Lymph node metastasis in early gastric cancer: a clinicopathological analysis

Endoscopic mucosal resection and laparoscopic wedge resection have become more common in the treatment of early gastric cancer. However, lymph node metastasis is a major poor prognostic factor influencing tumor recurrence and survival. To predict the risk of lymph node metastasis in early gastric cancer, the authors conducted a study to investigate the clinicopathologic characteristics of early gastric cancer with lymph node metastasis.

From 1982 to 1998, 181 patients of early gastric cancer underwent primary surgery and were included in the study. Patient data was postoperatively reviewed regarding age, gender, tumor size, depth of invasion, histologic differentiation, macroscopic classification and anatomic level of lymph node metastasis. The chi 2 test or Student's t test was used for statistical analysis. Logistic regression analysis was used to evaluate the independent risk factors for lymph node metastasis.

Lymph node metastasis was observed in 19 cases (11%). Early gastric cancer with size larger than 4 cm (P < 0.05), with submucosal invasion (P < 0.01), and with poor differentiation (P < 0.05) was associated with higher risk of lymph node metastasis. The macroscopic classification had no predictive value. Multivariate analysis showed that submucosal invasion correlated best with lymph node spread (OR 10.25, 95% CI: 2.10-49.96), followed by tumor size larger than 4 cm (OR 4.99, 95% CI: 1.46-17.05), and poorly differentiated histological subtype (OR 3.31, 95% CI: 1.16-9.45).

Poor differentiation, submucosal invasion and large tumor size were independent risk factors for lymph node metastasis in early gastric cancer. Macroscopic classification was not correlated with lymph node metastasis.