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The Implications of Endoscopic Ulcer in Early Gastric Cancer: Can We Predict Clinical Behaviors from Endoscopy?

Authors
 Yoo Jin Lee  ;  Jie-Hyun Kim  ;  Jae Jun Park  ;  Young Hoon Youn  ;  Hyojin Park  ;  Jong Won Kim  ;  Seung Ho Choi  ;  Sung Hoon Noh 
Citation
 PLoS One, Vol.11(10) : e0164339, 2016 
Journal Title
 PLoS One 
Issue Date
2016
MeSH
Adult ; Early Detection of Cancer ; Female ; Gastrectomy ; Gastric Mucosa/pathology ; Gastroscopy ; Humans ; Logistic Models ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Severity of Illness Index ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery ; Ulcer/pathology*
Abstract
BACKGROUND: The presence of ulcer in early gastric cancer (EGC) is important for the feasibility of endoscopic resection, only a few studies have examined the clinicopathological implications of endoscopic ulcer in EGC. OBJECTIVES: To determine the role of endoscopic ulcer as a predictor of clinical behaviors in EGC. METHODS: Data of 3,270 patients with EGC who underwent surgery between January 2005 and December 2012 were reviewed. Clinicopathological characteristics were analyzed in relation to the presence and stage of ulcer in EGC. Based on endoscopic findings, the stage of ulcer was categorized as active, healing, or scar. Logistic regression analysis was performed to analyze factors associated with lymph node metastasis (LNM). RESULTS: 2,343 (71.7%) patients had endoscopic findings of ulceration in EGC. Submucosal (SM) invasion, LNM, lymphovascular invasion (LVI), perineural invasion, and undifferentiated-type histology were significantly higher in ulcerative than non-ulcerative EGC. Comparison across different stages of ulcer revealed that SM invasion, LNM, and LVI were significantly associated with the active stage, and that these features exhibited significant stage-based differences, being most common at the active stage, and least common at the scar stage. The presence of endoscopic ulcer and active status of the ulcer were identified as independent risk factors for LNM. CONCLUSIONS: Ulcerative EGC detected by endoscopy exhibited more aggressive behaviors than non-ulcerative EGC. Additionally, the endoscopic stage of ulcer may predict the clinicopathological behaviors of EGC. Therefore, the appearance of ulcers should be carefully evaluated to determine an adequate treatment strategy for EGC.
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DOI
10.1371/journal.pone.0164339
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김종원(Kim, Jong Won)
김지현(Kim, Jie-Hyun) ORCID logo https://orcid.org/0000-0002-9198-3326
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
박재준(Park, Jae Jun)
박효진(Park, Hyo Jin) ORCID logo https://orcid.org/0000-0003-4814-8330
윤영훈(Youn, Young Hoon) ORCID logo https://orcid.org/0000-0002-0071-229X
최승호(Choi, Seung Ho) ORCID logo https://orcid.org/0000-0002-9872-3594
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152350
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