Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers

Abstract

Abstract.With an increased incidence of early gastric cancer (egc) and advances in endoscopic technologies, endoscopic resection (er) has become an important treatment modality for egc. therefore, precise assessment of the risk of lymph node (ln) metastasis in er specimens has become essential. the widely accepted criteria for er have been mostly obtained from surgical data. this study was performed to evaluate the adequacy of these criteria and re-evaluate the predictive power of the criteria for ln metastasis. We evaluated a series of pathologic factors in er specimens from 79 gastric cancer patients treated with endoscopic mucosal resection (7) or endoscopic submucosal dissection (72) and underwent subsequent surgical resection due to the potential risk of ln metastasis. of the 79 patients, 10 patients (12.7%) exhibited regional ln metastasis. Univariate analysis revealed that the presence of lymphovascular invasion (lVI) was significantly associated with ln metastasis (26/69, 37.7 vs. 9/10, 90%, p=0.004). the number of LVI was significantly higher in the LN metastasis group (1.1±2.3 vs. 7.7±8.4, p<0.001). By multivariate analysis, the presence of lVI (odds ratio, 21.41; p=0.010) and undifferentiated histology (odds ratio, 11.15; P=0.016) were significantly correlated with ln metastasis. the presence of lVI, undifferentiated histology and the numbers of lVI were important risk factors for ln metastasis. Among these factors, the presence of lVI was the most important risk factor for ln metastasis in endoscopically resected early gastric cancer.

The Risk Factors of Lymph Node Metastasis in Early Gastric Cancer

“…Tumor size, submucosal invasion, and lymphatic invasion are independent risk factors for lymph node metastasis in EGC [15]. Among these factors, lymphatic invasion is the most important factor for lymph node metastasis [16]. In the present study, lymphatic invasion was associated with lymph node metastasis in both T1a and T1b lesions.…”

Epstein–Barr virus positivity, not mismatch repair-deficiency, is a favorable risk factor for lymph node metastasis in submucosa-invasive early gastric cancer

“…In many studies, the presence of LVI has been proven to be the most important and reliable risk factor for LNM [44][45][46]. In our previous study using a series (n = 79) of endoscopically resected EGCs sequentially treated by gastrectomy and lymph node dissection, the odds ratio of LVI for LNM was 21.41 (95 % confidence interval 2.11-217.28, p = 0.010) [46]. In our current study, the presence of LVI was also found to be the most important risk factor (odd ratio 7.45).…”

Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer

“…However, when the tumor invades into the sub-mucosa layer of the stomach wall in which lymphatic vessels are abundant, the rate of LNM increases significantly to above 10% [ 5 ] and the prognosis is relatively poor (Figs 1 and 2 ). Moreover, in some large-scale studies performed in Japan and Korea, the overall survival rate of lymph node-positive EGC fell to 70%-80%, and the relapse rate rose to 8%[ 6 – 8 ]. The use of radical surgery depends on the status of LNM.…”