Risk Factors for Lymph Node Metastasis in Undifferentiated Early Gastric Cancer
- 47 Downloads
The indication for endoscopic resection is differentiated gastric cancer ≤ 2 cm in size without an ulcer, of which the depth of invasion is clinically diagnosed as tumor confined to the mucosa. Endoscopic resection is not indicated for undifferentiated gastric intramucosal carcinoma, which is associated with a high rate of lymph node metastasis. This study aimed to analyze the factors associated with lymph node metastasis and to determine the validity of endoscopic resection in patients with undifferentiated early gastric cancer (EGC). This study included 141 patients who underwent gastrectomy with lymph node dissection for undifferentiated EGC. The clinicopathological findings were retrospectively analyzed to identify the factors associated with lymph node metastasis. According to the depth of tumor invasion, lymph node metastasis was observed in 13 patients (9.2%), including three with intramucosal carcinoma (3.6%) and ten with submucosal invasive carcinoma (17.2%). Univariate analysis identified tumor size (p = 0.038), depth of tumor invasion (p = 0.008), and lymphovascular invasion (LVI) (p = 0.0002) as risk factors for lymph node metastasis. On multivariate analysis, LVI (p = 0.002) was identified as the only independent risk factor for lymph node metastasis. The use of endoscopic resection for the undifferentiated EGC should be considered carefully for patients with LVI because of the risk for lymph node metastasis.
KeywordsEndoscopic resection Lymph node metastasis Risk factor Undifferentiated early gastric cancer
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.(2011) Japanese classification of gastric carcinoma. 3rd English Edition. Japanese gastric cancer association. Gastric Cancer 14:101–112Google Scholar
- 2.Sasako M, Kinoshita T, Maruyama K (1993) Prognosis of early gastric cancer (in Japanese with English abstract). Stomach and Intestine 28(Suppl):139–146Google Scholar
- 3.Japanese gastric cancer treatment guidelines 2010 (ver. 3). Japanese gastric cancer association (2011). Gastric Cancer 14:113–123,Google Scholar
- 17.Park JM, Kim SW, Nam KW, Cho YK, Lee IS, Choi M-G, Chung I-S, Song KY, Park CH, Jung CK (2009) Is it reasonable to treat early gastric cancer with signet ring cell histology by endoscopic resection? Analysis of factors related to lymph-node metastasis. Eur J Gastroenterol Hepatol 21:1132–1135CrossRefGoogle Scholar
- 19.Kim HM, Pak KH, Chung MJ, Cho JH, Hyung WJ, Noh SH, Kim CB, Lee YC, Song SY, Lee SK (2011) Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions. Surg Endosc 25:3087–3093CrossRefGoogle Scholar
- 20.(2018) Japanese gastric cancer treatment guidelines (ver. 5) (in Japanese). Japanese gastric cancer associationGoogle Scholar