title: Risk factors for lymph node metastasis from intramucosal gastric carcinoma.
abstract: BACKGROUND
  Although regional lymph node metastasis from intramucosal early gastric carcinoma (EGC) is rare, it is very important to clarify the characteristics of patients having lymph nodal metastases in order to determine appropriate therapy.
  
  
  METHODS
  The authors investigated 1196 patients with solitary intramucosal EGC who underwent resection at the National Cancer Center Hospital in Tokyo, with special reference to lymph node metastases. Eight clinicopathologic factors (age, sex, tumor: size, location, macroscopic type, histologic type, histologic ulceration of the tumor, and lymphatic vessel invasion) were investigated by univariate and multivariate analyses for their possible relationship to lymph node metastasis.
  
  
  RESULTS
  Lymph node metastases were found in 43 patients (3.5%). Univariate analysis revealed that younger age (< 57 years), macroscopic depressed type, larger tumor size (> or= 30 mm), undifferentiated histologic type, histologic ulceration of the carcinoma, and lymphatic vessel invasion had a significant association with regional lymph node metastasis. Multivariate analysis revealed that lymphatic vessel invasion, histologic ulceration of the tumor, and larger size (> or = 30 mm) were independent risk factors for regional lymph node metastasis. The incidence of lymph node metastasis from intramucosal EGC negative for these 3 risk factors was only 0.36% (1 in 277 patients).
  
  
  CONCLUSIONS
  Lymphadenectomy is unnecessary for patients with small intramucosal EGC with neither histologic ulceration of the tumor nor lymphatic vessel invasion because the incidence of regional lymph node metastasis is extremely low in those patients. The therapeutic options for such patients would be local resection or endoscopic resection.
authors.affiliation: Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamao
authors.forename: K
authors.initials: K
authors.lastname: Shirao
authors.forename: H
authors.initials: H
authors.lastname: Ono
authors.forename: H
authors.initials: H
authors.lastname: Kondo
authors.forename: D
authors.initials: D
authors.lastname: Saito
authors.forename: H
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: M
authors.initials: M
authors.lastname: Sasako
authors.forename: T
authors.initials: T
authors.lastname: Sano
authors.forename: A
authors.initials: A
authors.lastname: Ochiai
authors.forename: S
authors.initials: S
authors.lastname: Yoshida
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D005753:Gastric Mucosa; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery