title: Histology-based prediction of lymph node metastases in early gastric cancer as decision guidance for endoscopic resection.
abstract: BACKGROUND
  Selected cases of early gastric cancer (EGC) can be successfully treated by endoscopic therapy if the risk of concurrent lymph node metastases (LNM) is negligible. Criteria for endoscopic resection based on risk factor analyses for LNM have been established mainly in Asia. However, it is not clear to what extent these recommendations can be transferred to Western collectives. The aim of this study was to analyze predictors for LNM in EGC in a Western study population.
  
  
  METHODS
  From our institutional archive, we selected all patients with gastric adenocarcinoma who had undergone gastrectomy with lymphadenectomy (1972 - 2005). Among 1970 patients 275 cases with EGC were identified. Clinical and pathological data were collected and logistic regression analyses performed.
  
  
  RESULTS
  LNM were present in 36/275 (13.1%) patients. With deeper invasion proportion of LNM increased. At submucosa level (sm1), patients were almost five times more likely to have LNM than at mucosa levels.Multivariable logistic regression analysis revealed lymphovascular invasion, diffuse- and mixed-type, and invasion depth as significant independent histopathological predictors of LNM. In patients with intestinal type according to Lauren and no lymphovascular invasion, we found only one LNM-positive case out of 43 patients in the pT1b (sm1 and sm2) groups.
  
  
  CONCLUSIONS
  Our results underline the recommendation of most guidelines that endoscopic resection is sufficient for pT1a ECG because of the low incidence of LNM in this group. However, there seems also a role for endoscopic therapy in cases of pT1b (sm1/2) EGC with intestinal type differentiation and no lymphovascular invasion.
authors: Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Ulrich
authors: U
authors: Ronellenfitsch
authors: Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Christiane
authors: C
authors: Lippert
authors: Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland.
authors: Rainer
authors: R
authors: Grobholz
authors: First Department of Medicine, Division of Biostatistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Siegfried
authors: S
authors: Lang
authors: Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Stefan
authors: S
authors: Post
authors: Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Georg
authors: G
authors: Kähler
authors: Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Timo
authors: T
authors: Gaiser
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*
keywords: Western study population; early gastric cancer; endoscopic treatment; histopathological risk factors; lymph node metastases