[Clinical significance of micrometastasis in lymph nodes and microinvasion in primary lesion in submucosal gastric cancer].
OBJECTIVE
To clarify the clinicopathologic characteristics of micrometastasis in lymph nodes and microinvasion in primary lesion for the treatment options with regard to submucosal gastric cancer.


METHODS
1945 lymph nodes and 68 primary tumors resected from 79 patients with submucosal gastric cancer were examined. Two consecutive sections were prepared for simultaneous staining with HE and immunostaining with anti-cytokeratin antibody (CAM 5.2), respectively.


RESULTS
The incidence of nodal involvement in 79 patients with submucosal gastric cancer was increased from 13% (10/79 patients) by HE staining to 34% (27/79 patients) by cytokeratin immunostaining. Micrometastasis in the lymph nodes were found in 17 of 69 patients (25%) with cancer-free nodes examined by HE staining. Microinvasion to the muscularis properia was found in 11 of 68 patients (16%) who were histologically diagnosed as submucosal gastric cancer. Survival analysis demonstrated a worse 5-year survival in the patients with micrometastasis in lymph nodes (82%) and with microinvasion to muscularis properia (73%). A higher incidence of nodal involvement was found in submucosal cancers of large size (> 2 cm; 43%), a depressed type (48%), lymphatic invasion (73%), and deeper submucosal invasion (submucosal 3; 53%). A higher incidence of microinvasion was found with the diffused-type carcinoma (33%).


CONCLUSIONS
Cytokeratin immunostaining is useful for detecting micrometastasis and microinvasion in submucosal gastric cancer. Tumor size, microscopic type, lymphatic invasion, and the depth of submucosal invasion are strongly associated with lymph node involvement. Micrometastasis in lymph nodes and microinvasion in primary lesion indicate an unfavorable outcome of the patients with submucosal gastric cancer.
Cai
Jian-Hui
JH
Department of Surgery, Second Affiliated Hospital, Hebei Medical University, Shijiazhuang 050000, China. Jianhuicai@yahoo.com
Liu
Jin
J
Ikeguch
Masahide
M
Yan
Qing-Hui
QH
Zhou
Bao-Jun
BJ
Song
Wei-Qing
WQ
Wang
Feng-An
FA
Xue
Ping
P
Kaibara
Nobuaki
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology*; D016019:Survival Analysis