Predictive factors for lymph node metastasis in early gastric cancer with lymphatic invasion after endoscopic resection
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Lymph node (LN) metastasis is found in only about 5–10% of the patients who undergo additional surgery after non-curative endoscopic resection. Lymphatic invasion after endoscopic submucosal dissection (ESD) is regarded as non-curative resection due to risk of reginal LN metastasis. This study was aimed to identify clinicopathologic predictive factors for LN metastasis in early gastric cancer (EGC) with lymphatic invasion after endoscopic resection.
Among a total of 2036 patients who underwent endoscopic resection for EGC at Samsung Medical Center from April 2000 to May 2011, 146 patients were diagnosed with lymphatic invasion. And 123 patients who had gastrectomy with LN dissection due to presence of lymphatic invasion as one of the non-curative factors were included in this study. Demographics, endoscopic tumor findings, histological findings, surgical findings with pathologic reports, and follow-up data were collected from the patient’s medical records. Pathological re-evaluation of resected specimens was performed.
Among a total of 123 patients, LN metastases were found in seven patients (5.7%). The univariate analysis revealed that the LN metastasis was significantly more frequent in patients with certain morphology of lymphatic invasion that shows adhesion to endothelium of lymphatic tumor emboli (p = 0.016), higher number of lymphatic tumor emboli in whole section (p < 0.001) and papillary adenocarcinoma component (p = 0.024). In multivariate analysis, the number of lymphatic tumor emboli [OR 93.5, 95% CI (2.62–3330.81)] and the presence of papillary adenocarcinoma component [OR 552.5, 95% CI (1.20–254871.81)] were identified as independent predictors of LN metastasis in patients with lymphatic invasion after endoscopic resection.
The number of lymphatic tumor emboli and the presence of papillary adenocarcinoma component were significant predictors for LN metastasis in patients with lymphatic invasion after endoscopic resection.
KeywordsLymph node metastasis Early gastric cancer Lymphatic invasion Endoscopic resection
Compliance with ethical standards
Drs Ji Won Park, Sangjeong Ahn, Hyuk Lee, Byung-Hoon Min, MD, Jun Haeng Lee, Poong-Lyul Rhee, Kyoung-Mee Kim, and Jae J. Kim have no conflicts of interest or financial ties to disclose.
- 3.Roviello F, Rossi S, Marrelli D, Pedrazzani C, Corso G, Vindigni C, Morgagni P, Saragoni L, de Manzoni G, Tomezzoli A (2006) Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol 94:275–280 (discussion 274)CrossRefPubMedGoogle Scholar
- 17.Novara G, Matsumoto K, Kassouf W, Walton TJ, Fritsche HM, Bastian PJ, Martinez-Salamanca JI, Seitz C, Lemberger RJ, Burger M, El-Hakim A, Baba S, Martignoni G, Gupta A, Karakiewicz PI, Ficarra V, Shariat SF (2010) Prognostic role of lymphovascular invasion in patients with urothelial carcinoma of the upper urinary tract: an international validation study. Eur Urol 57:1064–1071CrossRefPubMedGoogle Scholar
- 19.Son SY, Park JY, Ryu KW, Eom BW, Yoon HM, Cho SJ, Lee JY, Kim CG, Lee JH, Kook MC, Choi IJ, Kim YW (2013) The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection: is the minimal lymph node dissection applicable? A retrospective study. Surg Endosc 27:3247–3253CrossRefPubMedGoogle Scholar
- 22.Nishida T, Tanaka S, Haruma K, Yoshihara M, Sumii K, Kajiyama G (1995) Histologic grade and cellular proliferation at the deepest invasive portion correlate with the high malignancy of submucosal invasive gastric carcinoma. Int Soc Cell 52:340–346Google Scholar
- 24.Sekiguchi M, Kushima R, Oda I, Suzuki H, Taniguchi H, Sekine S, Fukagawa T, Katai H (2015) Clinical significance of a papillary adenocarcinoma component in early gastric cancer: a single-center retrospective analysis of 628 surgically resected early gastric cancers. J Gastroenterol 50:424–434CrossRefPubMedGoogle Scholar
- 27.Nakamoto J, Torisu R, Aoki R, Kimura Y, Yasuda M, Shiota K, Yamamoto Y, Ito S (2007) Clinicopathological evaluation of biological behavior of submucosal invasive gastric carcinomas: relationship among lymph node metastasis, mucin phenotype and proliferative activity. J Med Invest 54:99–108CrossRefPubMedGoogle Scholar
- 28.Song JP, Kitayama Y, Igarashi H, Guo RJ, Wang YJ, Kobayashi T, Konno H, Kataoka H, Tanaka M, Sugimura H (2002) Centromere numerical abnormality in the papillary, papillotubular type of early gastric cancer, a further characterization of a subset of gastric cancer. Int J Oncol 21:1205–1211PubMedGoogle Scholar