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One-dimensional and 2-dimensional tumor size measurement for prediction of lymph node metastasis in differentiated early gastric cancer with minute submucosal invasion.

Abstract：

BACKGROUND AND AIMS:Differentiated minute submucosal cancers measuring ≤3 cm that exhibit no lymphovascular invasion are considered eligible for endoscopic resection; however, the ≤3-cm criterion remains debatable. The aim of this study was to verify the optimal tumor size cutoff for endoscopic resection eligibility, and to determine whether 2-dimensional tumor size measurement would be more accurate for this purpose. METHODS:The clinicopathologic data for 574 patients undergoing curative surgery for differentiated minute submucosal cancer were reviewed retrospectively. A receiver operating curve analysis and bootstrapped samples were used to identify the optimal cutoff values for predicting lymph node (LN) metastasis. RESULTS:Four hundred fourteen patients were eligible for the study. LN metastasis accompanied 2.5% of differentiated minute submucosal cancers that were ≤3 cm in size and lacked lymphovascular invasion. There was no lymph node metastasis in the tumors with 1-dimensional sizes ≤1.0 cm and 2-dimensional sizes ≤1.0 cm2. When 10,000 bootstrapped data were used, optimal cutoff values were 2.9 cm (LN metastasis: 2.1%) and 8.3 cm2 (LN metastasis: 2.5% incidence) for 1- and 2-dimensional tumor size, respectively. Although the area under the curve was 0.611 (P = .046) for 2-dimensional size, specificity and accuracy were greater for the dichotomized 2-dimensional measure than for the dichotomized 1-dimensional measure (P < .001, McNemar test). In addition, 2-dimensional tumor size was the only significant risk factor for LN metastasis (odds ratio, 1.09; 95% confidence interval, 1.01-1.20). CONCLUSIONS:One- and 2-dimensional cutoff values of 2.9 cm and 8.3 cm2 might be suitable for patients at high risk of postoperative morbidity and mortality. Two-dimensional tumor size is an acceptable measurement method for estimating the risk of LN metastasis.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Kim TJ,Lee H,Min YW,Min BH,Lee JH,Kim KM,Kim MJ,Kim K,Rhee PL,Kim JJ

doi

10.1016/j.gie.2016.07.046

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

730-736

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(16)30431-X

journal_volume

pub_type

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One-dimensional and 2-dimensional tumor size measurement for prediction of lymph node metastasis in differentiated early gastric cancer with minute submucosal invasion.