In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 3_suppl ( 2014-01-20), p. 21-21
Abstract:
21 Background: Clinical T1 gastric cancer sometimes metastasizes to regional lymph nodes. Standard surgery is D2 gastrectomy for clinical T1N+ gastric cancer patients, however, clinical detection of nodal metastasis by Computed Tomography is unreliable, with only 4% sensitivity in our previous study. The present study aimed to predict pathological nodal metastases in clinical T1 gastric cancer. Methods: Patients were selected from the prospective database of Kanagawa Cancer Center between Oct 2000 and Oct 2007 based on the following criteria; (1) histologically proven adenocarcinoma of the stomach, (2) patients were diagnosed with clinical T1 by gastrointestinal endoscopy, (3) patients received radical surgery with D1 or more lymphadenectomy as a primary treatment. First, univariate logistic-regression model was used to select risk factors for prediction of pathological nodal metastasis by analyzing clinical factors of tumor location, clinical depth (cT1a or cT1b), macroscopic type, maximal tumor diameter, and pathological type. Then, the optimal cut-off value and predictive accuracy was determined by ROC curve using significant factors selected in logistic regression. Results: A total of 511 patients were entered into this study. Among these, pathological N+ was observed in 46 patients (9.0%). Clinical depth (p=0.002), tumor diameter (p 〈 0.001) and pathological type (p=0.002) were significant risk factors for pathological nodal metastasis. Using these factors in multivariate logistic regression, the AUC was calculated to be 0.75. Cut-off value was different depending on the histology and clinical depth; 7.9 cm for differentiated type and 4.8 cm for undifferentiated type in cT1a and 4.3 cm for differentiated type and 1.1 cm for undifferentiated type in cT1b. Using these criteria, sensitivity and specificity for prediction of pathological nodal metastasis were 67.4% and 71.6%, respectively. Conclusions: Pathological nodal metastasis in clinical T1 gastric cancer was predictable by clinical depth, pathological type, and tumor size, however, specificity was not so high. D2 surgery is highly recommended for clinical T1 when the tumors satisfy these criteria.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2014.32.3_suppl.21
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2014
detail.hit.zdb_id:
2005181-5
