Risk factors and prognosis of lymph node metastasis and residual cancer following endoscopic submucosal dissection in early gastric cancer / 国际外科学杂志

ABSTRACT

Objective:To explore the risk factors and prognosis of lymph node metastasis and residual cancer following additional surgery after endoscopic submucosal dissection (ESD) in early gastric cancer (EGC).Methods:Retrospective analysis was performed on the data of 42 patients with EGC who received additional surgery after ESD in General Surgery Department of Beijing Friendship Hospital, Capital Medical University from August 2012 to August 2019, including 35 males and 7 females, with a male to female ratio of 5∶1 and an average age of 62 (32 to 82 years old). The primary outcomes were lymph node metastasis risk and residual cancer risk, while the secondary outcomes were 3-year and 5-year overall survival. Logistic regression model was used to analyze the risk factors of lymph node metastasis and residual cancer, and Kaplan-Meier survival analysis was performed.Results:Multivariate analysis showed that gender ( OR 45.3, 95% CI 3.762-546.250, P=0.003), invasion depth ( OR 3.965, 95% CI 1.1019-15.432, P=0.047) and histological type ( OR 9.455, 95% CI 0.946-94.482, P=0.049) were independent risk factors for lymph node metastasis of early gastric cancer. The type of tumor invasion ( OR 10.675, 95% CI 1.840-61.932, P=0.008) and the horizontal resection margin ( OR 9.341, 95% CI 1.47-59.346, P=0.018) were independent risk factors affecting the occurrence of residual cancer. Stratified analysis showed that in men, the tumor invaded to T 1b-SM1, and the pathological type was undifferentiated; and in women, the tumor invaded to T 1b-SM2, regardless of the pathological type, lymph node metastasis occurred. When the horizontal margin was positive, regardless of the infiltration pattern; and the infiltration pattern is INF-c, regardless of the horizontal margin, residual cancer occurred. Survival analysis showed that the 3-year (100% vs 60%, P< 0.001) and 5-year overall survival rate (100% vs 25%, P< 0.001) were better than those with lymph node metastasis.The 3-year (100% vs 80%) and 5-year overall survival rates (100% vs 62.5%) of patients without residual cancer were significantly better than those with residual cancer, with statistically significant differences ( P<0.001). Conclusions:Gender, invasion depth and histological type are independent risk factors for lymph node metastasis of early gastric cancer, and tumor invasion form and horizontal incision margin are independent risk factors for the appearance of residual cancer. The long-term survival rate of patients with early gastric cancer without lymph node metastasis and residual cancer was significantly better than that of patients with lymph node metastasis and residual cancer. Therefore, ESD is one of the safe and effective treatment methods for patients with early gastric cancer, but some patients need additional surgery according to the specific situation in order to improve the prognosis.