Skip to main content


Log in

Lymphovascular Invasion: Traditional but Vital and Sensible Prognostic Factor in Early Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript



Although patients with early gastric cancer have good prognosis, recurrence after treatment may occur. Lymphovascular invasion (LVI) in gastric cancer has long been suggested as a poor prognostic indicator. This study sought to evaluate the prognostic effect of LVI in patients with early gastric cancer.


From 2005 to 2016, 6516 patients with early gastric cancer who underwent radical gastrectomy were analyzed. The patients were categorized according to LVI and lymph node (LN) status.


LVI was present in 853 patients (13.1%). Patients with LVI or LN metastasis had more aggressive tumor characteristics than patients without both LVI and LN metastasis. The overall and relapse-free survival in patients with LVI were significantly worse than in patients without LVI. When we compared the survival rate of patients stratified by LVI and LN status, there was a significant overall and relapse-free survival difference between patients without both LVI and LN metastasis compared with those with LVI but without LN metastasis (p < 0.001). The overall and relapse-free survival of patients with LVI but without LN metastasis were similar to those without LVI but with LN metastasis (p = 0.818). Patients with LVI or LN metastasis showed a high frequency of recurrence (p < 0.001). Multivariate analysis showed that LVI and LN status were independent risk factors for relapse-free survival of early gastric cancer patients.


Early gastric cancer with LVI is associated with poor prognosis and frequent recurrence. When predicting the prognosis of patients with early gastric cancer, LVI should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S. Recurrence after curative resection of early gastric cancer. Ann Surg Oncol. 2010;17:448–54.

    Article  Google Scholar 

  2. Chen R, He Q, Cui J, Bian S, Chen L. Lymph node metastasis in early gastric cancer. Chin Med J (Engl). 2014;127:560–7.

    PubMed  Google Scholar 

  3. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.

    Article  Google Scholar 

  4. Hyung WJ, Lee JH, Choi SH, Min JS, Noh SH. Prognostic impact of lymphatic and/or blood vessel invasion in patients with node-negative advanced gastric cancer. Ann Surg Oncol. 2002;9:562–7.

    Article  Google Scholar 

  5. 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;135:1218–23.

    Article  CAS  Google Scholar 

  6. Liu C, Zhang R, Lu Y, et al. Prognostic role of lymphatic vessel invasion in early gastric cancer: a retrospective study of 188 cases. Surg Oncol. 2010;19:4–10.

    Article  Google Scholar 

  7. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Astric Cancer. 2019;19:1–48.

    Article  Google Scholar 

  8. Edge SB, Edge SB. AJCC cancer staging manual. 8th edn. Berlin: Springer; 2017.

    Google Scholar 

  9. Lehnert T, Erlandson RA, Decosse JJ. Lymph and blood capillaries of the human gastric mucosa. A morphologic basis for metastasis in early gastric carcinoma. Gastroenterology. 1985;89:939–50.

    Article  CAS  Google Scholar 

  10. Listrom MB, Fenoglio-Preiser CM. Lymphatic distribution of the stomach in normal, inflammatory, hyperplastic, and neoplastic tissue. Gastroenterology. 1987;93:506–14.

    Article  CAS  Google Scholar 

  11. Zhao B, Huang X, Zhang J, et al. Clinicopathologic factors associated with recurrence and long-term survival in node-negative advanced gastric cancer patients. Rev Esp Enferm Dig. 2019;111:111–20.

    PubMed  Google Scholar 

  12. Kim YI, Lee JH, Kook MC, et al. Lymph node metastasis risk according to the depth of invasion in early gastric cancers confined to the mucosal layer. Gastric Cancer. 2016;19:860–8.

    Article  Google Scholar 

  13. 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;246:749–53.

    Article  Google Scholar 

  14. Yu JW, Wu JG, Tajima Y, et al. Study on lymph node metastasis correlated to lymphangiogenesis, lymphatic vessel invasion, and lymph node micrometastasis in gastric cancer. J Surg Res. 2011;168:188–96.

    Article  Google Scholar 

  15. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2020;24;1–21.

  16. Maehara Y, Oshiro T, Baba H, Ohno S, Kohnoe S, Sugimachi K. Lymphatic invasion and potential for tumor growth and metastasis in patients with gastric cancer. Surgery. 1995;117:380–5.

    Article  CAS  Google Scholar 

  17. Choi HJ, Kim SM, An JY, et al. Risk factors and tumor recurrence in pT1N0M0 gastric cancer after surgical treatment. J Gastric Cancer. 2016;16:215–20.

    Article  Google Scholar 

  18. Noguchi Y. Blood vessel invasion in gastric carcinoma. Surgery. 1990;107:140–8.

    CAS  PubMed  Google Scholar 

  19. Kim Y, Kim KM, Choi MG, et al. Adjuvant chemotherapy with or without concurrent radiotherapy for patients with stage IB gastric cancer: a subgroup analysis of the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) phase III trial. J Gastric Cancer. 2018;18:348–55.

    Article  Google Scholar 

  20. Park JH, Ryu MH, Kim HJ, et al. Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer. Gastric Cancer. 2016;19:226–33.

    Article  CAS  Google Scholar 

  21. Ajani JA, D’Amico TA, Almhanna K, et al. Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14:1286–312.

    Article  Google Scholar 

  22. Wu YF, Xu HM, Chen JQ. Relations of proliferative activities of gastric carcinoma cells to lymphatic involvement, venous invasion and prognosis. Chin Med J. 2004;117:1530–5.

    PubMed  Google Scholar 

  23. Lu J, Dai Y, Xie JW, et al. Combination of lymphovascular invasion and the AJCC TNM staging system improves prediction of prognosis in N0 stage gastric cancer: results from a high-volume institution. BMC Cancer. 2019;19:216.

    Article  Google Scholar 

  24. Du CY, Chen JG, Zhou Y, et al. Impact of lymphatic and/or blood vessel invasion in stage II gastric cancer. World J Gastroenterol. 2012;18:3610–6.

    Article  Google Scholar 

  25. Kim JJ, Song KY, Hur H, Hur JI, Park SM, Park CH. Lymph node micrometastasis in node negative early gastric cancer. Eur J Surg Oncol. 2009;35:409–14.

    Article  CAS  Google Scholar 

  26. Arigami T, Uenosono Y, Yanagita S, et al. Clinical significance of lymph node micrometastasis in gastric cancer. Ann Surg Oncol. 2013;20:515–21.

    Article  Google Scholar 

  27. Lee T, Tanaka H, Ohira M, et al. Clinical impact of the extent of lymph node micrometastasis in undifferentiated-type early gastric cancer. Oncology. 2014;86:244–52.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Woo Jin Hyung MD, PhD.

Ethics declarations


Dr. Hyung WJ reports receiving research grants from Medtronic and GC Pharma and is the chief executive officer of Hutom and holds its stock. He provided consultancy services to Ethicon and Verb Surgical outside the submitted work. He received lecture fees from Stryker. The other authors report no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, S., Song, J.H., Lee, S. et al. Lymphovascular Invasion: Traditional but Vital and Sensible Prognostic Factor in Early Gastric Cancer. Ann Surg Oncol 28, 8928–8935 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: