Predictors of lymph node metastasis in early gastric cancer

Abstract

Data were analysed on 396 patients with early gastric cancer who underwent resection in this department; special reference was made to lymph node metastasis. Metastases were present in the dissected lymph nodes of 47 patients (11.9 per cent). The survival rate for patients with metastasis to lymph nodes was lower than for those without such metastasis (P less than 0.05). Lymph node metastasis was associated with larger tumour, a higher incidence of submucosal invasion, a higher rate of lymphatic vessel involvement, an advanced stage of disease and a non-curative resection rate of 6.4 per cent. Multivariate analysis showed that the independent risk factors for lymph node metastasis in patients with early gastric cancer were large tumour size, lymphatic vessel involvement and invasion into the submucosal layer. In patients with these risk factors, lymph node dissection and postoperative adjuvant therapy should be performed in an attempt to prevent recurrence in the form of lymph node metastasis.

Early gastric cancer mimicking advanced gastric cancer

“…In the present study, massive sm invasion was particularly frequent when EGCs mimicking AGCs also had lymph node metastasis. This result is explainable by the observation that the submucosal layer of the stomach is rich in lymphatic capillaries (Inoue et al, 1991;Maehara et al, 1992;Sano et al, 1992). We showed that 60% of EGCs simulating AGC had sm3 invasion, whereas 24% of the other EGCs had sm3 invasion.…”

“…The resected lymph nodes were also examined using three central sections to confirm the presence of metastasis. (Hioki et al, 1990;Maehara et al, 1992). Our study revealed that, of these factors, a greater tumour size, massive sm invasion and frequent lymph vessel invasion were more prominent in EGCs mimicking AGCs than in the other EGCs.…”

“…This low frequency indicates that extensive lymph node dissection is not required for the surgical treatment of the majority of EGC cases. A number of previous studies have shown that patients with EGCs have an excellent survival prognosis, and the recurrence rate is under 10% in most Japanese hospitals (Hioki et al, 1990;Maehara et al, 1992). The observations mentioned above are reflected by a recent trend in the surgical treatment for patients with EGCs: it is currently common to choose a surgical procedure such as limited surgery so that a complete cure is achieved and the patient's quality of life is improved (Ichiyoshi et al, 1990;Kitamura et al, 1 995b).…”

“…Early gastric cancer (EGC) now accounts for over 50% of all gastric malignancies in most Japanese hospitals (Hioki et al, 1990;Maehara et al, 1992). As these incidences have increased, the clinicopathological features of EGCs have been gradually elucidated by various authors (Mori et al, 1985;Ohta et al, 1987;Moreaux et al, 1993).…”

“…Lymph node metastasis in EGCs is infrequent, and is generally no more than 10% (Hioki et al, 1990;Maehara et al, 1992;Kitamura et al, 1995a). This low frequency indicates that extensive lymph node dissection is not required for the surgical treatment of the majority of EGC cases.…”