Cancer Research and Treatment

Gastrointestinal cancer

Development and Validation of Models to Predict Lymph Node Metastasis in Early Gastric Cancer Using Logistic Regression and Gradient Boosting Machine Methods: Hae Dong Lee, Kyung Han Nam, Cheol Min Shin, Hye Seung Lee, Young Hoon Chang, Hyuk Yoon, Young Soo Park, Nayoung Kim, Dong Ho Lee, Sang-Hoon Ahn, Hyung-Ho Kim; Cancer Res Treat. 2023;55(4):1240-1249. Published online March 21, 2023; DOI: https://doi.org/10.4143/crt.2022.1330

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Purpose
To identify important features of lymph node metastasis (LNM) and develop a prediction model for early gastric cancer (EGC) using a gradient boosting machine (GBM) method.
Materials and Methods
The clinicopathologic data of 2556 patients with EGC who underwent gastrectomy were used as training set and the internal validation set (set 1) at a ratio of 8:2. Additionally, 548 patients with EGC who underwent endoscopic submucosal dissection (ESD) as the initial treatment were included in the external validation set (set 2). The GBM model was constructed, and its performance was compared with that of the Japanese guidelines.
Results
LNM was identified in 12.6% (321/2556) of the gastrectomy group (training set & set 1) and 4.3% (24/548) of the ESD group (set 2). In the GBM analysis, the top five features that most affected LNM were lymphovascular invasion, depth, differentiation, size, and location. The accuracy, sensitivity, specificity, and the area under the receiver operating characteristics of set 1 were 0.566, 0.922, 0.516, and 0.867, while those of set 2 were 0.810, 0.958, 0.803, and 0.944, respectively. When the sensitivity of GBM was adjusted to that of Japanese guidelines (beyond the expanded criteria in set 1 [0.922] and eCuraC-2 in set 2 [0.958]), the specificities of GBM in sets 1 and 2 were 0.516 (95% confidence interval, 0.502-0.523) and 0.803 (0.795-0.805), while those of the Japanese guidelines were 0.502 (0.488-0.509) and 0.788 (0.780-0.790), respectively.
Conclusion
The GBM model showed good performance comparable with the eCura system in predicting LNM risk in EGCs.

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Kenichi Ishizu, Satoshi Takahashi, Nobuji Kouno, Ken Takasawa, Katsuji Takeda, Kota Matsui, Masashi Nishino, Tsutomu Hayashi, Yukinori Yamagata, Shigeyuki Matsui, Takaki Yoshikawa, Ryuji Hamamoto
npj Digital Medicine.2025;[Epub] CrossRef
The artificial intelligence revolution in gastric cancer management: clinical applications
Runze Li, Jingfan Li, Yuman Wang, Xiaoyu Liu, Weichao Xu, Runxue Sun, Binqing Xue, Xinqian Zhang, Yikun Ai, Yanru Du, Jianming Jiang
Cancer Cell International.2025;[Epub] CrossRef
Machine learning models for prediction of lymph node metastasis in patients with gastric cancer: a Chinese single-centre study with external validation in an Asian American population
Qian Li, Shangcheng Yan, Weiran Yang, Zhuan Du, Ming Cheng, Renwei Chen, Qiankun Shao, Yuan Tian, Mengchao Sheng, Wei Peng, Yongyou Wu
BMJ Open.2025; 15(3): e098476. CrossRef
Intratumoural and peritumoural CT-based radiomics for diagnosing lepidic-predominant adenocarcinoma in patients with pure ground-glass nodules: a machine learning approach
Y. Zou, Q. Mao, Z. Zhao, X. Zhou, Y. Pan, Z. Zuo, W. Zhang
Clinical Radiology.2024; 79(2): e211. CrossRef
eCura and W-eCura: different scores, different populations, same goal
Rui Morais, Diogo Libanio, João Santos-Antunes
Gut.2024; 73(11): e29. CrossRef
A machine learning model for predicting the lymph node metastasis of early gastric cancer not meeting the endoscopic curability criteria
Minoru Kato, Yoshito Hayashi, Ryotaro Uema, Takashi Kanesaka, Shinjiro Yamaguchi, Akira Maekawa, Takuya Yamada, Masashi Yamamoto, Shinji Kitamura, Takuya Inoue, Shunsuke Yamamoto, Takashi Kizu, Risato Takeda, Hideharu Ogiyama, Katsumi Yamamoto, Kenji Aoi,
Gastric Cancer.2024; 27(5): 1069. CrossRef
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Amin Zadeh Shirazi, Morteza Tofighi, Alireza Gharavi, Guillermo A. Gomez
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An-Lin Zhang, Yan-Mei Fu, Zhi-Yang He
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Screening of gastric cancer diagnostic biomarkers in the homologous recombination signaling pathway and assessment of their clinical and radiomic correlations
Ahao Wu, Tengcheng Hu, Chao Lai, Qingwen Zeng, Lianghua Luo, Xufeng Shu, Pan Huang, Zhonghao Wang, Zongfeng Feng, Yanyan Zhu, Yi Cao, Zhengrong Li
Cancer Medicine.2024;[Epub] CrossRef

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MET-Amplified Intramucosal Gastric Cancer Widely Metastatic after Complete Endoscopic Submucosal Dissection: Dakeun Lee, Young Chul Kim, Kee Myung Lee, Joon-Kee Yoon, Young-Bae Kim; Cancer Res Treat. 2015;47(1):120-125. Published online August 25, 2014; DOI: https://doi.org/10.4143/crt.2013.137

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Intramucosal gastric cancer (IGC) is associated with a very low risk of lymph node metastasis; thus it is the main candidate for minimally invasive surgical procedures, such as endoscopic submucosal dissection (ESD). Herein, we document an extraordinary case of IGC, which showed a very aggressive clinical course. A 66-year-old female underwent ESD for early gastric cancer. Histologically, the tumor consisted mainly of moderately differentiated adenocarcinoma measuring 1.6 cm in diameter, and the tumor was confined to the mucosa. Despite annual esophagogastroduodenoscopic follow-up, the tumor recurred, with wide metastasis to multiple lymph nodes and bones throughout the body after three years. Fluorescence in situ hybridization study demonstrated MET gene amplification as well as low grade polysomy 7 in both original and recurrent tumors. The clinical characteristics of metastatic IGCs and the implication of MET amplification are discussed.

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MicroRNA signatures associated with lymph node metastasis in intramucosal gastric cancer
Seokhwi Kim, Won Jung Bae, Ji Mi Ahn, Jin-Hyung Heo, Kyoung-Mee Kim, Kyeong Woon Choi, Chang Ohk Sung, Dakeun Lee
Modern Pathology.2021; 34(3): 672. CrossRef

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Clinical Analysis of 1136 Early Gastric Cancers: Jin Pok Kim, Yoon Seok Hur, Kuk Jin Choe, Kuhn Uk Lee, Kyoo Wan Choi, Byung Ihn Choi, Yong Il Kim; J Korean Cancer Assoc. 1993;25(6):808-818. Published online August 1, 2014

Abstract PDF: Gastric cancer is the most frequent cancer and leading cause of death from cancer in Korea. From 1974 to l992, we had experienced 7606 cases of gastric cancer and performed 6928 gastric resections. 1136 cases were early gastric cancer(14.9% of all cases and 16.4% of resected cases). These lesians were in 757 men and in 379 women. The mean age was 54.8 years and peak incidence of age was 6th decade in male, and 5th decade in female. The diagnostic tools were upper gastrointestinal series and gastrofibroscope, and the accuracy was 89.8% and 93.8% respectively. Among them mucosal lesions were 548 cases(48.2%), submucosal lesions were 588 cases(51.8%) and 178 cases(15.7%) had lymph nade metastasis. According to the depth of invasion, the rate of lymph node metastasis was 6.4% in mucosal lesion and 24.3% in submucosal lesion. Macroscopically, Type IIc was the most frequently encountered lesion(52.2%, 593 cases). Histologically, signet ring cell type is the most frequent(25.6%). Overall five-year survival rate was 91.8%, and 94.2% in mucosal lesions, 91.3% in submucosal lesions, 94.5% in NO lesions, 88.3% in Nl lesions and 77.3% in N2 lesions. The most important factor for survival was the status of lymph nade metastasis. The factors associated with lymph node metastasis were depth of invasion, macroscopic type (protruding type) but the size of the lesion, histologic type, sex and age, site of lesion had no association statistically.

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Dietary Habit and Helicobacter pylori Infection in Early Gastric Cancer Patient: Sang Ah Lee, Daehee Kang, Weon Seon Hong, Ki Nam Shim, Jae Won Choe, Haymie Choi; Cancer Res Treat. 2002;34(2):104-110. Published online April 30, 2002; DOI: https://doi.org/10.4143/crt.2002.34.2.104

Abstract PDF

PURPOSE
Helicobacter pylori (H. pylori) is now generally accepted to be strongly associated with the development of gastric cancer, as well as intakes of some salted foods, charred foods, etc. To evaluate the association among dietary habits, H. pylori infection, and early gastric cancer in Koreans, a hospital based case-control study was conducted. Material and Method: A total of 268 persons participated in this case-control study. Sixty nine patients were newly diagnosed as an early gastric cancer (EGC) at the Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea. One hundred ninety-nine subjects with no symptoms who visited the Health Promotion Center for their general checkups were selected as the controls. All subjects were examined for H. pylori infection, biochemical blood test the life style, and dietary habit were interviewed by a trained dietition with semi-quantitative food frequency question naire (FFQ) and adaptive salt concentration were taste evaluated.
RESULTS
H. pylori seropositivity was observed in 88.4% in cases, as compared with 74.9% in controls (OR=2.5, 95% CI: 1.1-5.7). The adaptive salt concentration was associated with early gastric cancer risk (chi-squir=50.8, p<0.001). The analysis of food intake frequency demonstrated that early gastric cancer risk was reduced by the intake of clear soups, raw vegetables, fruits and juices, beef with vegetables and soybean curds. On the other hand, high intake of salt-fermented fish and kimchi elevated the risk of early gastric cancer.
CONCLUSION
These results suggest that some dietary factors and H. pylori infection have a significant association with the development of early gastric cancer.

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Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies
Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim
Epidemiology and Health.2023; 45: e2023102. CrossRef
Effect of dietary vitamin C on gastric cancer risk in the Korean population
Bach Viet Hoang, Jeonghee Lee, Il Ju Choi, Young-Woo Kim, Keun Won Ryu, Jeongseon Kim
World Journal of Gastroenterology.2016; 22(27): 6257. CrossRef
Epidemiology and screening of gastric cancer in Korea
Minkyo Song, Hwi-Won Lee, Daehee Kang
Journal of the Korean Medical Association.2015; 58(3): 183. CrossRef
Gastric Cancer Epidemiology in Korea
Aesun Shin, Jeongseon Kim, Sohee Park
Journal of Gastric Cancer.2011; 11(3): 135. CrossRef
Fresh and pickled vegetable consumption and gastric cancer in Japanese and Korean populations: A meta‐analysis of observational studies
Hyun Ja Kim, Sun Young Lim, Jung‐Sug Lee, Sohee Park, Aesun Shin, Bo Youl Choi, Taichi Shimazu, Manami Inoue, Shoichiro Tsugane, Jeongseon Kim
Cancer Science.2010; 101(2): 508. CrossRef
Identifying the Risk Factors Through the Development of a Predictive Model for Gastric Cancer in South Korea
Dong-Suk Lee, Han-Kwang Yang, Jong-Won Kim, Jeong-Whan Yook, Seong-Hoon Jeon, Sung-Hak Kang, Young-Ju Kim
Cancer Nursing.2009; 32(2): 135. CrossRef

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Clinicopathological Analysis for Recurrence after Surgery for Early Gastric Cancer: K W Chung, S J Cho, H K Yang, W H Kim, K U Lee, K J Choe, Y I Kim, J P Kim; J Korean Cancer Assoc. 2000;32(2):312-320.

Abstract PDF: PURPOSE
The incidence of early gastric cancer (EGC) is increasing in Korea. The prognosis of EGC is excellent but a small portion of patients experience recurrence after curative resection. We aimed to study recurrence rate of EGC, recurrence pattern of EGC and to find predicting factors for recurrence. We analyzed treatment results after recurrence in EGC.
MATERIALS AND METHODS
One thousand four hundred fifty eight patients with EGC at Department of Surgery, Seoul National University Hospital (1986~1995) were reviewed for recurrence retrospectively.
RESULTS
Twenty-six patients had recurrence after curative resection (1.79%). Thirteen cases (50%) recurred within 24 months (early recurrence) and late recurrence after 60 months occured in 4 cases (15%). The common modes of recurrence were locoregional (9, 34.6%) and distant metastasis (9, 34.6%). Submucosal invasion was in 19 cases and lymph node metastasis was positive in 14 cases. Median survival after recurrence was 5.6 months. Median survival after recurrence was 3.1 months after conservative management, 5.8 months after chemotherapy, and 46.8 months after resection. Recurrence rate was significantly higher in submucosal invasion group than mucosal invasion group (2.6% vs. 1.0%, p<0.05) and lymph node metastasis positive group than negative group (7.4% vs. 1.0%, p <0.001) by univariate analysis. Multivariate analysis revealed significantly high correlation between positive lymph node metastasis and recurrence (p < 0.001).
CONCLUSION
Lymph node metastasis is the most significant predictor of recurrence. Resection for locoregional recurrence can be beneficial.

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Clinicopathologic Findings of Early Gastic Cancer: Young Bae Ko, Won Gon Kim, Joon Mee Kim; J Korean Cancer Assoc. 1999;31(1):62-71.

Abstract PDF: PURPOSE
The prognosis forearly gastric cancer (EGC) is generally excellent after curative gastrectomy alone. However, the EGC of young patients was generally more invasive and metastasizing, and the prognosis of them was poorer than those of the elderly. We performed a retrospective study to evaluate clinica1 and pathological factors influencing the prognosis of EGC.
MATERIALS AND METHODS
The authors investigated 66 cases of EGC resected at Inha Hospital in Song-Nam, from January 1987 to December 1996. We analyzed 9 clinicopathologic factors: age, sex, macroscopic type, tumor size, depth of invasion, location, lymph node metastasis, Williss classification and Laurens classification.
RESULTS
Out of 66 cases (42 males, 24 females) of EGC, the sex ratio (M: F) was 1.75: 1, and the mean age was 55.5 years in male and 54.3 in female. The age incidence revealed a greater prevalence on 6th decade (33.3%). The most common macroscopic type of EGC was IIb and its combined type (43 cases, 65.2%). In tumor size, 16 cases (24.2%) were between 2.0 and 2.9 cm, and 13 cases (19.6%) between 1.0 and 1.9 cm, 10 cases (15%) between 3.0 and 3.9 cm. The tumors smaller than 2.0 cm were 33.2% but greater than 5.0 cm were 18.8%. In male, mucosal lesions were more common (66.6%) than submucosal lesions (33.4%); but in female, the incidence of both types of lesions were the same. The submucosal lesion in female was the most frequent at 4th decade. The major location of EGC was antrum (51.5%). Lymph node metastases were found in 3 females and 1 male. By Williss classification, poorly differentiated adenocarcinoma and signet ring cell carcinoma were more common in female (29.2%, 25%) than in male (11.9%, 14.3%). By Laurens classification, the diffuse type was more common in female (50%) than in male (33.3%). This type was the most frequent in 4th decade female patients. However, none of the above data reached statistical significance.
CONCLUSION
We found the generalized tendency, though not statistically confinned, that the young female patients of EGC frequently had larger and poorly differentiated, diffuse adenocarcinomas with more frequent lymph node metastasis than male. The authors emphasizes that a further study would be needed in young female patients of EGC on hormonal factors influencing its clinicopathologic findings.

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Prognostic Factor in Early Gastric Cancer: Seung Hwan Lee, Hyung Rok Kim, Dong Yi Kim, Young Jin Kim, Shin Kon Kim; J Korean Cancer Assoc. 1998;30(6):1096-1102.

Abstract PDF: PURPOSE
In advanced gastric cancer, the important prognostic factors are depth of invasion and status of lymph node metastasis, etc. In early gastric cancer, it remains controversial that depth of invasion or lymph node metastasis is corelated to the prognosis. A retrospective analysis of early gastric cancer was performed to evaluate the clinicopathologic features and to know the factors affecting the prognosis.
MATERIALS AND METHODS
From January 1981 to May 1997, we experienced 1850 cases of gastric cancer who performed gastric resections. Among them, 371 cases were early gastric cancer (20.1% of all resected gastric cancer cases). We defined 12 variable factors such as sex, age, tumor location, gross type, histologic type, depth of invasion, status of lymph node metastasis, tumor size, DNA ploidy pattem, stage, operation type, and resection type for prognostic factor and analyzed them.
RESULTS
Overall five year survival rate was 89.6% and ten year survival rate was 82.0%. The trend of annual incidence in recent nine years showed steady increase from 13.1% in 1988 to 25.7% in 1996. Survival showed no significant correlation with sex, age, tumor location, gross type, histologic type, tumor size, DNA ploidy, resection type. According to univariate analysis, depth of invasion, lymph node metastasis, stage had statistically significant association with prognosis. Among them, lymph node metastasis had an inde- pendent and predominant impact on survival according to multivariate analysis.
CONCLUSION
Early gastric cancer appears to show steady increase of annual incidence, and lymph node metastasis appears to be closely related to the prognosis.

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Prognostic Factors in Early Gastric Cancer: Song Cheol Kim, Yoon Seok Hur, Jin Pok Kim; J Korean Cancer Assoc. 1994;26(1):1-9.

Abstract PDF: A retrospective study of 797 cases of early gastric cancer(EGC) operated from 1981 to 199l at Seoul National University Hospital was performed to evaluate its prognostic factors for 9 clinicopathologic factors(sex, age, tumor location, gross type, histology, depth of invasion, lymph node metastasis, resection type). The incidence of EGC in gastric cancer was 20.l% and overall 5 year survival rate was 93%. In univariate and multivariate analysis af the above mentioned 9 factors, stastically significant prognostic factor was only regional lymph node metastasis(P<0.05). In addition, signet ring cell carcinoma was more prevalent in EGC(2.9 times) than in AGC and had a good prognosis than other histalogic type. In conclusion, extensive lymphadenectomy(R2 or R2+a) is needed only in AGC but also in EGC. And more extensive study on the prognostic factors of the signet ring cell carcinoma that has been considered as a poor prognostic type is further necessory to clarify the good effect in EGC and bad effect in AGC.

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Are There Any Clinicopathologic Differences Between Mucosal And Subumucosal Cancer Of Stomach ?: Byung Wha Chung, Cho Hyun Park, Seong Taek Oh, Jong Soe Lee, Woo Bae Park, Byoung Kee Kim, Sang Yong Choo, In Chul Kim; J Korean Cancer Assoc. 1994;26(3):385-392.

Abstract PDF: From 1980 through 1991, 17Z9 patients underwent operation for gastric cancer at Department of Surgery, Catholic University Medical College in Seoul, Korea. Three hundred and twelve patients (18.0%) were early gastric cancer (EGC): mucosal cancer were 107 cases (34.3%) and submucosa1 cancer were 205 cases (65.7%). The purpose of the present study was to compare the clinicopathologic features of EGC between mucosal cancer and submucosal cancer. Submucosal cancer developed in older age than mucosal cancer (average 55 vs 49 years old). No differences, however, were noted in clinical manifestations and duration of symptoms. Macroscopically, elevated lesions (type I or IIa predominant) were frequently encountered in submucosal cancer than mucosal cancer (24.6 vs 9.7%). Histologically, differentiated carcinoma or intestinal type by Lauren's classification was more common in submucosal cancer than mucosal cancer. The incidence of lymph node metastasis of EGC was 15.1% (47/312): 2.8% (3/ 107) in mucosal cancer and 21.5% (44/205) in submucosal cancer. Lymph node involvement of submucosal cancer was significantly higher in patients with elevated lesions (35.3%) than in depressed lesions (13.5%). No lymphatic or venous invasion was noted in mucosal cancer. In submucosal cancer, however, incidence of venous and lymphatic invasion was 7.2% and 20.3%, respectively. Kaplan-Meier estimates for 5-year survival were 98% for mucosal lesions and 79% for submucosal lesions (overall 5-year survival rate; 86.3%). The Syear survival rate in patients of submucosal cancer with lymph node metastasis was only 60% comyared with 88.5% in pa- tients of submucosal cancer without lymph node involvement. All recurrent cases were submucosal cancer patients. Six out of the 9 recurrent patients were macroscopically elevated type and had lymph nade metastasis. The authors conclude that there is definite difference in terms of clinicopathologic findings between mucosal and submucosal cancer of stomach even though EGC includes both lesions by definition. So, therapeutic approach of submucosal cancer should be different from mucosal cancer.

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Analysis of High Risk Factors for Lymph Node Metastasis in Early Gastric Cancer: Sung Hoon Noh, Wan Soo Kim, Ki Hyeok Lah, Yong Il Kim, Seung Ho Choi, Coong Bai Kim, Jin Sik Min, Kyung Shik Lee; J Korean Cancer Assoc. 1996;28(1):27-35.

Abstract PDF: The prognosis of early gastric cancer (EGC) is generally excellent, and the proportion of EGC cases to advanced gastric cancer cases is steadily increasing nowadays. The presence or absence of lymph node metastasis in EGC is important prognostic factor, in other words, the survival rate or recurrence rate of node negative EGC is known to be much better than that of node positive ones. Retrospective analysis was performed for 682 EGC cases which underwent more than D2 resection in Yonsei medical center between 1986 Jan. to 1993 Dec, in order to investigate the clinicopathological factors to predict the possibility of lymph node metastasis. In this study, several factors such as age, sex, tumor location, tumor size, multiplicity, depth of invasion, macroscopic and histologic type were evaluated to determine the significance. In the analysis of these eight factors, sex, tumor size, depth of invasion and macroscopic type were statistically correlated with lymph node metastasis. We consider these factors to be possible high risk factors for lymph node metastasis in early gastric cancer.

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Analysis of Recurrence and Survival Rate in Early Gastric Castric Cancer Patients: Seong Kwang Chang, Nam Sun Paik, Nan Mo Moon, Ho Yoon Bang, Jong Inn Lee, Dong Wook Choi; J Korean Cancer Assoc. 1996;28(6):1021-1032.

Abstract PDF: The prognosis of surgically treated early gastric cancer(EGC) is usually excellent and the recurrence rate is quite low. From January l985 to December l993, 708 cases of EGC among 4408 cases of gastric cancer underwent gastrectomy in Korea Cancer Center Hospital. Among them 619 cases could be followed-up, and disclosed 24 cases(3.9%) of recurred EGC. 5 and 10 year survival rate in EGC exclusive of other cause of death were 95.8% and 95.4%. Mean interval between surgery and recurrence was 31.7 month and mean survival time was 40.3 month. Retrospective analysis was performed to evaluate the clinicopathological factors which relate to recurrence and survival rate. In univariated and multivariated analysis of factors, statistically significant prognostic factors are regional lymph node metastasis and macroscopically elevated type(p<0.05). Mode of recurrence in EGC was commonly hematogenous metastasis(69.7%), and frequent metastatic sites were liver, bone and lung

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Histocompatibility Antigens in Primary Gastric Carcinoma in Young Korean Adults: Tai Ho Chung, Jung Chul Kim, Da Mi Lee, Suk Joo Lee, Soo Il Chang, Wan Sik Yu, In Sun Lee; J Korean Cancer Assoc. 1996;28(6):1032-1040.

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