Prediction of the indication criteria for endoscopic resection of early gastric cancer.
OBJECTIVE
To find risk factors of lymph node metastasis (LNM) in early gastric cancer (EGC) and to find proper endoscopic therapy indication in EGC.


METHODS
We retrospectively reviewed the 2270 patients who underwent curative operation for EGC from January 2001 to December 2008. EGC was defined as malignant lesions that do not invade beyond the submucosal layer of the stomach wall irrespective of presence of lymph node metastasis.


RESULTS
Among 2270 enrolled patients, LNM was observed in 217 (9%) patients. LNM in intramucosal (M) cancer and submucosal (SM) cancer was detected in 38 (2.8%, 38/1340) patients and 179 (19%, 179/930) patients, respectively. In univariate analysis, the risk factors for LNM in EGC were size of tumor, Lauren classification, ulcer, lymphatic invasion, vascular invasion, and depth of invasion. However, in multivariate analysis, size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in EGC. Size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in cases of intramucosal cancer and submucosal cancer. In particular, there was no lymph node metastasis in cases of well differentiated early gastric cancer below 1 cm in size without ulcer regardless of lymphovascular invasion.


CONCLUSIONS
Tumor size, perilymphatic-vascular invasion, and depth of invasion were risk factors for LNM in EGC. There was no LNM in EGC below 1 cm regardless risk factors.
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Jae Hyun
JH
Park
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Si Hyung
SH
Lee
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Joon Mo
JM
Park
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Chan Seo
CS
Park
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Kyung Sik
KS
Park
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Eun Soo
ES
Kim
Jae Hyun Park, Si Hyung Lee, Joon Mo Park, Chan Seo Park, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Kwang Bum
KB
Cho
D000368:Aged; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden
Early gastric cancer; Endoscopic resection; Lymph node metastasis