title: Multifocality in early gastric cancer does not increase the risk of lymph node metastasis in a single-center study.
abstract: BACKGROUND
  The multifocality rate of EGC ranges from 4 to 20%, but there are few data regarding both lymph node metastasis and feasibility of the endoscopic treatment. We investigated the risk of lymph node metastasis with the purpose to evaluate the potential for endoscopic treatment in patients with multifocal EGC.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients who underwent radical gastrectomy to treat EGC between January 2001 and December 2007 at Severance Hospital, Seoul, Korea. Synchronous multifocal EGC was defined as EGC having two or more malignant foci, whereas solitary EGC was defined as EGC having single focus.
  
  
  RESULTS
  Of 1,693 patients, 55 (3.2%) were diagnosed with synchronous multifocal EGC. The rates of lymph node metastasis were 12.7% in synchronous multifocal EGC and 10% in solitary EGC. In the multivariate analysis, synchronous multifocal EGC was not associated with lymph node metastasis (odds ratio, 1.1; 95% confidence interval, 0.4-2.7) compared with solitary EGC. In a subgroup analysis of 55 patients with synchronous multifocal EGC, older age (≥65 years) and lymphovascular invasion were associated with lymph node metastasis. In synchronous multifocal EGC, none of the cases had lymph node metastasis in major and minor lesions representing mucosal cancer without lymphovascular invasion.
  
  
  CONCLUSIONS
  Synchronous multifocality of EGC does not increase the risk of lymph node metastasis compared with solitary EGC. Therefore, endoscopic treatment can be planned when major and minor lesions are predicted to represent mucosal cancer without lymphovascular invasion.
authors: Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, and Gangnam Severance Hospital, Seoul, Republic of Korea.
authors: Hee Man
authors: HM
authors: Kim
authors: Hyun Ki
authors: HK
authors: Kim
authors: Sang Kil
authors: SK
authors: Lee
authors: Jae Hee
authors: JH
authors: Cho
authors: Kyung Ho
authors: KH
authors: Pak
authors: Woo Jin
authors: WJ
authors: Hyung
authors: Sung Hoon
authors: SH
authors: Noh
authors: Choong Bai
authors: CB
authors: Kim
authors: Yong Chan
authors: YC
authors: Lee
authors: Si Young
authors: SY
authors: Song
authors: Young Hoon
authors: YH
authors: Youn
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate