Clinicopathologic Factors Influencing Endoscopic Versus Surgical Approaches in Patients With T1b Gastric Carcinoma With Lymphoid Stroma.

Pathologic T1b (pT1b) gastric carcinoma with lymphoid stroma (GCLS) has been proposed as a potential candidate for endoscopic resection due to reported low rates of lymph node metastasis (LMN). Evaluation of the clinicopathological factors associated with the risk of LNM may lead to improved treatment options for patients with pT1b GCLS. A retrospective cohort analysis examined 102 patients with resected pT1b GCLS from 2012 to 2022. Patients with pT1b gastric adenocarcinoma (GAC) served as the control group. We investigated the clinicopathologic factors associated with the risk of LNM and potential morbidities related to endoscopic approaches in patients with T1b GCLS. Of the 102 patients with pT1b GCLS, 88.2% had positive Epstein-Barr virus (EBV) tests. Tumors were located in the upper stomach in 20.6% of pT1b GCLS patients, with a median submucosal invasion depth of 1430 µm. LNM was identified in 11.8% of these patients (each, p < 0.01). In comparison, among the 143 patients with pT1b GAC, only 0.7% had positive EBV tests. Tumors were located in the upper stomach in 5.6% of these patients, with a median submucosal invasion depth of 700 µm, and 20.3% of GAC patients had LNM. Considering the higher rates of deeply invading submucosal tumors and of LNM, our study suggests that surgical approaches should remain the standard recommended therapy for patients with pT1b GCLS.