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1
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Song K, Wu J, Xu M, Li M, Chen Y, Zhang Y, Chen H, Jiang C. An ensemble learning model to predict lymph node metastasis in early gastric cancer. Sci Rep 2025; 15:11257. [PMID: 40175493 PMCID: PMC11965319 DOI: 10.1038/s41598-025-95794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/24/2025] [Indexed: 04/04/2025] Open
Abstract
Lymph node metastasis is a critical factor for determining therapeutic strategies and assessing the prognosis of early gastric cancer. This work aimed to establish a more dependable predictive model for identify lymph node metastasis in early gastric cancer. The study utilized both univariate and multivariate logistic regression analyses to identify independent risk factors for lymph node metastasis of early gastric cancer, while employing five distinct algorithms to calculate feature weights. The optimal feature combination for each algorithm model was determined by combining the six highest weight features from all five models along with the independent risk factors. An ensemble learning model was subsequently constructed by integrating these five models. The model's performance was evaluated by the AUC, accuracy, and F1 score. Following this, a threshold was determined based on the F1 score, and the model's performance was assessed using an external validation set. The lymph node metastasis rate of early gastric cancer in our study was 16.4%. The ensemble learning model achieved an AUC value of 0.860 in the test set, with an accuracy of 82.35% and an F1 score of 0.611. Based on the F1 score, the model's threshold was set at 0.18. Additionally, the model demonstrated an AUC of 0.892 in the external validation set, along with an accuracy of 78.30% and an F1 score of 0.60.We constructed an ensemble learning model for predicting lymph node metastasis of early gastric cancer. Gastric surgery should be considered as the preferred treatment when the risk of lymph node metastasis exceeds 18%.
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Affiliation(s)
- Kaiqing Song
- Department of Gastroenterology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaming Wu
- Department of Gastroenterology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Muchen Xu
- Department of Radiotherapy, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
- Department of Radiotherapy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Mengying Li
- Department of Gastroenterology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuqi Chen
- Department of Gastroenterology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Zhang
- Department of General Surgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Chen
- Department of General Surgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.
| | - Caifeng Jiang
- Department of Gastroenterology, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.
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Lee H. Management Strategy of Non-curative ESD in Gastric Cancer: Curative Criteria, and the Critical Building Block for Determining Beyond It. J Gastric Cancer 2025; 25:210-227. [PMID: 39822176 PMCID: PMC11739647 DOI: 10.5230/jgc.2025.25.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Revised: 12/07/2024] [Accepted: 12/07/2024] [Indexed: 01/19/2025] Open
Abstract
Endoscopic submucosal dissection is performed in cases of early gastric cancer, where the risk of lymph node metastasis (LNM) is expected to be negligible, and 12%-21% of these patients are deemed to have undergone non-curative resections based on pathological criteria. In such cases, decisions regarding additional treatments must be made to maximize curability, depending on the anticipated LNM risk. Well-established risk factors for LNM include lymphatic invasion, vascular invasion, deep submucosal invasion, positive vertical margins, and larger tumor size. When pathological factors associated with a clear LNM risk, such as lymphatic or deep submucosal invasion, are present, additional gastrectomy with lymph node dissection should be considered. Conversely, in cases involving only a positive horizontal margin, additional endoscopic treatment may be an effective therapeutic option as opposed to gastrectomy because of the negligible risk of LNM despite the potential risk of residual tumors. Endoscopic resection is particularly advantageous for determining complete resection. In addition to pathological curability, patient-specific factors, such as age and comorbidities, must be considered. Several retrospective cohort studies have shown that the cause of mortality among patients placed only on observation without additional treatment after non-curative resection is generally related to underlying conditions irrelevant to gastric cancer. Thus, it is crucial to assess both GC-specific mortality and all-cause mortality to finalize treatment decisions that help minimize such mortality. Therefore, new treatment algorithms that integrate pathological curability with patient-specific factors must be developed.
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Affiliation(s)
- Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Liu QH, Zhang JW, Xia L, Wise SG, Hambly BD, Tao K, Bao SS. Clinical implications of interleukins-31, 32, and 33 in gastric cancer. World J Gastrointest Oncol 2022; 14:1808-1822. [PMID: 36187404 PMCID: PMC9516641 DOI: 10.4251/wjgo.v14.i9.1808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/21/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is one of the most common malignancies in China with a high morbidity and mortality. AIM To determine whether interleukin (IL)-31, IL-32, and IL-33 can be used as biomarkers for the detection of GC, via evaluating the correlations between their expression and clinicopathological parameters of GC patients. METHODS Tissue array (n = 180) gastric specimens were utilised. IL-31, IL-32, and IL-33 expression in GC and non-GC tissues was detected immunohistochemically. The correlations between IL-31, IL-32, and IL-33 expression in GC and severity of clinicopathological parameters were evaluated. Survival curves were plotted using the Kaplan-Meier method/Cox regression. Circulating IL-31, IL-32, and IL-33 were detected by ELISA. RESULTS We found that the expression levels of IL-31, IL-32, and IL-33 were all lower in GC than in adjacent non-GC gastric tissues (P < 0.05). IL-33 in peripheral blood of GC patients was significantly lower than that of healthy individuals (1.50 ± 1.11 vs 9.61 ± 8.00 ng/mL, P <0.05). Decreased IL-31, IL-32, and IL-33 in GC were observed in younger patients (< 60 years), and IL-32 and IL-33 were lower in female patients (P < 0.05). Higher IL-32 correlated with a longer survival in two GC subgroups: T4 invasion depth and TNM I-II stage. Univariate/multivariate analysis revealed that IL-32 was an independent prognostic factor for GC in the T4 stage subgroup. Circulating IL-33 was significantly lower in GC patients at TNM stage IV than in healthy people (P < 0.05). CONCLUSION Our findings may provide new insights into the roles of IL-31, IL-32, and IL-33 in the carcinogenesis of GC and demonstrate their relative usefulness as prognostic markers for GC. The underlying mechanism of IL-31, IL-32, and IL-33 actions in GC should be further explored.
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Affiliation(s)
- Qing-Hua Liu
- Department of Pathology, Xuzhou Medical University, Xuzhou 221004, Jiangsu Province, China
| | - Ji-Wei Zhang
- Department of Surgery, The Central Hospital of Songjiang District, Shanghai Jiaotong University, Shanghai 201699, Shanghai, China
| | - Lei Xia
- Department of Pathology, Xuzhou Medical University, Xuzhou 221004, Jiangsu Province, China
| | - Steven G Wise
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney 2006, NSW, Australia
| | | | - Kun Tao
- Department of Pathology,Tongren Hospital, Shanghai 200336, China
| | - Shi-San Bao
- Department of Pathology,Tongren Hospital, Shanghai 200336, China
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4
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Hayashi T, Yoshikawa T, Ishizu K, Tsutsui M, Wada T, Yamagata Y, Katai H. Suprapancreatic nodal dissection should not be uniformly selected in additional gastrectomy for the patients who diagnosed as pT1b gastric cancer by endoscopic resection. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1785-1789. [DOI: 10.1016/j.ejso.2022.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/09/2022] [Accepted: 01/30/2022] [Indexed: 02/07/2023]
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Zhou CM, Wang Y, Ye HT, Yan S, Ji M, Liu P, Yang JJ. Machine learning predicts lymph node metastasis of poorly differentiated-type intramucosal gastric cancer. Sci Rep 2021; 11:1300. [PMID: 33446730 PMCID: PMC7809018 DOI: 10.1038/s41598-020-80582-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022] Open
Abstract
To construct a machine learning algorithm model of lymph node metastasis (LNM) in patients with poorly differentiated-type intramucosal gastric cancer. 1169 patients with postoperative gastric cancer were divided into a training group and a test group at a ratio of 7:3. The model for lymph node metastasis was established with python machine learning. The Gbdt algorithm in the machine learning results finds that number of resected nodes, lymphovascular invasion and tumor size are the primary 3 factors that account for the weight of LNM. Effect of the LNM model of PDC gastric cancer patients in the training group: Among the 7 algorithm models, the highest accuracy rate was that of GBDT (0.955); The AUC values for the 7 algorithms were, from high to low, XGB (0.881), RF (0.802), GBDT (0.798), LR (0.778), XGB + LR (0.739), RF + LR (0.691) and GBDT + LR (0.626). Results of the LNM model of PDC gastric cancer patients in test group : Among the 7 algorithmic models, XGB had the highest accuracy rate (0.952); Among the 7 algorithms, the AUC values, from high to low, were GBDT (0.788), RF (0.765), XGB (0.762), LR (0.750), RF + LR (0.678), GBDT + LR (0.650) and XGB + LR (0.619). Single machine learning algorithm can predict LNM in poorly differentiated-type intramucosal gastric cancer, but fusion algorithm can not improve the effect of machine learning in predicting LNM.
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Affiliation(s)
- Cheng-Mao Zhou
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Ying Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hao-Tian Ye
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuping Yan
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Muhuo Ji
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Panmiao Liu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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6
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Liu Q, Zhang Y, Zhang J, Tao K, Hambly BD, Bao S. Inverse correlation between Interleukin-34 and gastric cancer, a potential biomarker for prognosis. Cell Biosci 2020; 10:94. [PMID: 32765828 PMCID: PMC7399616 DOI: 10.1186/s13578-020-00454-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/25/2020] [Indexed: 12/17/2022] Open
Abstract
Background Gastric cancer (GC) is a malignancy with high morbidity/mortality, partly due to a lack of reliable biomarkers for early diagnosis. It is important to develop reliable biomarker(s) with specificity, sensitivity and convenience for early diagnosis. The role of tumour-associated macrophages (TAMs) and survival of GC patients are controversial. Macrophage colony stimulating factor (MCSF) regulates monocytes/macrophages. Elevated MCSF is correlated with invasion, metastasis and poor survival of tumour patients. IL-34, a ligand of the M-CSF receptor, acts as a “twin” to M-CSF, demonstrating overlapping and complimentary actions. IL-34 involvement in tumours is controversial, possibly due to the levels of M-CSF receptors. While the IL-34/M-CSF/M-CSFR axis is very important for regulating macrophage differentiation, the specific interplay between these cytokines, macrophages and tumour development is unclear. Methods A multi-factorial evaluation could provide more objective utility, particularly for either prediction and/or prognosis of gastric cancer. Precision medicine requires molecular diagnosis to determine the specifically mutant function of tumours, and is becoming popular in the treatment of malignancy. Therefore, elucidating specific molecular signalling pathways in specific cancers facilitates the success of a precision medicine approach. Gastric cancer tissue arrays were generated from stomach samples with TNM stage, invasion depth and the demography of these patients (n = 185). Using immunohistochemistry/histopathology, M-CSF, IL-34 and macrophages were determined. Results We found that IL-34 may serve as a predictive biomarker, but not as an independent, prognostic factor in GC; M-CSF inversely correlated with survival of GC in TNM III–IV subtypes. Increased CD68+ TAMs were a good prognostic factor in some cases and could be used as an independent prognostic factor in male T3 stage GC. Conclusion Our data support the potency of IL-34, M-CSF, TAMs and the combination of IL-34/TAMs as novel biological markers for GC, and may provide new insight for both diagnosis and cellular therapy of GC.
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Affiliation(s)
- Qinghua Liu
- Department of Pathology, Xuzhou Medical University, Xuzhou, 221000 China.,Discipline of Pathology, Bosch Institute and School of Medical Sciences, Charles Perkins Center D17, Sydney Medical School, The University of Sydney, Sydney, NSW 2006 Australia
| | - Ying Zhang
- Department of Pathology, Xuzhou Medical University, Xuzhou, 221000 China
| | - Jiwei Zhang
- Department of Surgery, Songjiang Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201600 China
| | - Kun Tao
- Tongren Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200336 China
| | - Brett D Hambly
- Discipline of Pathology, Bosch Institute and School of Medical Sciences, Charles Perkins Center D17, Sydney Medical School, The University of Sydney, Sydney, NSW 2006 Australia.,Tongren Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200336 China
| | - Shisan Bao
- Discipline of Pathology, Bosch Institute and School of Medical Sciences, Charles Perkins Center D17, Sydney Medical School, The University of Sydney, Sydney, NSW 2006 Australia.,Tongren Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200336 China
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7
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Lin JX, Wang ZK, Wang W, Desiderio J, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Zheng CH, Li P, Parisi A, Zhou ZW, Huang CM. Risk factors of lymph node metastasis or lymphovascular invasion for early gastric cancer: a practical and effective predictive model based on international multicenter data. BMC Cancer 2019; 19:1048. [PMID: 31694573 PMCID: PMC6836519 DOI: 10.1186/s12885-019-6147-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/10/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. METHODS EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set. RESULTS In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. CONCLUSIONS The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested.
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Affiliation(s)
- Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zu-Kai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Wei Wang
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jacopo Desiderio
- Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, 05100, Terni, Italy
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Amilcare Parisi
- Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, 05100, Terni, Italy
| | - Zhi-Wei Zhou
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China.
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Kwak DS, Min YW, Lee JH, Kang SH, Jang SH, Lee H, Min BH, Kim JJ, Kim KM, Sohn TS, Kim S. Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort. Gut Liver 2018; 12:263-270. [PMID: 29271182 PMCID: PMC5945257 DOI: 10.5009/gnl17247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/19/2017] [Accepted: 08/18/2017] [Indexed: 12/23/2022] Open
Abstract
Background/Aims Outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC) need to be further evaluated. We aimed to simulate the outcomes of ESD for undifferentiated-type EGC from a surgical database. Methods Among 802 patients who underwent gastrectomy with endoscopic biopsy for poorly differentiated adenocarcinoma (PD-type) or signet ring cell carcinoma (SRC-type), ESD candidates meeting the expanded indication (n=280) were selected by reviewing the endoscopic images. According to the surgical pathologic results, the outcomes of the ESD simulation were evaluated. Results Among the candidates, 104 (37.1%) were PD-type and 176 (62.9%) were SRC-type. The curative resection (CR) rate was 42.1%. Among the patients with CR, three patients (2.5%) showed lymph node metastasis (LNM). Three EGCs with CR and LNM were mucosal cancers ≥1.0 cm in size. The CR rate was higher in the SRC-type than in the PD-type (48.3% vs 31.7%, respectively, p=0.007). In the SRC-type, the CR rate was increased, with a smaller size criterion for the ESD indication, but was similar between the 1.0 cm and 0.6 cm criteria (63.3% and 63.6%, respectively), whereas the CR rate was below 50% in all of the different tumor size criteria (2.0 to 0.6 cm) in the PD-type. Conclusions In undifferentiated-type EGC, ESD should be considered in selected patients with tumor sizes ＜1 cm and SRC histology.
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Affiliation(s)
- Dong Shin Kwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Hoon Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyeon Jang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Zhao X, Cai A, Xi H, Chen L, Peng Z, Li P, Liu N, Cui J, Li H. Predictive Factors for Lymph Node Metastasis in Undifferentiated Early Gastric Cancer: a Systematic Review and Meta-analysis. J Gastrointest Surg 2017; 21:700-711. [PMID: 28120275 DOI: 10.1007/s11605-017-3364-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/04/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Less invasive surgery is gaining popularity for the treatment of early gastric cancer (EGC), but there are no definitive guidelines for the use of less invasive surgery for the treatment of undifferentiated EGC. The aims of this meta-analysis were to identify potential predictive factors for lymph node metastasis (LNM) in undifferentiated EGC and to guide the personalized therapeutic modality for patients with undifferentiated EGC. METHODS An extensive search of the PubMed, Embase, and Cochrane Library databases was performed to identify relevant articles involving undifferentiated EGC and LNM. Eligible data were systematically reviewed through a meta-analysis using Review Manager 5.3. RESULTS In total, 23 studies were included in this analysis. The meta-analysis found that the variables sex (female), age (greater than 60 years), tumor size (greater than 20 mm), depth of invasion (submucosal invasion), presence of lymphovascular involvement, presence of ulcer findings, histology type (non-signet ring carcinoma), and tumor location (not in the middle part of the stomach) were significantly associated with LNM. CONCLUSIONS Eight variables were identified as predictive factors for LNM in undifferentiated EGC. The significance of these variables should be further confirmed during the process of LNM in undifferentiated EGC patients for future clinical application.
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Affiliation(s)
- Xudong Zhao
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Aizhen Cai
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hongqing Xi
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lin Chen
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Zheng Peng
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Peiyu Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Na Liu
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jianxin Cui
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hua Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Surgical Oncology, Affiliated Xing Tai People Hospital of Hebei Medial University, Xingtai, 054001, Hebei Province, China
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10
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Jung HY. Current Status of Endoscopic Resection of Early Gastric Cancer in Korea. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:121-127. [DOI: 10.4166/kjg.2017.70.3.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hwoon-Yong Jung
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Xu L. RE: A Risk Prediction Model of Thyroid Cancer in Euthyroid Asymptomatic Patients: Importance of Model Validation. Korean J Radiol 2016; 17:824-924. [PMID: 27586199 PMCID: PMC5007413 DOI: 10.3348/kjr.2016.17.5.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Li Xu
- Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital & Postdoctoral Mobile Research Station of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510120, China
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