Differences Of Lymph Node Metastasis And Prognosis After Endoscopic Submucosal Dissection Between Early Proximal And Distal Gastric Cancer

Chapter 1Differences of Lymph Node Metastasis Between Early Proximal and Distal Gastric CancerObjective:To explore differences of lymph node metastasis(LNM)between early proximal gastric cancer(PGC)and distal gastric cancer(DGC).Methods:The clinical data of 420 early gastric cancer(EGC)patients(PGC n=101,DGC n=319)who underwent curative gastrostomy from June 2013 to June 2016 at The Affiliated Drum Tower Hospital of Nanjing University Medical School were retrospectively analyzed.Risk factors for LNM in EGC were analyzed and differences in LNM between early PGC and DGC were compared.Results:Compared to DGC,PGC demonstrated older patients(64.6 ± 8.5 years vs 58.2 ± 12.0 years),higher proportion of males(77.2%vs 65.2%),more frequent differentiated cancers(86.1%vs 62.1%),less ulcers(19.8%vs 36.4%)and lower LNM rate(9.9%vs 21.3%),and the difference was statistically significant(P<0.05).However,the two groups had no significant differences in tumor size,general type,depth of invasion,and lymphovascular invasion(P>0.05).The total rate of LNM for EGCs was 18.6%(78/420),including 7.7%(15/195)in mucosal cancers,and 28.0%(63/225)in submucosal cancers.Tumor location(proximal and distal stomach),tumor size,depth of invasion,histological differentiation and lymphovascular invasion were significantly correlated with lymph node metastasis by univariate analysis(P<0.05).Multivariate analysis revealed that tumor location(proximal and distal stomach),depth of invasion,histological differentiation and lymphovascular invasion were independent risk factors for LNM(P<0.05).The LNM rate of mucosal,differentiated and lymphovascular invasion negative PGC was 2.8%(1/36),which was lower than that of DGC(8.5%,8/94).Conclusions:Tumor sites(proximal and distal stomach),depth of invasion,histological differentiation,and lymphovascula invasion are independent risk factors for LNM in EGCs.The LNM rate of mucosal,differentiated and lymphovascular invasion negative PGC is lower and more suitable for endoscopic resection.Chapter 2Prognosis of Early Proximal and Distal Gastric Cancer after Endoscopic Submucosal DissectionObjective:To explore prognosis of early proximal gastric cancer(PGC)and distal gastric cancer(DGC)after endoscopic submucosal dissection(ESD).Methods:The clinical data of 187 early gastric cancer(EGC)patients(PGC n=80,DGC n=107)who treated with ESD from June 2013 to June 2016 at The Affiliated Drum Tower Hospital of Nanjing University Medical School were retrospectively analyzed.The prognosis of early PGC and DGC after ESD was analyzed.Results:Among the 187 patients,90 cases met the absolute indications of ESD for EGC,60 cases relative indications,and 27 cases out of indications.Average follow-up time was 32(2 to 57)months.Local recurrence was found in 3 cases(all met the relative indications;1 case in the proximal stomach,2 cases in the distal stomach),gastric cancer-related death in 2 cases(1 case met absolute indications,1 case met the relative indications;both in the proximal stomach),non-stomach cancer deaths in 3 cases,and no metastatic recurrence was found.The total local recurrence rate for EGCs which met absolute or relative indications was 1.9%(3/160),including 1.6%(1/63)in PGCs and 2.1%(2/97)in DGCs,and the difference was not statistically significant(P>0.05).The total Lymph node metastasis(LNM)rate for EGCs which met absolute or relative indications was 1.3%(2/160),including 3.2%(2/63)in PGCs and 0%(0/97)in DGCs,and the difference was not statistically significant(P>0.05).Conclusions:The LNM rate for early PGC and DGC met ESD absolute or relative indications are lower,and their prognosis are both better.