title: Lymph node metastasis in multiple synchronous early gastric cancer.
abstract: BACKGROUND
  Although endoscopic resection for early gastric cancer (EGC) is increasingly available, it has not been determined whether indications for endoscopic resection are equally acceptable for multiple EGCs.
  
  
  OBJECTIVE
  To compare the various clinicopathologic factors and risk of lymph node (LN) metastasis between multiple and solitary EGCs.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  This study involved 1717 patients with 156 multiple and 1561 solitary EGCs.
  
  
  METHODS
  Gastrectomy with LN dissection.
  
  
  METHODS
  Incidence of LN metastasis.
  
  
  RESULTS
  In multiple EGCs, main lesions had larger tumor size and deeper invasion depth than the accessory lesions (P < .001). The clinicopathologic features of multiple EGCs were similar to those of solitary EGCs with respect to tumor size, depth of invasion, lymphovascular invasion, and incidence of LN metastasis. Importantly, the risk of LN metastasis in multiple EGCs that met the indication criteria for endoscopic resection was not significantly different from that in solitary EGCs. Tumors meeting conventional indications for endoscopic resection had no risk of LN metastasis, whereas tumors meeting expanded indications showed a similar risk of LN metastasis in the two groups. In multiple EGCs, tumor size ≥3 cm and lymphovascular invasion were independent risk factors of LN metastasis.
  
  
  CONCLUSIONS
  Small number of patients with multiple EGCs studied.
  
  
  CONCLUSIONS
  Multiple EGCs had clinicopathologic characteristics and risk of LN metastasis similar to those of solitary EGCs. Endoscopic resection may be adopted as curative treatment for multiple EGCs that meet indications for endoscopic resection. Further studies are needed to verify the present study results.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeongmin
authors.initials: J
authors.lastname: Choi
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Im
authors.forename: Seung Joo
authors.initials: SJ
authors.lastname: Kang
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Woo Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
authors.forename: In Sung
authors.initials: IS
authors.lastname: Song
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000367:Age Factors; D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005743:Gastrectomy; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery