The Risk Factors of Lymph Node Metastasis in Early Gastric Cancer.
Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is an effective alternative treatment for early gastric cancer. However, a major concern is the likelihood of lymph node metastasis. From December 1987 to December 2006, 391 patients who underwent curative surgery for gastric cancer with mucosal (T1a, n = 265) or submucosal (T1b, n = 126) invasion and a retrieved lymph node number ≧ 15 were enrolled. The frequency and risk factors of lymph node metastasis were analyzed. The frequency of lymph node metastasis was 4.9 % in T1a lesions and 21.4 % in T1b lesions. Although the depth of submucosal tumor invasion was < 2 mm, there was a 28.6 % chance of lymph node metastasis. A T1b lesion, i.e., the width of the submucosal tumor invasion was < 5 mm, resulted in fewer lymph node metastases than lesions > 5 mm in width. Multivariate analysis demonstrated that Lauren's diffuse type and lymphatic invasion were independent risk factors for lymph node metastasis in T1a lesions, while lymphatic invasion was the strongest risk factor for lymph node metastasis in T1b lesions. EMR/ESD is a good alternative for T1a intestinal type adenocarcinoma without lymphatic invasion. Surgical resection is necessary for patients with T1b gastric cancer with lymphatic invasion.
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei City, Taiwan, 11217, s821094@hotmail.com.
Wen-Liang
WL
Fang
Kuo-Hung
KH
Huang
Yuan-Tzu
YT
Lan
Ming-Huang
MH
Chen
Yee
Y
Chao
Su-Shun
SS
Lo
Chew-Wun
CW
Wu
Yi-Ming
YM
Shyr
Anna Fen-Yau
AF
Li
D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000368:Aged; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery