• Elvira L Vos, Masaya Nakauchi, Mithat Gönen, Jason A Castellanos, Alberto Biondi, Daniel G Coit, Johan L Dikken, Domenico D'ugo, Henk Hartgrink, Ping Li, Makoto Nishimura, Mark Schattner, Kyo Young Song, Laura H Tang, Ichiro Uyama, Santosha Vardhana, VerhoevenRob H ARHADepartment of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; and., WijnhovenBas P LBPLDepartment of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands., and Vivian E Strong.
• Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
• Ann. Surg. 2023 Feb 1; 277 (2): e339e345e339-e345.

ObjectiveWe sought to define criteria associated with low lymph node metastasis risk in patients with submucosal (pT1b) gastric cancer from 3 Western and 3 Eastern countries.Summary Background DataAccurate prediction of lymph node metastasis risk is essential when determining the need for gastrectomy with lymph node dissection following endoscopic resection. Under present guidelines, endoscopic resection is considered definitive treatment if submucosal invasion is only superficial, but this is not routinely assessed.MethodsLymph node metastasis rates were determined for patient groups defined according to tumor pathological characteristics. Clinicopathological predictors of lymph node metastasis were determined by multivariable logistic regression and used to develop a nomogram in a randomly selected subset that was validated in the remainder. Overall survival was compared between Eastern and Western countries.ResultsLymph node metastasis was found in 701 of 3166 (22.1%) Eastern and 153 of 560 (27.3%) Western patients. Independent predictors of lymph node metastasis were female sex, tumor size, distal stomach location, lymphovascular invasion, and moderate or poor differentiation. Patients fulfilling the National Comprehensive Cancer Network guideline criteria, excluding the requirement that invasion not extend beyond the superficial submucosa, had a lymph node metastasis rate of 8.9% (53/594). Excluding moderately differentiated tumors lowered the rate to 3.4% (10/296). The nomogram's area under the curve was 0.690. Regardless of lymph node status, overall survival was better in Eastern patients.ConclusionsThe lymph node metastasis rate was lowest in patients with well differentiated tumors that were ≤3 cm and lacked lymphovascular invasion. These criteria may be useful in decisions regarding endoscopic resection as definitive treatment for pT1b gastric cancer.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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