J Gastric Cancer.  2017 Dec;17(4):331-341. 10.5230/jgc.2017.17.e37.

Risk Factors of Microscopic Invasion in Early Gastric Cancer

• Choi JH
• Suh YS
• Park SH
• Kong SH
• Lee HJ
• Kim WH
• Yang HK

• KMID: 2398799
• DOI: http://doi.org/10.5230/jgc.2017.17.e37

Abstract

PURPOSE
This study aimed to evaluate the clinical significance of microscopic invasion to determine the adequate resection margin in early gastric cancer (EGC).
MATERIALS AND METHODS
A retrospective review was performed that included patients who underwent gastrectomy for clinical early gastric cancer (cEGC) at Seoul National University Hospital between January 2007 and December 2010. After subtracting the microscopic resection margin from the gross resection margin for each proximal or distal resection margin, microscopic invasion was represented by the larger value. Microscopic invasion and its risk factors were analyzed according to the clinicopathologic characteristics.
RESULTS
In total, 861 patients were enrolled in the study. Microscopic invasion of cEGC was 6.0±12.8 mm, and the proportion of patients with microscopic invasion ≥0 mm was 78.4%. In the risk group, tumor location, pT stage, and differentiation did not significantly discriminate the presence of microscopic invasion. The microscopic invasion of EGC-IIb was 13.9±16.8 mm, which was significantly greater than that of EGC-I. No linear correlation was observed between the overall tumor size and microscopic invasion (R=0.030). The independent risk factors for microscopic invasion ≥20 mm were EGC-IIb vs. EGC-I/IIa/IIc/III (odds ratio [OR], 3.103; 95% confidence interval [CI], 1.533-6.282; P=0.002) and male vs. female sex (OR, 1.655; 95% CI, 1.012-2.705; P=0.045).
CONCLUSIONS
Male sex and EGC-IIb were independent risk factors for microscopic invasion ≥20 mm. Examination of intraoperative frozen sections is highly recommended to avoid resection margin involvement, especially in cases of EGC-IIb.

Keyword

Stomach neoplasm; Risk factors

MeSH Terms

Female
Frozen Sections
Gastrectomy
Humans
Male
Retrospective Studies
Risk Factors*
Seoul
Stomach Neoplasms*

Figure

• 

  Fig. 1 Distribution of microscopic invasion according to the clinicopathologic characteristics in the risk group. Microscopic invasion according to (A) tumor location, (B) pT stage, (C) differentiation, and (D) Lauren's classification. Boxes indicate the interquartile ranges and median values; whiskers indicate the minimum and maximum values. P-values in the upper right corner were determined by Student's t-test or 1-way ANOVA. P-values in the upper section of the box (D) were generated using Student's t-test. ANOVA = analysis of variance.

• 

  Fig. 2 Distribution of microscopic invasion according to gross type in the risk group. Boxes indicate the interquartile ranges and median values; whiskers indicate the minimum and maximum values. The P-value in the upper right corner was determined by 1-way ANOVA. P-values in the upper section of the box were generated using Student's t-test. ANOVA = analysis of variance; EGC = early gastric cancer.

• 

  Fig. 3 Distribution of microscopic invasion according to tumor size in the risk group. (A) Entire risk group, (B) EGC-I, (C) EGC-IIa, (D) EGC-IIb, (E) EGC-IIc, and (F) EGC-III. Regression lines, CIs, and correlation coefficients (R) are displayed in the scatter plots. EGC = early gastric cancer; CI = confidence interval.

• 

  Fig. 4 Survival analysis according to microscopic invasion. (A) Overall survival (P=0.692). (B) Recurrence-free survival (P=0.796). Each line is presented safe group (microscopic invasion of <0 mm, n=186), microscopic invasion of ≥0 and <20 mm (n=588), and high-risk group (microscopic invasion of ≥20 mm, n=87).

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