Analysis of Factors Related to Lymph Node Metastasis in Early Gastric Cancers

Kim, Dong Hee; Song, Tae Jin; Kim, Seung Joo; Kim, Chong Suk; Koo, Bum Hwan

Abstract

PURPOSE: Gastric cancer is the most common cancer and cause of cancer death in Korea, although the incidence is decreasing in western countries and Japan. However, early gastric cancer (EGC) has an excellent prognosis compared to that of advanced gastric cancer. Especially, the important prognostic factor in EGC is the absence of lymph-node metastasis. Despite conserving surgery being suggested for EGC at present, a standard D2 dissection should be performed in EGC with lymph-node metastasis. The authors analyzed factors related to lymph-node metastasis in EGC to determine an appropriate therapy.
METHODS
The authors investigated 265 patients with EGC who underwent operations from January 1990 to December 1997 at the Department of Surgery, Guro Hospital, Korea University, with special emphasis on lymph-node metastasis. Seven clinicopathologic factors, such as age, sex, location, tumor size, depth of invasion, histologic grade, and macroscopic type, were investigated to analyze the relationships to lymph-node metastasis. RESULTS: Lymph-node metastases were found in 33 patients (12.5%). Statistical analysis revealed that tumor sizes above 20 mm, submucosal invasion of the tumor, and poorly differentiated and signet-ring cell types were statistically independent risk factors for regional lymph-node metastasis (p<0.025). For the other factors, age, sex, location, and macroscopic type, no statistical relations to lymph-node metastasis were found. CONCLUSION: This study suggests that tumor size, depth of tumor invasion, and histologic grade are possible risk factors for lymph-node metastasis in early gastric cancers. Therefore, a standard lymphadenectomy may be a prerequisite for patients with these high-risk factors.