Predictable Factors for Lymph Node Metastasis in Early Gastric Cancer—Analysis of Single Institutional Experience

  • Man Sup Lim
  • Hae-Wan Lee
  • Hyoungjune Im
  • Byung Seup Kim
  • Mi Yeol Lee
  • Jang Yong Jeon
  • Dae Hyun Yang
  • Bong Hwa Lee
Original Article



Prediction of lymph node metastasis in early gastric cancer (EGC) is very important to decide treatment strategies preoperatively. The aim of this study was to evaluate factors that predict the presence of lymph node metastasis and to indentify the differences between mucosal and submucosal gastric cancers.


A total of 376 patients with EGC who underwent gastrectomy from March 1999 through December 2007 were retrospectively identified. The clinopathological factors and biological markers (p53, Ki67) were analyzed.


The rate of lymph node metastasis was 9.6% (mucosal cancer 2.8%, submucosal cancer 18.4%). Tumor size, depth of invasion, macroscopic type, and lymphovascular invasion were related to lymph node metastasis in EGC. When the carcinomas were confined to the mucosal layer, tumor size and lymphovascular invasion showed significant correlation with lymph node metastasis. On the other side, macroscopic type and lymphovascular invasion were association with lymph node metastasis in submucosal carcinoma.


The risk factors for lymph node metastasis in EGC are quite different depending on depth of tumor invasion. To predict lymph node metastasis in EGC, it is recommended that distinct assessment according to individual situation should be clearly established.


Early gastric cancer Lymph node metastasis p53 KI67 


  1. 1.
    Kajitani T. The general rules for the gastric cancer study in surgery and pathology. Part I. Clinical classification. Jpn J Surg 1981;11:127–139.PubMedCrossRefGoogle Scholar
  2. 2.
    Borie F, Millat B, Fingerhut A, Hay JM, Fagniez PL, De Saxce B. Lymphatic involvement in early gastric cancer: prevalence and prognosis in France. Arch Surg 2000;135:1218–1223.PubMedCrossRefGoogle Scholar
  3. 3.
    Roviello F, Rossi S, Marrelli D, Pedrazzani C, Corso G, Vindigni C, Morgagni P, Saragoni L, de Manzoni G, Tomezzoli A. Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol 2006;94:275–280.PubMedCrossRefGoogle Scholar
  4. 4.
    Pelz J, Merkel S, Horbach T, Papadopoulos T, Hohenberger W. Determination of nodal status and treatment in early gastric cancer. Eur J Surg Oncol 2004;30:935–941.PubMedCrossRefGoogle Scholar
  5. 5.
    Kim DY, Joo JK, Ryu SY, Kim YJ, Kim SK. Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma. World J Gastroenterol 2004;10:737–740.PubMedGoogle Scholar
  6. 6.
    Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH. Application of minimally invasive treatment for early gastric cancer. J Surg Oncol 2004;85:181–185.PubMedCrossRefGoogle Scholar
  7. 7.
    Park DJ, Lee HK, Lee HJ, Lee HS, Kim WH, Yang HK, Lee KU, Choe KJ. Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery. World J Gastroenterol 2004;10:3549–552.PubMedGoogle Scholar
  8. 8.
    An JY, Baik YH, Choi MG, Noh JH, Sohn TS, Kim S. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg 2007;246:749–753.PubMedCrossRefGoogle Scholar
  9. 9.
    Fenoglio-Preiser CM, Wang J, Stemmermann GN, Noffsinger A. TP53 and gastric carcinoma: a review. Hum Mutat 2003;21:258–270.PubMedCrossRefGoogle Scholar
  10. 10.
    Xiangming C, Hokita S, Natsugoe S, Tanabe G, Baba M, Takao S, Kuroshima K, Aikou T. Cooccurrence of reduced expression of alpha-catenin and overexpression of p53 is a predictor of lymph node metastasis in early gastric cancer. Oncology 1999;57:131–137.PubMedCrossRefGoogle Scholar
  11. 11.
    Weigel MT, Dowsett M. Current and emerging biomarkers in breast cancer: prognosis and prediction. Endocr Relat Cancer 2010;17:R245-262.PubMedCrossRefGoogle Scholar
  12. 12.
    Goishi H, Tanaka S, Haruma K, Yoshihara M, Sumii K, Kajiyama G, Shimamoto F. Predictive value of cathepsin D and Ki-67 expression at the deepest penetration site for lymph node metastases in gastric cancer. Oncol Rep 2000;7:713–18.PubMedGoogle Scholar
  13. 13.
    Roukos DH. Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer. Ann Surg Oncol 1999;6:46–56.PubMedCrossRefGoogle Scholar
  14. 14.
    Korean Cancer Center Registry. Ministry of Health and Welfare Republic of Korea. Annual report of Korea Central Cancer Registry 2005.Google Scholar
  15. 15.
    The Information Committee of the Korean Gastric Cancer Association. 2004 Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc 2007;7:47–54.Google Scholar
  16. 16.
    Noh SH, Hyung WJ, Cheong JH. Minimal invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol 2005;90:188–193.PubMedCrossRefGoogle Scholar
  17. 17.
    Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumor. Br J Surg 1992;79:241–244.PubMedCrossRefGoogle Scholar
  18. 18.
    Adachi Y, Shiraishi N, Kitano S. Modern treatment of early gastric cancer: review of the Japanese experience. Dig Surg 2002;19:333–339.PubMedCrossRefGoogle Scholar
  19. 19.
    Okabayashi T, Kobayashi M, Sugimoto T, Okamoto K, Hokimoto N, Araki M. Clinicopathological investigation of early gastric carcinoma; is less invasive surgery right for early gastric carcinoma. Hepatogastroenterology 2007;54:609–612.PubMedGoogle Scholar
  20. 20.
    Shen L, Huang Y, Sun M, Xu H, Wei W, Wu W. Clinicopathological features associated with lymph node metastasis in early gastric cancer: analysis of a single institution experience in China. Can J Gastroenterol 2009;23:353–356.PubMedGoogle Scholar
  21. 21.
    Li C, Kim SS, Lai JF, Oh SJ, Hyoung WJ, Choi WH, Choi SH, Zhu ZG, Noh SH. Risk factors for lymph node metastasis in undifferentiated early gastric cancer. Ann Surg Oncol 2008;15:764–769.PubMedCrossRefGoogle Scholar
  22. 22.
    Song SY, Park S, Kim S, Son HJ, Rhee JC. Characteristics of intramucosal gastric carcinoma with lymph node metastatic disease. Histopathology 2004;44:437–444.PubMedCrossRefGoogle Scholar
  23. 23.
    Ohashi S, Okamura S, Urano F, Maeda M. Clinicopathological variables associated with lymph node metastasis in submucosal invasive gastric cancer. Gastric Cancer 2007;10:241–250.PubMedCrossRefGoogle Scholar
  24. 24.
    Bryne M, Boysen M, Alfsen CG, Abeler VM, Sudbø J, Nesland JM, Kristensen GB, Piffko J, Bankfalvi A et al. The invasive front of carcinomas. The most important area for tumour prognosis? Anticancer Res 1998;18:4757–4764.PubMedGoogle Scholar
  25. 25.
    Levine AJ, Momand J, Finlay CA. The p53 tumor suppressor gene. Nature 1991;351:453–456.PubMedCrossRefGoogle Scholar
  26. 26.
    Gerdes J, Lemke H, Baisch H, Wacker HH, Schwab U, Stein H. Cell cycle analysis of cell proliferation-associated human nuclear antibody Ki-67. J Immunol 1984;133:1710–1715.PubMedGoogle Scholar
  27. 27.
    Mita T, Shimoda T. Risk factors for lymph node metastasis of submucosal invasive differentiated type gastric carcinoma: clinical significance of histological heterogeneity. J Gastroenterol 2001;36:661–668.PubMedCrossRefGoogle Scholar
  28. 28.
    Pan W, Ishil H, Ebihara Y, Gobe G. Prognostic use of growth characteristics of early gastric cancer and expression patterns of apoptotic, cell proliferation, and cell adhesion proteins. J Surg Oncol 2003;82:104–110.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Man Sup Lim
    • 1
  • Hae-Wan Lee
    • 2
  • Hyoungjune Im
    • 3
  • Byung Seup Kim
    • 1
  • Mi Yeol Lee
    • 1
  • Jang Yong Jeon
    • 1
  • Dae Hyun Yang
    • 4
  • Bong Hwa Lee
    • 1
  1. 1.Department of SurgeryHallym University Sacred Heart HospitalAnyangSouth Korea
  2. 2.Department of SurgeryHallym University Hangang Sacred Heart HospitalSeoulSouth Korea
  3. 3.Department of Occupation and Environmental MedicineHallym University Sacred Heart HospitalAnyangSouth Korea
  4. 4.Department of SurgeryHallym University Kangnam Sacred Heart HospitalSeoulSouth Korea

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