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Clin Gastroenterol Hepatol. 2018 Nov 21. pii: S1542-3565(18)31274-6. doi: 10.1016/j.cgh.2018.11.031. [Epub ahead of print]

Low Frequency of Lymph Node Metastases in Patients in the United States With Early-stage Gastric Cancers That Fulfill Japanese Endoscopic Resection Criteria.

Author information

1
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD.
2
Department of Medicine, University of Washington, Seattle, WA.
3
Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA.
4
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL.
5
Department of Medicine, New York University School of Medicine, New York, NY.
6
Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY.
7
Section of Gastroenterology, Fox Chase Cancer Center, Philadelphia, PA.
8
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
9
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
10
Department of Surgery, New York University School of Medicine, New York, NY.
11
Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL.
12
Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA.
13
Department of Surgery, Columbia University Medical Center, New York, NY.
14
Digestive Diseases Center, Cedars-Sinai Medical Center, Los Angeles, CA.
15
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA.
16
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
17
Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA.
18
Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY.
19
Division of Gastroenterology, University of Washington, Seattle, WA.
20
Department of Pathology, University of Washington, Seattle, WA.
21
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD.
22
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
23
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD. Electronic address: sngamru1@jhmi.edu.

Abstract

BACKGROUND & AIMS:

In the West, early gastric cancer is increasingly managed with endoscopic resection (ER). This is, however, based on the assumption that the low prevalence and risk of lymph node metastases observed in Asian patients is applicable to patients in the United States. We sought to evaluate the frequency of and factors associated with metastasis of early gastric cancers to lymph nodes, and whether the Japanese ER criteria are applicable to patients in the US.

METHODS:

We performed a retrospective study of 176 patients (mean age 68.5 years; 59.1% male; 58.5% Caucasian) who underwent surgical resection with lymph node dissection of T1 and Tis gastric adenocarcinomas, staged by pathologists, at 7 tertiary care centers in the US from January 1, 1999 through December 31, 2016. The frequency of lymph node metastases and associated risk factors were determined.

RESULTS:

The mean size of gastric adenocarcinomas was 23.0±16.6 mm-most were located in the lower-third of the stomach (67.0%), invading the submucosa (55.1%), and moderately differentiated (31.3%). Lymphovascular invasion was observed in 18.2% of lesions. Overall, 20.5% of patients had lymph node metastases. Submucosal invasion (odds ratio, 3.9; 95% CI 1.4-10.7) and lymphovascular invasion (odds ratio, 4.6; 95% CI, 1.8-12.0) were independently associated with increased risk of metastasis to lymph nodes. The frequency of lymph node metastases among patients fulfilling standard and expanded Japanese criteria for ER were 0 and 7.5%, respectively.

CONCLUSION:

The frequency of lymph node metastases among patients with early gastric cancer in a US population is higher than that of published Asian series. However, early gastric cancer lesions that meet the Japanese standard criteria for ER are associated with negligible risk of metastasis to lymph nodes, so ER can be recommended for definitive therapy. Expanded criteria cancers appear to have a higher risk of metastasis to lymph nodes, so ER may be considered for select cases.

KEYWORDS:

endoscopic submucosal dissection; lymphovascular invasion; non-gastroesophageal junction early gastric cancer; submucosal invasion

PMID:
30471457
DOI:
10.1016/j.cgh.2018.11.031

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