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Endoscopic appearance of stages of ulcer in EGC. (A) A1 stage (B) A2 stage (C) H1 stage (D) H2 stage (E) S1 stage (F) S2 stage. doi:10.1371/journal.pone.0164339.g001
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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...
Similar publications
Endoscopic resection for early gastric cancer (EGC) without lymph node metastasis may be a valuable treatment option. To date, endoscopic resection for undifferentiated EGC is being investigated. We evaluated the risk of lymph node metastasis in undifferentiated EGC by examining the preoperative endoscopic findings and operated pathologic specimen....
Citations
... But further analysis results showed that only the Ulcerative type is an independent risk factor (P = 0.04). Lee et al. (2016) study Jie Xu performed the experiments, prepared figures and/or tables, and approved the final draft. Zhiyong Meng analyzed the data, authored or reviewed drafts of the paper, and approved the final draft. ...
Background
Lymphangio vascular invasion (LVI) and perineural invasion (PNI) are associated with survival following resection for gastrointestinal cancer. But the relationship between LVI/PNI and survival of esophageal squamous cell carcinoma (ESCC) is still unclear. We aim to demonstrate the prognostic significance of LVI/PNI in ESCC.
Methods
A total of 195 ESCC patients underwent curative surgery from 2012 to 2018 was collected in the 2nd Affiliated Hospital of Fujian Medical University. All the patients were divided into four groups based on the status of the neurovascular invasion: (1) neither LVI nor PNI (V0N0); (2) LVI alone (V1N0); (3) PNI alone (V0N1); (4) combined LVI and PNI (V1N1). First, the analysis included the Kaplan-Meier survival estimates with the Log rank test were performed to determine median overall survival (OS) in different groups divided according to the clinical factor, respectively. And the association between OS with multi clinical factors was examined using Cox regression analysis. Next, the risk factors for recurrence in patients with V1N1 were analyzed with univariate and multivariate logistic regression analyses, respectively.
Results
The cases in V0N0, V1N0, V0N1, and V1N1 groups were 91 (46.7%), 62 (31.8%), 9 (4.6%) and 33 (16.9%), respectively. The OS in the four groups was different ( P < 0.001). The 1-, 3- and 5-year OS in V0N0 group was higher than that in V1N1 group, respectively (1-year OS: 93.4% vs 75.8%, 3-year OS: 53.8 % vs 24.2%, 5-year OS: 48.1% vs 10.5%). The OS in stage I-II for patients with V1N1 was significantly lower than that in the other groups (V0N0, V1N0, V0N1) ( P < 0.001). The postoperative adjuvant chemotherapy was a significant impact factor of OS for ESCC patients with V1N1 ( P = 0.004). Lymphatic invasion and LVI were significantly prognosis factors associated ( P = 0.036, P = 0.030, respectively). The ulcerative type is a risk factor for V1N1 occurance ( P = 0.040).
Conclusions
The LVI and PNI are important prognosis factors for ESCC patients. ESCC patients with simultaneous lymphangio vascular and perineural invasion (V1N1) showed worse OS than patients with either lymphangio vascular or perineural invasion alone (V1N0 or V0N1) or none (V0N0). In addition, adjuvant chemotherapy may prolong the OS for ESCC patients with V1N1.
... Известно, что язвенные формы раннего рака желудка протекают более агрессивно, нежели приподнятые [34]. А ранняя диагностика рака желудка улучшает прогноз и 5-летнюю выживаемость до 90 % [35]. ...
... Еще важно отмечать стадией язвенного процесса так как прослеживается связь с морфологической характеристикой при раннем раке желудка. Недифференцированный тип наиболее часто встречался в рубце 60,2 % [34]. Морфологически большинство ранних раков желудка -это дифференцированные аденокарциномы. ...
The review includes 70 articles, most of which have been published for the last 5 years.The aim of the review: explore the modern possibilities and prospects of early diagnosis of stomach cancer. In 2018 in Russia, the mortality rate within one year after the diagnosis was 47.4%. Leading experts in luminal endoscopy from Japan, where more than 60% cases of stomach cancer are detected at an early stage, recommend using advanced endoscopic equipment for routine diagnostics, which allows enlarging the image, examining the capillaries of the mucosa and taking series of pictures. Artificial intelligence improves accuracy. Gastroscopic study with artificial intelligence compensates errors and limited capabilities of people, and provides greater accuracy. However, this technology is expensive, and esophagogastroduodenoscopy itself is an invasive method and can be used only in a clinical setting. In patients with a detectable lesion, a biopsy should be performed. It is important to obtain a sufficient amount of tissue when collecting material, however, many patients take anticoagulants, and thus sampling of numerous fragments can lead to bleeding. Given the limitations of esophagogastroduodenoscopy with biopsy and the fact that only 12.4% cases of stomach cancer in 2018 in Russia identified on the stage I, the searching of effective diagnostic tools is still relevant. MicroRNAs have been in the «cancer research arena» for over 10 years and are considered biomarkers that can help to differentiate between the patients with normal range, dysplasia and those with cancer. MicroRNA regulates all vital processes of a cell, moreover, they are stable and easily extracted from various biological materials, including tissues, blood, feces, saliva, ascitic fluid and even paraffin blocks. And although microRNAs are only entering clinical practice, the results obtained are encouraging.
... Ulcerative EGCs have a higher risk of submucosal invasion and LN metastasis. 18 However, deep depression is not a characteristic of submucosal cancer in differentiated-type EGC. One possible explanation of this result is a different tumor-spreading pattern of the undifferentiated-type histology compared to the differentiated-type. ...
Background/Aims: The prediction of invasion depth is important to decide the treatment modality for undifferentiated-type early gastric cancer (EGC) less than 20 mm in size without ulceration. We aimed to identify the endoscopic features associated with submucosal invasion in undifferentiated-type EGC that meet the criteria of size and ulcer status.Methods: A total of 120 patients with undifferentiated-type EGC who underwent endoscopic submucosal dissection (ESD) or gastrectomy between August 2008 and December 2017 were enrolled and reviewed retrospectively. All lesions met the ESD indications except for the invasion depth. We analyzed the endoscopic features of the tumors before resection and invasion depth after resection.Results: There were 97 mucosal and 23 submucosal cancer lesions. Multivariable analysis revealed that the polypoid (OR, 90.8; 95% CI, 3.5~2,346.2) or elevated (OR, 5.0; 95% CI, 1.2~21.3) types, deep depression (OR, 76.0; 95% CI, 4.5~1,284.6), and upper (OR, 22.7; 95% CI, 3.0~170.8) or middle location (OR, 10.3; 95% CI, 1.9~55.4) were significant risk factors of submucosal invasion.Conclusions: The treatment modality for undifferentiated-type EGC of the polypoid/elevated type or with deep depression located in the upper two-thirds of the stomach should be carefully considered, even if the tumor size and ulcer status meet the ESD indications.
... The results of this research indicated that ulcer is a related factor of lymph node metastasis in early gastric cancer. Lee YJ [24] found that 343 patients (71.7 %) had endoscopic EGC ulcers by retrospectively analyzing EGC patients, and the study showed that the rate of LNM was significantly increased in ulcerative EGC compared with non-ulcerative EGC. According to the results of Xu C et al. [25] , the presence and the size of ulcers may be a potential predictor of LNM in patients with gastric cancer. ...
Background:
endoscopic submucosal dissection (ESD) has been widely recognized by patients and doctors due to its advantages in early gastric cancer (EGC). The accurate prediction of the risk of lymph node metastasis (LNM) in EGC is important to select suitable treatments with this procedure for patients. Unfortunately, the accuracy of endoscopic ultrasound and computed tomography in the diagnosis of EGC lymph node status is extremely limited. The purpose of the present study was to establish an LNM nomogram risk model of early gastric cancer patients based on clinical data, to guide treatment for clinicians.
Methods:
a retrospective examination of the records of EGC patients undergoing radical gastrectomy from August 2012 to August 2019 in the Gastrointestinal Center of Subei People's Hospital was performed. The clinicopathological data were classified into a training set and validation set according to the time. Univariate and multivariate analyses were performed to identify risk factors related to LNM. A risk model for predicting the occurrence of LNM in EGC was established and validated.
Results:
of the 503 EGC patients, 78 (15.5 %) had lymph node metastasis. Logistic stepwise regression analysis showed that the predictive factors included sex, tumor location, tumor diameter, differentiation, ulcer and lymphatic vascular invasion. The discrimination of the LNM prediction model was satisfactory with an AUC of 0.8033 (internal validation) and 0.7353 (external validation). The correction effect of the calibration was satisfactory and the DCA decision curve analysis showed a strong clinical practicability.
Conclusion:
the nomogram risk prediction model of LNM has been established for EGC patients to assist in formulating personalized treatment plans.
... Subsequently, expanded indications were proposed for ESD that included ulcerated lesions, but the application was still limited to differentiated mucosal lesions with diameters smaller than 30 mm. 1 In contrast with its use in non-ulcerative-type EGC, endoscopic submucosal resection is less commonly used in ulcerative-type EGC because of the higher risk of LNM in these tumors. [8][9][10] Indeed, the factors affecting LNM have seldom been evaluated in patients with ulcerative EGC in previous studies. ...
... Overall, the incidence of LNM in ulcerative-type EGC patients was 16.5%, which is higher than the 12.5% reported by Lee et al. 10 We found that deeper invasion and LVI are independent risk factors for LNM. In previous studies, depth of infiltration was also considered to be extremely relevant to LNM. 8,20,23,28,29 Some studies reported that, although the mucosa showed an enrichment of blood capillaries, lymphatic ducts were only abundant in the deeper lamina propria and submucosa. ...
... A previous study reported that presence of type 0-III (excavated) ulcers and incomplete ulcer healing were strongly associated with higher incidence of submucosal invasion. 34 Similarly, Lee et al. 10 showed that, for early gastric tumors, active ulcers are an LNM risk factor compared with healing and scarred ulcers but that elevated gross type was an independent risk factor for only differentiated-type gastric cancers. Since they can be approximately determined through endoscopy, gross appearance and activity of ulcers could be useful additional parameters to include in the preoperative indications for ESD, and a series of standardized descriptions are needed. ...
Background:
When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration.
Patients and methods:
We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed.
Results:
LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P < 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P < 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions < 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer.
Conclusions:
Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC < 30 mm in size, and additional investigation is needed to evaluate its safety.
... 9 Submucosal invasion was independently associated with endoscopic findings such as type III ulcers, tumorous bank, a fusion of converging folds, hardness or decreased flexibility, and incomplete ulcer healing on follow-up endoscopy. In the study of the association of ulcer stage with clinical behaviors in EGCs, 10 it was shown that the endoscopic stage of ulcers may predict the clinicopathological behaviors of EGC. The active ulcer stage was one of the independent risk factors for LN metastasis. ...
... Anatomical differences, such as the thickness of the gastric wall and submucosal layer and the density of muscle bundles of smooth muscle cells and lymphatic capillaries, may have accounted for this finding [26,27]. Among these characteristics, ulcerative EGC has been associated with submucosal or deeper invasion, and this form of EGC was regarded as unsuitable for endoscopic treatment [28]. However, the accuracy of conventional endoscopic parameters for predicting the depth of cancer invasion is likely affected by several factors, such as the degree of air inflation, the degree of surrounding mucosal inflammation/ edema, and the number and intensity of previous endoscopic biopsies [29]. ...
Background
The aims of this study are to evaluate the usefulness of submucosal deformity pattern analysis with endoscopic ultrasonography (EUS) for predicting the depth of invasion in early gastric cancer (EGC) and the treatment results of endoscopic submucosal dissection (ESD).
Methods
The endoscopic and EUS parameters of 345 patients with endoscopically suspected EGC who underwent endoscopic or surgical resection between July 2012 and May 2017 were retrospectively reviewed. All patients were classified into three categories as follows according to the morphologic type of submucosal deformity identified by EUS: (1) no submucosal deformity, (2) wedge-shaped deformity, and (3) arch-shaped deformity. The presence of an arch-shaped submucosal deformity on EUS and an active endoscopic ulcer or surrounding mucosal fold convergence/clubbing on conventional endoscopy were defined as suggestive of deep submucosal cancer invasion (SCI).
Results
Upper location (p = 0.034) and the presence of an arch-shaped submucosal deformity on EUS (p < 0.001) were significant predictors of deep submucosal invasion, with the presence of an arch-shaped submucosal deformity showing the highest predictive value (odds ratio of 26.27). The overall diagnostic accuracy of EUS for predicting deep SCI was 83.5%, with a sensitivity of 84.0% and a specificity of 83.3%, which were significantly higher than those of conventional endoscopy. A larger lesion size and the presence of an arch-shaped submucosal deformity were significant factors associated with noncurative resection after ESD.
Conclusions
Submucosal deformity pattern analysis with EUS can provide more accurate information than conventional endoscopy for predicting deep SCI. The presence of an arch-shaped submucosal deformity on EUS was an effective predictor of deep SCI and noncurative resection.
... [8,9] However, in the early stage of gastric cancer, LNM could be present in some cases, and the LN dissection was not possible in the ESD process, which limited the application of EGC therapy. [10] Therefore, the evaluation of LNM is very important in the treatment of EGC and even determines the treatment modality. ...
Objective:
Lymph node metastasis (LNM) is one of the important prognostic factors of early gastric cancer (EGC). Moreover, LNM is also important when choosing therapeutic intervention for EGC patients. The purpose of this study is to explore the risk factors of LNM in EGC and to discuss the corresponding treatment.
Design:
We retrospectively reviewed the medical records of 253 patients with EGC who underwent surgical therapy in our department between 2012 and 2015. Univariate analysis and Multivariate Cox regression were used to evaluate the independent risk factors of LNM.
Results:
LNM was present in 38 cases among 253 patients (15%). Univariate analysis showed an obvious correlation between LNM and tumour location, tumour size, depth of invasion, morphological classification, gross type of the lesion and venous invasion. Multivariate analysis indicated that poorly differentiated carcinoma, submucosal cancer, tumour size ≥2 cm and venous invasion were the independent risk factors for LNM.
Conclusion:
Tumour size, depth of invasion, morphological classification and blood vessel invasion were predictive risk factors for LNM in EGC. We propose that EGC patients with those risk factors should be accepted gastrectomy with LN dissection.
... Tumor locations were divided into the upper, middle, and lower thirds EGC early gastric cancer, ESD endoscopic submucosal dissection, Bx biopsy, Ix indication according to the Japanese Classification of Gastric Cancer [13]. Endoscopic features of suspected deep SM invasion (subepithelial tumor-like marginal elevation, fusion of convergent folds, irregular nodular/depressed surface, or SM fibrosis), the color of the lesion's surface (white, redness, discolor), and the presence of ulcer scarring were also evaluated (Fig. 2) [14][15][16]. Endoscopic features were identified based on the consensus between two endoscopists (CW Choi, SJ Kim) who were blinded to the pathological information using the images recorded at the time of diagnostic endoscopy. Histopathologic examination was performed after serial sectioning of the ESD specimen into 2 mm thick slices. ...
Background:
To successfully resect early gastric cancer (EGC), prediction of lymph node metastasis is essential. Beyond endoscopic submucosal dissection (ESD) indication or lymphovascular invasion (LVI) are known risk factors associated with lymph node metastasis. However, accurate prediction of tumor invasion depth or LVI is impossible before endoscopic resection even when endoscopic ultrasound is used. The aim of this study was to identify the predictive factors associated with beyond ESD indication or LVI after ESD for EGC.
Methods:
Between Jan 2011 and Feb 2015, 532 lesions from 506 patients who received ESD for EGCs were included. We reviewed the data of patients diagnosed as EGCs without ulceration or those smaller than 3 cm with ulceration.
Results:
The incidence of EGCs found to be beyond expanded ESD indications or present of LVI after ESD was 11.1% (59/532). On multivariable analysis, endoscopic features of SM invasion, surface color changes, and elevated lesions were associated with beyond ESD indication or LVI. In particular, submucosal (SM) invasive features such as SM tumor-like marginal elevation [odds ratio (OR) 17.2; 95% confidence interval (CI) 2.0-146.7], fusion of convergent folds (OR 12.9; 95% CI 3.9-42.1), irregular surface (OR 17.8; 95% CI 5.6-56.8), and discoloration of the tumor surface (OR 16.1; 95% CI 2.4-105.9) were significant risk factors for beyond ESD indication or LVI.
Conclusions:
The decision to proceed with endoscopic resection for EGCs with endoscopic features of SM invasion, surface color changes, or elevated forms must be made cautiously.
... There have been some studies suggesting the association between endoscopic gross appearances and clinical behaviour of EGC [28,29]. A total of 546 (35%) patients had elevated lesion among 1,780 cases undergoing ESD for EGC in our study, compared to 15.9-19.8% in previous studies with surgically treated EGC patients [28,30,31]. ...
Background
Metachronous gastric tumor (MGT) is one of major concerns after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Optimal follow-up strategy has not been yet well-established. The aim of this study was to identify the different clinical features of the patients according to the time interval to development of MGT.
Methods
Among 1,780 consecutive patients with EGC who underwent ESD between 2005 and 2014, 115 patients with MGT were retrospectively reviewed. MGT was defined as secondary gastric cancer or dysplasia detected > 1 year after initial ESD. Clinicopathological factors associated with early development of MGT were evaluated.
Results
The median interval to development of MGT was 37 months. In univariate analysis, the median interval to MGT was shorter if EGC lesion was non-elevated type (39.4 vs 57.0 months, p = 0.011), or synchronous primary lesion was absent (39.8 vs 51.4 months, p = 0.050). In multivariate Cox’s proportional hazards analysis, the hazard ratios for early occurrence of MGT were 1.966 (95% CI: 1.141–3.386, p = 0.015) and 1.911 (95% CI: 1.163–3.141, p = 0.011), respectively. There was no significant difference in overall survival after diagnosis of MGT between the early occurrence group and the late occurrence group.
Conclusions
Non-elevated gross type and absence of synchronous gastric tumor were independent risk factors for early development of MGT. Meticulous endoscopic inspection is especially important for the detection of MGT during the early follow-up period in patients with these initial tumor characteristics.
