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

Authors
 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 
Citation
 Annals of Surgical Oncology, Vol.24(6) : 1643-1649, 2017 
Journal Title
 Annals of Surgical Oncology 
ISSN
 1068-9265 
Issue Date
2017
MeSH
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*
Abstract
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.
Full Text
https://link.springer.com/article/10.1245%2Fs10434-017-5791-9
DOI
10.1245/s10434-017-5791-9
Appears in Collections:
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
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
박준철(Park, Jun Chul) ORCID logo https://orcid.org/0000-0001-8018-0010
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
이용찬(Lee, Yong Chan)
정다현(Jung, Da Hyun)
최승호(Choi, Seung Ho) ORCID logo https://orcid.org/0000-0002-9872-3594
허철웅(Huh, Cheal Wung)
홍정화(Hong, Jung Hwa)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160208
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