title: Predictors of Lymph Node Metastasis in Western Early Gastric Cancer.
abstract: BACKGROUND
  The application of endoscopic and local resection for early gastric cancer (EGC) is limited by the risk of regional lymph node (LN) metastasis. We sought to determine the incidence and predictors of LN metastasis in a contemporary cohort of Western patients with early gastric cancer.
  
  
  METHODS
  Sixty-seven patients with pT1 gastric adenocarcinoma underwent radical surgery without neoadjuvant therapy at our institution between 1995 and 2011, and clinicopathologic factors predicting LN metastasis were analyzed.
  
  
  RESULTS
  LN metastases were present in 15/67 (22 %) pT1 tumors, including 1/23 (4 %) T1a tumors and 14/44 (32 %) T1b tumors. Tumor size, site, degree of differentiation, macroscopic tumor sub-classification, perineural invasion status, and depth of submucosal tumor penetration did not predict LN metastasis. The presence of lymphovascular invasion (LVI) and positive nodal status by endoscopic ultrasound (EUS) were the only factors that predicted LN metastasis on multivariate analysis. T1a tumors without LVI had a 0 % rate of positive LN, whereas T1b tumors with LVI had a 64.3 % rate of positive LN.
  
  
  CONCLUSIONS
  EGC limited to the mucosa, without evidence of LVI, and N0 on EUS, may be considered for limited resection. However, any EGC with submucosal invasion, LVI, or positive nodes on EUS should undergo radical resection with lymphadenectomy.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
authors.forename: Rima
authors.initials: R
authors.lastname: Ahmad
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Namrata
authors.initials: N
authors.lastname: Setia
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Schmidt
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Wo
authors.affiliation: Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Eunice L
authors.initials: EL
authors.lastname: Kwak
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA. jmullen@partners.org.
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D055088:Early Detection of Cancer; D019160:Endosonography; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D014481:United States
keywords: Early gastric cancer; Lymph node metastasis; Predictors; T1 stage