Assessing Lymph Node Metastasis Risk in Patients With Mucosal Gastric Cancer: A Comparison of the
                    <scp>WHO</scp>
                    and Japanese Criteria and Implications for Endoscopic Submucosal Dissection

doi:10.1002/jgh3.70432

DOI: 10.1002/jgh3.70432 ISSN: 2397-9070

Assessing Lymph Node Metastasis Risk in Patients With Mucosal Gastric Cancer: A Comparison of the WHO and Japanese Criteria and Implications for Endoscopic Submucosal Dissection

Jane Chungyoon Kim, Yo‐Seok Cho, Yoonjin Kwak, Seong‐Ho Kong, Do Joong Park, Soo‐Jeong Cho, Hyuk‐Joon Lee, Hye Seung Lee, Han‐Kwang Yang

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ABSTRACT

Background and Aim

Endoscopic submucosal dissection (ESD) is an established treatment for early gastric cancer. However, concerns remain regarding the risk of lymph node metastasis (LNM) under expanded criteria and its applicability across different populations. This study assessed LNM risk in patients with mucosal gastric cancer using WHO and Japanese criteria.

Methods

This retrospective cohort study included 2232 patients with mucosal gastric cancer who underwent curative gastrectomy. Clinicopathological factors, including tumor size, histological type, ulceration, and lymphovascular invasion (LVI), were analyzed. Independent risk factors for LNM were identified through multivariate logistic regression.

Results

LNM occurred in 3.5% of the patients. Undifferentiated‐type (UD‐type) tumors within the updated ESD criteria (size ≤ 2 cm, without ulceration) had a 2.1% LNM occurrence rate. In contrast, differentiated‐type (D‐type) tumors (no ulceration with size > 2 cm or presence of ulceration with size ≤ 3 cm) showed 3.3% and 1.4% LNM occurrence rates, respectively. The pattern of lymph node metastasis at each station indicated that D1+ lymph node dissection is sufficient for mucosal gastric cancers. Multivariate analysis identified large tumor size, ulceration, UD‐type, and LVI as significant LNM risk factors, with UD‐type tumors consistently showing higher LNM rates than D‐type tumors across different size categories.

Conclusions

These findings underscore the LNM risk in mucosal gastric cancer under the updated ESD criteria. Individualized treatment and counseling, particularly for young patients with good performance status, are essential. A cautious approach aligning treatment with patient characteristics is recommended.