Frequency and Predictive Factors of Lymph Node Metastasis in Mucosal Cancer

Abstract

PurposeThe incidence of lymph node metastasis has been reported to range from 2.6 to 4.8% in early stage gastric cancer with mucosal invasion (T1a cancer). Lymph node metastasis in early stage gastric cancer is known as an important predictive factor. We analyzed the prediction factors of lymph node metastasis in T1a cancer.Materials and MethodsA total of 9,912 patients underwent radical gastrectomy due to gastric cancer from October 1994 to July 2006 in the Department Of Surgery at Samsung Medical Center. We did a retrospective analysis of 2,524 patients of these patients, ones for whom the cancer was confined within the mucosa.ResultsAmong the 2,524 patients, 57 (2.2%) were diagnosed with lymph node metastasis, and of these, cancer staging was as follows: 41 were N1, 8 were N2, and 8 were N3a. Univariate analysis of clinicopathological factors showed that the following factors were significant predictors of metastasis: tumor size larger than 4 cm, the presence of middle and lower stomach cancer, poorly differentiated adenocarcinoma and signet-ring cell carcinoma, diffuse type cancer (by the Lauren classification), and lymphatic invasion. Multivariate analysis showed that lymphatic invasion and tumor larger than 4 cm were significant factors with P<0.001 and P=0.024, respectively.ConclusionsThe frequency of lymph node metastasis is extremely low in early gastric cancer with mucosal invasion. However, when lymphatic invasion is present or the tumor is larger than 4 cm, there is a greater likelihood of lymph node metastasis. In such cases, surgical treatments should be done to prevent disease recurrence.

Risk factors of early proximal gastric carcinoma in Chinese diagnosed using WHO criteria

“…Guided by the 2010 WHO diagnostic criteria on EGC, we found a relatively low percentage (14.0%) of GC resection at our hospital, similar to that reported from Brazil and Germany, 21,22 but much lower than that from Japan and Korea, where EGC accounts for over half of all GC resection. [23][24][25][26] This discrepancy may be related to the population-based national endoscopic screening program in those countries and also to the different EGC diagnostic criteria used by Japanese and Korean pathologists, who follow the Japanese diagnostic criteria of EGC, 27 while Chinese pathologists generally adopt the WHO rules, as we did in this study.…”

Rates of lymph node metastasis and survival in T1a gastric adenocarcinoma in Western populations

“…The incidence of LN involvement in T1a gastric cancers in large Asian series is reported to be 2% to 5%. 2,3,15 Though these are the largest studies reported, the populations are relatively homogenous in terms of race/ethnicity. Our study shows an LN+ rate of 7.8% in surgically resected T1a gastric cancers in the US SEER database.…”

“…1 Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been developed in Asia for low morbidity treatment of EGC based on the very low node-positive (LN+) rates in large retrospective Asian studies of radical surgical resection of EGC cases. 2,3 According to the Japanese Gastric Cancer Association treatment guidelines, gastric adenocarcinomas that are (1) clinically staged as T1a, (2) ≤ 2 cm, (3) well-differentiated, and (4) lack ulceration fall under the standard criteria for EMR/ESD. 4 Although EMR/ESD are frequently used in Asia and permit curative treatment of EGC without the morbidity of gastrectomy, the standard of care in Western countries remains formal resection.…”

Clinical utility of tumor marker cutoff ratio and a combination scoring system of preoperative carcinoembryonic antigen, carbohydrate antigen 19-9, carbohydrate antigen 72-4 levels in gastric cancer

“…Gastric cancer is particularly prevalent in Korea, being the second major cause of cancer-related deaths after lung cancer [2,3]. …”