Risk factors of lymph node metastasis in early gastric carcinomas diagnosed by WHO criteria in 379 Chinese patients

Abstract

LNM occurred in 12.9% of EGC diagnosed with the WHO criteria in Chinese patients. Independent risk factors of LNM were identified in early DGC only and included female sex, DGC, poorly cohesive carcinoma and lymphovascular invasion. Early PGC has a much lower risk for LNM than early DGC.

Clinicopathology of Early Gastric Carcinoma: An Update for Pathologists and Gastroenterologists

“…More recently, Lee et al [26] reported a high (18.3%, 9/49) frequency of lymph node metastasis in early papillary adenocarcinoma of Korean patients. The abovementioned results have been confirmed most recently in Chinese patients [14,18]. Compared to early tubular adenocarcinoma, early papillary adenocarcinoma is associated with a significantly worse 5-year survival rate (80.5% compared to 96.8% in early tubular adenocarcinoma, p < 0.05), significantly more submucosal invasion (64.4 vs. 43.6%) ( p < 0.05), and the micropapillary growth pattern (6.8 vs. 0%) ( p < 0.003) [18].…”

“…The abovementioned results have been confirmed most recently in Chinese patients [14,18]. Compared to early tubular adenocarcinoma, early papillary adenocarcinoma is associated with a significantly worse 5-year survival rate (80.5% compared to 96.8% in early tubular adenocarcinoma, p < 0.05), significantly more submucosal invasion (64.4 vs. 43.6%) ( p < 0.05), and the micropapillary growth pattern (6.8 vs. 0%) ( p < 0.003) [18]. The cases with a micropapillary growth pattern were all associated with early papillary adenocarcinoma and had a high (50%, 2/4) nodal metastasis rate, though in a small sample [14,18].…”

“…In reality, invasion in the gastric lamina propria is difficult to detect on routine histology sections, and there is no reliable/established pathologic diagnostic criterion for lamina propria invasion. Nevertheless, intramucosal tubular adenocarcinoma has been confirmed to have a low risk of lymph node metastasis [14,18,19] and, therefore, can be safely removed endoscopically. In histopathology, most early tubular adenocarcinomas originate in the isthmus/neck of a gastric unit along the lesser curvature in the distal stomach [13,20].…”

“…Compared to early tubular adenocarcinoma, early papillary adenocarcinoma is associated with a significantly worse 5-year survival rate (80.5% compared to 96.8% in early tubular adenocarcinoma, p < 0.05), significantly more submucosal invasion (64.4 vs. 43.6%) ( p < 0.05), and the micropapillary growth pattern (6.8 vs. 0%) ( p < 0.003) [18]. The cases with a micropapillary growth pattern were all associated with early papillary adenocarcinoma and had a high (50%, 2/4) nodal metastasis rate, though in a small sample [14,18]. Thus, a growing body of the evidence suggests a dismal prognosis in early papillary adenocarcinoma, primarily due to deeper invasion, higher association with the micropapillary growth pattern, more frequent lymphovascular invasion and nodal metastasis.…”

“…While lymphovascular invasion has been confirmed worldwide as the most important risk factor for nodal metastasis in EGC [19,46,47], an extremely low frequency of nodal metastasis in EGC for intramucosal carcinoma, tumor size smaller than 2 cm, and superficial submucosal invasion without lymphovascular invasion, reported previously [43], has not been universally confirmed (Table 2). Several recent Chinese and Korean studies on nodal metastasis in EGC also demonstrate different risk factors such as female gender [18,19,48], intestinal type [47], and distal gastric location [18,49,50], but not ulceration [18,49,51]. A most recent systematic review of the world literature in 42 qualified studies shows low, but substantial, nodal metastasis rates of 6% for intramucosal carcinoma, 9% for EGC without lymphovascular invasion, 13% for the intestinal-type EGC, 13% for EGC with an elevated growth pattern, and 8% for EGC in the size smaller than 2 cm [47].…”