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Risk-Stratification Model Based on Lymph Node Metastasis After Noncurative Endoscopic Resection for Early Gastric Cancer

 Da Hyun Jung  ;  Cheal Wung Huh  ;  Jie-Hyun Kim  ;  Jung Hwa Hong  ;  Jun Chul Park  ;  Yong Chan Lee  ;  Young Hoon Youn  ;  Hyojin Park  ;  Seung Ho Choi  ;  Sung Hoon Noh 
 ANNALS OF SURGICAL ONCOLOGY, Vol.24(6) : 1643-1649, 2017 
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Adenocarcinoma/secondary* ; Adenocarcinoma/surgery ; Endoscopy, Digestive System/adverse effects* ; Female ; Follow-Up Studies ; Gastrectomy/adverse effects* ; Humans ; Lymph Node Excision ; Lymph Nodes/pathology* ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Models, Statistical* ; Neoplasm Invasiveness ; Prognosis ; Prospective Studies ; ROC Curve ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery*
BACKGROUND: Patients with early gastric cancer (EGC) who have undergone noncurative endoscopic resection (ER) generally require additional surgery due to the possibility of lymph node metastasis (LNM). This study aimed to develop a reliable risk-stratification system to predict LNM after noncurative ER for EGC. METHODS: A total of 2368 patients had a diagnosis of EGC and underwent ER. The study analyzed 321 patients who underwent additive gastrectomy and lymph node dissection after noncurative ER. Independent risk factors for LNM were identified and used to develop a risk-stratification system to estimate the relative risk of LNM. RESULTS: Of the 321 patients, 23 (7.2%) had LNM. A logistic regression analysis showed that female sex, lymphovascular invasion (LVI), and a positive vertical margin were significantly associated with LNM. The authors established a risk-stratification system using sex, LVI, and positive vertical margin (area under the receiver-operating characteristic [AUROC] curve, 0.811). The high-risk LNM group (score, ≥ 2 points) showed a significantly higher risk of LNM than the low-risk LNM group (score, <2 points) (14.0 vs 1.2%). No LNM was found in patients with a risk score of zero. After internal and external validation, the AUROC curve for predicting LNM was 0.788 and 0.842, respectively. CONCLUSIONS: The risk-stratification system developed in this study will facilitate identification of patients who should undergo LN dissection after noncurative ER. Although additive surgery should be performed after noncurative ER for patients with a high risk of LNM, a close follow-up visit could be considered for low-risk patients with multiple comorbidities or high operative risks.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Jung, Da Hyun(정다현) ORCID logo https://orcid.org/0000-0001-6668-3113
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0002-9872-3594
Huh, Cheal Wung(허철웅)
Hong, Jung Hwa(홍정화)
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