1. Latest guideline of endoscopic submucosal dissection of early gastric cancer may not be suitable for Chinese patients: retrospective study findings from two centers.
- Author
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Mei, Yu, Gao, Jianpeng, Zhang, Benyan, Feng, Tienan, Wu, Wei, Zhu, Zhenggang, and Zhu, Zhenglun
- Subjects
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MEDICAL protocols , *LYMPH nodes , *CANCER treatment , *RISK assessment , *GASTRECTOMY , *STOMACH tumors , *RESEARCH funding , *ULCERS , *MULTIPLE regression analysis , *RETROSPECTIVE studies , *DIAGNOSTIC errors , *DESCRIPTIVE statistics , *CANCER patients , *CHI-squared test , *MULTIVARIATE analysis , *GASTRIC mucosa , *METASTASIS , *IMMUNOHISTOCHEMISTRY , *ODDS ratio , *ENDOSCOPIC gastrointestinal surgery , *MEDICAL records , *ACQUISITION of data , *STATISTICS , *COMPARATIVE studies , *CONFIDENCE intervals , *DATA analysis software , *SPECIALTY hospitals , *PREDICTIVE validity - Abstract
Background: To analyze the diagnostic efficiency of the four absolute endoscopic submucosal dissection (ESD) indications for lymph node metastasis (LNM) of Chinese patients with early gastric cancer (EGC). Methods: We retrospectively analyzed EGC patients who underwent radical D2 gastrectomy from January 2019 to December 2022. We evaluated the rate of LNM, false-negative rate, and negative predictive value of the four ESD indications. Results: Of enrolled 2722 EGC patients, 388 (14.3%) patients presented LNM. Tumor size > 2 cm, ulceration, submucosal invasion, undifferentiated type, and lymphovascular invasion were independent risk factors of LNM in patients with EGC. 1062 (39%) cases of EGC conformed to the four EDS indications; however, 4% of them had LNM. 451 cases were fully in accord with the fourth ESD indication (undifferentiated intramucosal carcinoma without ulceration and a maximum lesion diameter of ≤ 2 cm), and 35 of them had LNM, with a false-negative rate (FNR) of 9.02% and a negative predictive value (NPV) of 92.24%. There was significant difference among the four indications in terms of the rate of LNM (1.0% vs 1.5% vs 1.3% vs 7.8%, P < 0.001), FNR (1.03% vs 0.52% vs 0.26% vs 9.02%, P < 0.001), and NPV (98.99% vs 98.53% vs 98.75% vs 92.24%, P < 0.001). Conclusion: Overall, the fourth ESD indication was associated with a high rate of LNM compared to the other three indications. Thus, it might not be safe to classify it as an absolute indication in Chinese patients with EGC. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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