Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

Abstract

Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

“…Ulceration was again confirmed as a non‐risk factor of LNM in this large multicenter study. Overall, these results are parallel to those reported previously and add to the growing body of knowledge by providing more precise features of LNM in EGC of Chinese patients . The findings may help to improve the decision‐making process for managing Chinese patients with EGC.…”

Risk factors of lymph node metastasis in early gastric carcinomas diagnosed by WHO criteria in 379 Chinese patients

“…Based on the latest WHO definition of EGC, poorly cohesive carcinomas, including signet ring cell carcinoma and its variants, as well as poorly differentiated adenocarcinomas, correspond to the diffuse GC in the Lauren classification and the undifferentiated type in the Japanese classification. This group of EGC is well‐known for its propensity for LNM . Indeed, poorly cohesive carcinomas account for over half of the LNM cases (26/49, 53.1%) in our cohort, reinforcing the notion that this type of EGC has a high risk of LNM.…”

“…The standard criteria for endoscopic resection of EGC, according to the Japanese Gastric Cancer Association (JGCA) guidelines, include tumors with mucosal or submucosal invasion up to 500 µm (SM1), size up to 2 cm for EMR and 3 cm for ESD, having a non‐excavated gross pattern and a differentiated histological type (i.e., tubular and papillary adenocarcinomas of the Lauren classification). Although widely adopted, the application of the JGCA guidelines in the management of EGC in Chinese patients has been questioned by many Chinese studies that have identified different independent risk factors such as male sex, tumor size ≥2 cm and depth of tumor invasion. Several Chinese studies also reported the recurrence rates of up to 12.2% and LNM rates up to 25.4% .…”

Endoscopic band ligation without resection in selected patients for small and superficial upper gastrointestinal tract lesions

“…Second, an obvious drawback of this technique is not having a histological piece, which would indicate the degree of T1 tumor involvement (m or sm; T1a or T1b, respectively) and, consequently, the need for a lymphadenectomy in a patient with no surgical risk. In esophageal cancer the lymph node metastasis rate is known to be 6% (T1m) and 29% (T1sm) (12); in gastric cancer 3.3% (T1m) and 23.5% (T1sm) (13); and in duodenal NET 4% (T1m) and 28% (T2) (14). For this reason, each patient was discussed among the members of the UGI multidisciplinary cancer committee and in each case it was decided that, owing to the patient's condition, histology would not change clinical management, and so the procedure was carried out.…”