Risk stratification for lymph node metastasis using Epstein–Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study
Background Lymphovascular invasion (LVI) is a strong predictive factor for lymph node metastasis (LNM) in early gastric cancer (GC). This study investigated the risk for LNM in pT1b GC without LVI based on Epstein–Barr virus (EBV) status in addition to conventional clinicopathological parameters. Me...
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| Veröffentlicht in: | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2019-11, Vol.22 (6), p.1176-1182 |
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| container_title | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association |
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| creator | Osumi, Hiroki Kawachi, Hiroshi Murai, Katsuyuki Kusafuka, Kimihide Inoue, Shuntaro Kitamura, Masaki Yoshio, Toshiyuki Kakusima, Naomi Ishihara, Ryu Ono, Hiroyuki Yamamoto, Noriko Sugino, Takashi Nakatsuka, Shinichi Ida, Satoshi Nunobe, Souya Bando, Etsuro Omori, Takeshi Takeuchi, Kengo Fujisaki, Junko |
| description | Background
Lymphovascular invasion (LVI) is a strong predictive factor for lymph node metastasis (LNM) in early gastric cancer (GC). This study investigated the risk for LNM in pT1b GC without LVI based on Epstein–Barr virus (EBV) status in addition to conventional clinicopathological parameters.
Methods
In total, 847 consecutive patients of pT1b GC without LVI who underwent surgery at three high-volume centers between 2005 and 2014 were retrospectively analyzed. Clinicopathological parameters and EBV status were evaluated, and univariate and multivariate analyses were performed to estimate LNM risk. With regard to the presence of those three parameters, risk stratification for LNM was performed and compared with a previously proposed risk classification that included low-risk (LNM |
| doi_str_mv | 10.1007/s10120-019-00963-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2232131259</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2308221654</sourcerecordid><originalsourceid>FETCH-LOGICAL-c564t-42d72d326bc882362d8eece3cb40f5a3f757d324e56193dae6e272d649a931aa3</originalsourceid><addsrcrecordid>eNp9ks9u1DAQxiMEoqXwAhyQJS7tIeCxE2fDDaryR6qEhMo58jqTrUtiB4-9aG-8Q9-Hh-FJcJstSBwqWR5b8_u-GWmmKJ4DfwWcN68JOAhecmhLzlsly-ZBcQiVVKWUvH549xYtHBRPiK44h7oF9bg4kMCVgLY-LH59sfSNUQw62sGafHvHBh_YuJvmS-Z8j2zCqCkfSyyRdRt2NlNE637_vH6nQ2BbGxJlDx1zsI5RWk_JeNJj_m2zbovseL6AE7bJPsEaZrQzGNgPGy99ikstn0mTRh32Iu_eMM2mNEZr0MWM-zVh2N62mK0ppn73tHg06JHw2T4eFV_fn12cfizPP3_4dPr2vDS1qmJZib4RvRRqbVYrIZXoV4gGpVlXfKi1HJq6yekKawWt7DUqFFmgqla3ErSWR8Xx4jsH_z0hxW6yZHActUOfqBNCCpAg6jajL_9Dr3wKueNMSb4SAlRd3UsJwWuAprnxEgtlgicKOHRzsJMOuw54d7MD3bIDXd6B7nYHuiaLXuyt8xyw_yu5G3oG5AJQTrkNhn-177H9A6HRwYI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2220511779</pqid></control><display><type>article</type><title>Risk stratification for lymph node metastasis using Epstein–Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Osumi, Hiroki ; Kawachi, Hiroshi ; Murai, Katsuyuki ; Kusafuka, Kimihide ; Inoue, Shuntaro ; Kitamura, Masaki ; Yoshio, Toshiyuki ; Kakusima, Naomi ; Ishihara, Ryu ; Ono, Hiroyuki ; Yamamoto, Noriko ; Sugino, Takashi ; Nakatsuka, Shinichi ; Ida, Satoshi ; Nunobe, Souya ; Bando, Etsuro ; Omori, Takeshi ; Takeuchi, Kengo ; Fujisaki, Junko</creator><creatorcontrib>Osumi, Hiroki ; Kawachi, Hiroshi ; Murai, Katsuyuki ; Kusafuka, Kimihide ; Inoue, Shuntaro ; Kitamura, Masaki ; Yoshio, Toshiyuki ; Kakusima, Naomi ; Ishihara, Ryu ; Ono, Hiroyuki ; Yamamoto, Noriko ; Sugino, Takashi ; Nakatsuka, Shinichi ; Ida, Satoshi ; Nunobe, Souya ; Bando, Etsuro ; Omori, Takeshi ; Takeuchi, Kengo ; Fujisaki, Junko</creatorcontrib><description>Background
Lymphovascular invasion (LVI) is a strong predictive factor for lymph node metastasis (LNM) in early gastric cancer (GC). This study investigated the risk for LNM in pT1b GC without LVI based on Epstein–Barr virus (EBV) status in addition to conventional clinicopathological parameters.
Methods
In total, 847 consecutive patients of pT1b GC without LVI who underwent surgery at three high-volume centers between 2005 and 2014 were retrospectively analyzed. Clinicopathological parameters and EBV status were evaluated, and univariate and multivariate analyses were performed to estimate LNM risk. With regard to the presence of those three parameters, risk stratification for LNM was performed and compared with a previously proposed risk classification that included low-risk (LNM < 3.0%), intermediate-risk (LNM ≥ 3.0 and < 19.6%), and high-risk (LNM ≥ 19.6%) groups.
Results
EBV-positive GC (EBVGC) accounted for 11.3% (96 of 847) of cases; LNM was lower in EBVGC than in non-EBVGC (1 of 96, 1.0% vs. 71/751, 9.5%). In the multivariate analysis, non-EBVGC [odds ratio (OR) 10.8, 95% confidence interval (CI) 1.48–78.9], age < 65 years (OR 2.13, 95% CI 1.30–3.48), and tumor diameter > 3 cm (OR 2.26, 95% CI 1.36–3.74) were independent risk factors for LNM. Patients with EBVGC were at low risk for LNM whereas those with all of three independent risk factors were at high risk (36 of 168, 21.4%, 95% CI 15.5–28.4).
Conclusion
LNM risk stratification that includes EBV status is useful for clinical decision-making in pT1b GC cases without LVI.</description><identifier>ISSN: 1436-3291</identifier><identifier>EISSN: 1436-3305</identifier><identifier>DOI: 10.1007/s10120-019-00963-7</identifier><identifier>PMID: 31062195</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Cancer Research ; Decision making ; Epstein-Barr virus ; Epstein-Barr Virus Infections - diagnosis ; Female ; Gastric cancer ; Gastroenterology ; Herpesvirus 4, Human - isolation & purification ; Humans ; Invasiveness ; Lymph nodes ; Lymphatic Metastasis ; Lymphatic system ; Male ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Middle Aged ; Multivariate analysis ; Neoplasm Invasiveness ; Observational studies ; Oncology ; Original Article ; Patients ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms - pathology ; Stomach Neoplasms - virology ; Surgery ; Surgical Oncology</subject><ispartof>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2019-11, Vol.22 (6), p.1176-1182</ispartof><rights>The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019</rights><rights>Gastric Cancer is a copyright of Springer, (2019). All Rights Reserved.</rights><rights>The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c564t-42d72d326bc882362d8eece3cb40f5a3f757d324e56193dae6e272d649a931aa3</citedby><cites>FETCH-LOGICAL-c564t-42d72d326bc882362d8eece3cb40f5a3f757d324e56193dae6e272d649a931aa3</cites><orcidid>0000-0002-6546-0329</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10120-019-00963-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10120-019-00963-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31062195$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Osumi, Hiroki</creatorcontrib><creatorcontrib>Kawachi, Hiroshi</creatorcontrib><creatorcontrib>Murai, Katsuyuki</creatorcontrib><creatorcontrib>Kusafuka, Kimihide</creatorcontrib><creatorcontrib>Inoue, Shuntaro</creatorcontrib><creatorcontrib>Kitamura, Masaki</creatorcontrib><creatorcontrib>Yoshio, Toshiyuki</creatorcontrib><creatorcontrib>Kakusima, Naomi</creatorcontrib><creatorcontrib>Ishihara, Ryu</creatorcontrib><creatorcontrib>Ono, Hiroyuki</creatorcontrib><creatorcontrib>Yamamoto, Noriko</creatorcontrib><creatorcontrib>Sugino, Takashi</creatorcontrib><creatorcontrib>Nakatsuka, Shinichi</creatorcontrib><creatorcontrib>Ida, Satoshi</creatorcontrib><creatorcontrib>Nunobe, Souya</creatorcontrib><creatorcontrib>Bando, Etsuro</creatorcontrib><creatorcontrib>Omori, Takeshi</creatorcontrib><creatorcontrib>Takeuchi, Kengo</creatorcontrib><creatorcontrib>Fujisaki, Junko</creatorcontrib><title>Risk stratification for lymph node metastasis using Epstein–Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study</title><title>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association</title><addtitle>Gastric Cancer</addtitle><addtitle>Gastric Cancer</addtitle><description>Background
Lymphovascular invasion (LVI) is a strong predictive factor for lymph node metastasis (LNM) in early gastric cancer (GC). This study investigated the risk for LNM in pT1b GC without LVI based on Epstein–Barr virus (EBV) status in addition to conventional clinicopathological parameters.
Methods
In total, 847 consecutive patients of pT1b GC without LVI who underwent surgery at three high-volume centers between 2005 and 2014 were retrospectively analyzed. Clinicopathological parameters and EBV status were evaluated, and univariate and multivariate analyses were performed to estimate LNM risk. With regard to the presence of those three parameters, risk stratification for LNM was performed and compared with a previously proposed risk classification that included low-risk (LNM < 3.0%), intermediate-risk (LNM ≥ 3.0 and < 19.6%), and high-risk (LNM ≥ 19.6%) groups.
Results
EBV-positive GC (EBVGC) accounted for 11.3% (96 of 847) of cases; LNM was lower in EBVGC than in non-EBVGC (1 of 96, 1.0% vs. 71/751, 9.5%). In the multivariate analysis, non-EBVGC [odds ratio (OR) 10.8, 95% confidence interval (CI) 1.48–78.9], age < 65 years (OR 2.13, 95% CI 1.30–3.48), and tumor diameter > 3 cm (OR 2.26, 95% CI 1.36–3.74) were independent risk factors for LNM. Patients with EBVGC were at low risk for LNM whereas those with all of three independent risk factors were at high risk (36 of 168, 21.4%, 95% CI 15.5–28.4).
Conclusion
LNM risk stratification that includes EBV status is useful for clinical decision-making in pT1b GC cases without LVI.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer Research</subject><subject>Decision making</subject><subject>Epstein-Barr virus</subject><subject>Epstein-Barr Virus Infections - diagnosis</subject><subject>Female</subject><subject>Gastric cancer</subject><subject>Gastroenterology</subject><subject>Herpesvirus 4, Human - isolation & purification</subject><subject>Humans</subject><subject>Invasiveness</subject><subject>Lymph nodes</subject><subject>Lymphatic Metastasis</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Neoplasm Invasiveness</subject><subject>Observational studies</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - virology</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>1436-3291</issn><issn>1436-3305</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks9u1DAQxiMEoqXwAhyQJS7tIeCxE2fDDaryR6qEhMo58jqTrUtiB4-9aG-8Q9-Hh-FJcJstSBwqWR5b8_u-GWmmKJ4DfwWcN68JOAhecmhLzlsly-ZBcQiVVKWUvH549xYtHBRPiK44h7oF9bg4kMCVgLY-LH59sfSNUQw62sGafHvHBh_YuJvmS-Z8j2zCqCkfSyyRdRt2NlNE637_vH6nQ2BbGxJlDx1zsI5RWk_JeNJj_m2zbovseL6AE7bJPsEaZrQzGNgPGy99ikstn0mTRh32Iu_eMM2mNEZr0MWM-zVh2N62mK0ppn73tHg06JHw2T4eFV_fn12cfizPP3_4dPr2vDS1qmJZib4RvRRqbVYrIZXoV4gGpVlXfKi1HJq6yekKawWt7DUqFFmgqla3ErSWR8Xx4jsH_z0hxW6yZHActUOfqBNCCpAg6jajL_9Dr3wKueNMSb4SAlRd3UsJwWuAprnxEgtlgicKOHRzsJMOuw54d7MD3bIDXd6B7nYHuiaLXuyt8xyw_yu5G3oG5AJQTrkNhn-177H9A6HRwYI</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Osumi, Hiroki</creator><creator>Kawachi, Hiroshi</creator><creator>Murai, Katsuyuki</creator><creator>Kusafuka, Kimihide</creator><creator>Inoue, Shuntaro</creator><creator>Kitamura, Masaki</creator><creator>Yoshio, Toshiyuki</creator><creator>Kakusima, Naomi</creator><creator>Ishihara, Ryu</creator><creator>Ono, Hiroyuki</creator><creator>Yamamoto, Noriko</creator><creator>Sugino, Takashi</creator><creator>Nakatsuka, Shinichi</creator><creator>Ida, Satoshi</creator><creator>Nunobe, Souya</creator><creator>Bando, Etsuro</creator><creator>Omori, Takeshi</creator><creator>Takeuchi, Kengo</creator><creator>Fujisaki, Junko</creator><general>Springer Singapore</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6546-0329</orcidid></search><sort><creationdate>20191101</creationdate><title>Risk stratification for lymph node metastasis using Epstein–Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study</title><author>Osumi, Hiroki ; Kawachi, Hiroshi ; Murai, Katsuyuki ; Kusafuka, Kimihide ; Inoue, Shuntaro ; Kitamura, Masaki ; Yoshio, Toshiyuki ; Kakusima, Naomi ; Ishihara, Ryu ; Ono, Hiroyuki ; Yamamoto, Noriko ; Sugino, Takashi ; Nakatsuka, Shinichi ; Ida, Satoshi ; Nunobe, Souya ; Bando, Etsuro ; Omori, Takeshi ; Takeuchi, Kengo ; Fujisaki, Junko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c564t-42d72d326bc882362d8eece3cb40f5a3f757d324e56193dae6e272d649a931aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer Research</topic><topic>Decision making</topic><topic>Epstein-Barr virus</topic><topic>Epstein-Barr Virus Infections - diagnosis</topic><topic>Female</topic><topic>Gastric cancer</topic><topic>Gastroenterology</topic><topic>Herpesvirus 4, Human - isolation & purification</topic><topic>Humans</topic><topic>Invasiveness</topic><topic>Lymph nodes</topic><topic>Lymphatic Metastasis</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Neoplasm Invasiveness</topic><topic>Observational studies</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - virology</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Osumi, Hiroki</creatorcontrib><creatorcontrib>Kawachi, Hiroshi</creatorcontrib><creatorcontrib>Murai, Katsuyuki</creatorcontrib><creatorcontrib>Kusafuka, Kimihide</creatorcontrib><creatorcontrib>Inoue, Shuntaro</creatorcontrib><creatorcontrib>Kitamura, Masaki</creatorcontrib><creatorcontrib>Yoshio, Toshiyuki</creatorcontrib><creatorcontrib>Kakusima, Naomi</creatorcontrib><creatorcontrib>Ishihara, Ryu</creatorcontrib><creatorcontrib>Ono, Hiroyuki</creatorcontrib><creatorcontrib>Yamamoto, Noriko</creatorcontrib><creatorcontrib>Sugino, Takashi</creatorcontrib><creatorcontrib>Nakatsuka, Shinichi</creatorcontrib><creatorcontrib>Ida, Satoshi</creatorcontrib><creatorcontrib>Nunobe, Souya</creatorcontrib><creatorcontrib>Bando, Etsuro</creatorcontrib><creatorcontrib>Omori, Takeshi</creatorcontrib><creatorcontrib>Takeuchi, Kengo</creatorcontrib><creatorcontrib>Fujisaki, Junko</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Osumi, Hiroki</au><au>Kawachi, Hiroshi</au><au>Murai, Katsuyuki</au><au>Kusafuka, Kimihide</au><au>Inoue, Shuntaro</au><au>Kitamura, Masaki</au><au>Yoshio, Toshiyuki</au><au>Kakusima, Naomi</au><au>Ishihara, Ryu</au><au>Ono, Hiroyuki</au><au>Yamamoto, Noriko</au><au>Sugino, Takashi</au><au>Nakatsuka, Shinichi</au><au>Ida, Satoshi</au><au>Nunobe, Souya</au><au>Bando, Etsuro</au><au>Omori, Takeshi</au><au>Takeuchi, Kengo</au><au>Fujisaki, Junko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk stratification for lymph node metastasis using Epstein–Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study</atitle><jtitle>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association</jtitle><stitle>Gastric Cancer</stitle><addtitle>Gastric Cancer</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>22</volume><issue>6</issue><spage>1176</spage><epage>1182</epage><pages>1176-1182</pages><issn>1436-3291</issn><eissn>1436-3305</eissn><abstract>Background
Lymphovascular invasion (LVI) is a strong predictive factor for lymph node metastasis (LNM) in early gastric cancer (GC). This study investigated the risk for LNM in pT1b GC without LVI based on Epstein–Barr virus (EBV) status in addition to conventional clinicopathological parameters.
Methods
In total, 847 consecutive patients of pT1b GC without LVI who underwent surgery at three high-volume centers between 2005 and 2014 were retrospectively analyzed. Clinicopathological parameters and EBV status were evaluated, and univariate and multivariate analyses were performed to estimate LNM risk. With regard to the presence of those three parameters, risk stratification for LNM was performed and compared with a previously proposed risk classification that included low-risk (LNM < 3.0%), intermediate-risk (LNM ≥ 3.0 and < 19.6%), and high-risk (LNM ≥ 19.6%) groups.
Results
EBV-positive GC (EBVGC) accounted for 11.3% (96 of 847) of cases; LNM was lower in EBVGC than in non-EBVGC (1 of 96, 1.0% vs. 71/751, 9.5%). In the multivariate analysis, non-EBVGC [odds ratio (OR) 10.8, 95% confidence interval (CI) 1.48–78.9], age < 65 years (OR 2.13, 95% CI 1.30–3.48), and tumor diameter > 3 cm (OR 2.26, 95% CI 1.36–3.74) were independent risk factors for LNM. Patients with EBVGC were at low risk for LNM whereas those with all of three independent risk factors were at high risk (36 of 168, 21.4%, 95% CI 15.5–28.4).
Conclusion
LNM risk stratification that includes EBV status is useful for clinical decision-making in pT1b GC cases without LVI.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>31062195</pmid><doi>10.1007/s10120-019-00963-7</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6546-0329</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2019-11, Vol.22 (6), p.1176-1182 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Cancer Research Decision making Epstein-Barr virus Epstein-Barr Virus Infections - diagnosis Female Gastric cancer Gastroenterology Herpesvirus 4, Human - isolation & purification Humans Invasiveness Lymph nodes Lymphatic Metastasis Lymphatic system Male Medicine Medicine & Public Health Metastases Metastasis Middle Aged Multivariate analysis Neoplasm Invasiveness Observational studies Oncology Original Article Patients Retrospective Studies Risk Factors Stomach Neoplasms - pathology Stomach Neoplasms - virology Surgery Surgical Oncology |
| title | Risk stratification for lymph node metastasis using Epstein–Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study |
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