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Related Experiment Video

Updated: Oct 22, 2025

Quantification of Tumor Cell Adhesion in Lymph Node Cryosections
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Lymph node involvement in gastric adenocarcinoma.

Rosemary Nustas1, Ahmed A Messallam1, Theresa Gillespie2

  • 1Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Surgical Endoscopy
|August 31, 2021
PubMed
Summary

Endoscopic resection for early gastric cancer may be safe for select patients. Low-risk factors like small size, low grade, and no lymphovascular invasion (LVI) predict minimal lymph node metastasis risk.

Keywords:
Endoscopic resectionGastric adenocarcinomaLymph node metastasis

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Pathology

Background:

  • Endoscopic management of early gastric cancer (EGC) is limited by the potential for lymph node metastasis.
  • Identifying predictors of nodal metastasis is crucial for selecting appropriate treatment strategies.

Purpose of the Study:

  • To examine the incidence and predictors of lymph node metastasis in early gastric adenocarcinoma (EGC) within a large US national cohort.
  • To identify patient and tumor characteristics associated with lymph node involvement in Tis, T1a, and T1b stages.

Main Methods:

  • Retrospective analysis of 1839 cases of Tis, T1a, and T1b gastric adenocarcinoma from the National Cancer Database (2004-2016).
  • Exclusion of cases with unknown characteristics, other cancers, or prior neoadjuvant therapy.
  • Multivariate analysis to identify independent predictors of lymph node metastasis.

Main Results:

  • Lymph node metastases were present in 18.1% of patients with early gastric cancer.
  • Lymphovascular invasion (LVI), high-grade histology, T1b stage, and tumor size >3 cm were independently associated with increased nodal metastasis risk.
  • LVI was the strongest predictor (OR 5.7), while Tis tumors showed no nodal metastasis. Low-grade T1a tumors (<3 cm) without LVI had a low risk (0.6-0.9%).

Conclusions:

  • Tumor size, LVI, histology grade, and T stage are key predictors of lymph node metastasis in early gastric cancer.
  • Patients with low-grade tumors, <3 cm, and no LVI have a very low risk of nodal involvement, suggesting suitability for endoscopic resection in this Western cohort.