Low Frequency of Lymph Node Metastases in Patients in the United States With Early-stage Gastric Cancers That Fulfill Japanese Endoscopic Resection Criteria

Yuri Hanada, Alyssa Y. Choi, Joo Ha Hwang, Peter V. Draganov, Lauren Khanna, Amrita Sethi, Michael J. Bartel, Neha Goel, Seiichiro Abe, Rabia A. De Latour, Kenneth Park, Marcovalerio Melis, Elliot Newman, Ioannis Hatzaras, Sanjay S. Reddy, Jeffrey M. Farma, X. Liu, Alexander Schlachterman, J. Kresak, Garrick TrappN. Ansari, Beth Schrope, Jong Yeul Lee, Deepti Dhall, S. Lo, Laith H. Jamil, Miguel Burch, Srinivas Gaddam, Y. Gong, Armando Del Portillo, Yutaka Tomizawa, Camtu D. Truong, Olaya I. Brewer Gutierrez, Elizabeth Montgomery, Fabian M. Johnston, Mark Duncan, Marcia Canto, Nita Ahuja, Anne Marie Lennon, Saowanee Ngamruengphong

Research output: Contribution to journalArticle

Abstract

Background & Aims: In the West, early gastric cancer is increasingly managed with endoscopic resection (ER). This is, however, based on the assumption that the low prevalence and risk of lymph node metastases observed in Asian patients is applicable to patients in the United States. We sought to evaluate the frequency of and factors associated with metastasis of early gastric cancers to lymph nodes, and whether the Japanese ER criteria are applicable to patients in the US. Methods: We performed a retrospective study of 176 patients (mean age 68.5 years; 59.1% male; 58.5% white) who underwent surgical resection with lymph node dissection of T1 and Tis gastric adenocarcinomas, staged by pathologists, at 7 tertiary care centers in the US from January 1, 1999, through December 31, 2016. The frequency of lymph node metastases and associated risk factors were determined. Results: The mean size of gastric adenocarcinomas was 23.0 ± 16.6 mm—most were located in the lower-third of the stomach (67.0%), invading the submucosa (55.1%), and moderately differentiated (31.3%). Lymphovascular invasion was observed in 18.2% of lesions. Overall, 20.5% of patients had lymph node metastases. Submucosal invasion (odds ratio, 3.9; 95% CI, 1.4–10.7) and lymphovascular invasion (odds ratio, 4.6; 95% CI, 1.8–12.0) were independently associated with increased risk of metastasis to lymph nodes. The frequency of lymph node metastases among patients fulfilling standard and expanded Japanese criteria for ER were 0 and 7.5%, respectively. Conclusions: The frequency of lymph node metastases among patients with early gastric cancer in a US population is higher than that of published Asian series. However, early gastric cancer lesions that meet the Japanese standard criteria for ER are associated with negligible risk of metastasis to lymph nodes, so ER can be recommended for definitive therapy. Expanded criteria cancers appear to have a higher risk of metastasis to lymph nodes, so ER may be considered for select cases.

Original languageEnglish (US)
Pages (from-to)1763-1769
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number9
DOIs
StatePublished - Aug 2019

Keywords

  • Endoscopic Submucosal Dissection
  • Lymphovascular Invasion
  • Non–Gastroesophageal Junction Early Gastric Cancer
  • Submucosal Invasion

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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