J collected the data; Guo TJ analyzed and drafted the manuscript; Wang YP provided analytical oversight; Yang JL designed the study and edited the manuscript; all authors have read and approved the final version to be published.
Supported by Science and Technology Department of Sichuan Provincefor Scientific Rearch, No. 2015SZ0123.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of West China Hospital of Sichuan University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jin-Lin Yang, MD, Gastroenterology Department of West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan Province, China.
Telephone: +86-28-85423387 Fax: +86-28-85423387
Received: May 14, 2015
Peer-review started: May 15, 2015
First decision: July 10, 2015
Revised: July 28, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 21, 2015

AIM: To analyze the relationship between lymph node metastasis and clinical pathology of early gastric cancer (EGC) in order to provide criteria for a feasible endoscopic therapy.

METHODS: Clinical data of the 525 EGC patients who underwent surgical operations between January 2009 and March 2014 in the West China Hospital of Sichuan University were analyzed retrospectively. Clinical pathological features were compared between different EGC patients with or without lymph node metastasis, and investigated by univariate and multivariate analyses for possible relationships with lymph node metastasis.

RESULTS: Of the 2913 patients who underwent gastrectomy with lymph node dissection, 529 cases were pathologically proven to be EGC and 525 cases were enrolled in this study, excluding 4 cases of gastric stump carcinoma. Among 233 patients with mucosal carcinoma, 43 (18.5%) had lymph node metastasis. Among 292 patients with submucosal carcinoma, 118 (40.4%) had lymph nodemetastasis. Univariate analysis showed that gender, tumor size, invasion depth, differentiation type and lymphatic involvement correlated with a high risk of lymph node metastasis. Multivariate analysis revealed that gender (OR = 1.649, 95%CI: 1.091-2.492, P = 0.018), tumor size (OR = 1.803, 95%CI: 1.201-2.706, P = 0.004), invasion depth (OR = 2.566, 95%CI: 1.671-3.941, P = 0.000), histological differentiation (OR = 2.621, 95%CI: 1.624-4.230, P = 0.000) and lymphatic involvement (OR = 3.505, 95%CI: 1.590-7.725, P = 0.002) were independent risk factors for lymph node metastasis. Comprehensive analysis showed that lymph node metastasis was absent in patients with tumor that was limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.

CONCLUSION: We propose an endoscopic therapy for EGC that is limited to the mucosa, size ≤ 2 cm, differentiated and without lymphatic involvement.

Keywords: Early gastric cancer, Clinical pathological features, Risk factor, Endoscopic therapy, Lymph node metastasis

Core tip: Early gastric cancer (EGC) is defined as invasive gastric cancer that invades no more deeply than the submucosa, irrespective of lymph node metastasis. Gastrectomy/endoscopic resection can be used for the treatment of patients meeting appropriate criteria. In this study, we retrospectively evaluated the relationship between lymph node metastasis and clinical pathological features of 525 EGC cases. Univariate and multivariate analyses were applied to confirm the risk factors for lymph node metastasis, and to establish indications for a feasible individualized endoscopic therapy for EGC.