Risk of lymph node metastases from early gastric cancer in relation to depth of invasion: experience in a single institution.

Zheng Wang,Li Ma,Zhi-Xiang Zhou,Xing-Mao Zhang

doi:10.7314/apjcp.2014.15.13.5371

Zheng Wang, Li Ma + Show 2 more

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https://doi.org/10.7314/apjcp.2014.15.13.5371

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Abstract

An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of early gastric cancers. Therefore, this study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. A total of 518 early gastric cancer patients who underwent radical gastrectomy were reviewed in this study. Clinicopathological features were analyzed to identify predictive factors for lymph node metastasis. The rate of lymph node metastasis in early gastric cancer was 15.3% overall, 3.3% for mucosal cancer, and 23.5% for submucosal cancer. Using univariate analysis, risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. When the carcinomas were confined to the mucosal layer, tumor size showed a significant correlation with lymph node metastasis. On the other hand, histological type and lymphovascular invasion were associated with lymph node metastasis in submucosal carcinomas. Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer. Risk factors are quite different depending on depth of tumor invasion. Endoscopic treatment might be possible in highly selective cases.

Highlights

In 1962, the Japanese Society of Gastroenterological Endoscopy defined early gastric cancer as a lesion confined to the mucosa and/or submucosa, regardless of lymph node metastatic status (Murakami et al, 1971)
Histological type and lymphovascular invasion were independently associated with lymph node metastasis in submucosal gastric carcinoma group (Table 3)
The average 5-year survival rate in patients with early gastric cancer is over 90%, and it is up to 94.2% in patients without lymph node metastasis (Noh et al, 2005)

Summary

Introduction

In 1962, the Japanese Society of Gastroenterological Endoscopy defined early gastric cancer as a lesion confined to the mucosa and/or submucosa, regardless of lymph node metastatic status (Murakami et al, 1971). Many investigations have shown that the presence of lymph node metastasis is the most important prognostic factor for patients with early gastric cancer and has a significant influence on the selection of possible treatment (Ohta et al, 1987; Haves et al, 1996). This study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. Risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. Conclusions: Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer.

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