Young-Il Kim1, Jun Ho Lee1,2, Myeong-Cherl Kook1, Jong Yeul Lee1, Chan Gyoo Kim1, Keun Won Ryu1, Young-Woo Kim1, Il Ju Choi3. 1. Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro Ilsandong-gu, Goyang, Gyeonggi, 410-769, Korea. 2. Department of Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. 3. Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro Ilsandong-gu, Goyang, Gyeonggi, 410-769, Korea. cij1224@ncc.re.kr.
Abstract
BACKGROUND: Early gastric cancers (EGCs) within the mucosal layer of the gastric wall have a small risk of lymph node (LN) metastasis. METHODS: We reviewed clinicopathology data for patients who underwent surgery for EGC between 2001 and 2013 at the National Cancer Center, Korea. Poisson regression analyses were performed to compare the risk of LN metastasis according to the depth of tumor invasion in patients with mucosal EGCs. RESULTS: Among the 1776 EGC patients included, 580 (32.7 %) had tumors confined to the lamina propria (LP; LP group) and 1196 (67.3 %) had tumors invading the muscularis mucosae (MM; MM group). Seventy-one patients (4.0 %) had LN metastasis, and the MM group had a significantly higher rate of LN metastasis (59 patients, 4.9 %) than the LP group (12 patients, 2.1 %; P = 0.004). A multivariate analysis showed that tumors invading the MM (adjusted risk ratio 1.95; P = 0.045) were significantly associated with LN metastasis in addition to well-known risk factors, including tumor size greater than 3 cm, presence of ulceration, undifferentiated histologic type, and lymphovascular invasion. The incidence of LN metastasis was 1.87 % (95 % confidence interval 0.23-6.59 %) within tumors invading the MM that met the expanded criterion for endoscopic resection of differentiated histologic type of size 3 cm or smaller with ulceration. LN metastasis was not found in tumors meeting the absolute criteria for endoscopic resection. CONCLUSIONS: EGCs invading the MM had a higher rate of lymph node metastasis than those confined to the LP. Further study is needed to evaluate whether different curative treatment criteria are needed for LP-confined and MM-invading EGCs.
BACKGROUND: Early gastric cancers (EGCs) within the mucosal layer of the gastric wall have a small risk of lymph node (LN) metastasis. METHODS: We reviewed clinicopathology data for patients who underwent surgery for EGC between 2001 and 2013 at the National Cancer Center, Korea. Poisson regression analyses were performed to compare the risk of LN metastasis according to the depth of tumor invasion in patients with mucosal EGCs. RESULTS: Among the 1776 EGC patients included, 580 (32.7 %) had tumors confined to the lamina propria (LP; LP group) and 1196 (67.3 %) had tumors invading the muscularis mucosae (MM; MM group). Seventy-one patients (4.0 %) had LN metastasis, and the MM group had a significantly higher rate of LN metastasis (59 patients, 4.9 %) than the LP group (12 patients, 2.1 %; P = 0.004). A multivariate analysis showed that tumors invading the MM (adjusted risk ratio 1.95; P = 0.045) were significantly associated with LN metastasis in addition to well-known risk factors, including tumor size greater than 3 cm, presence of ulceration, undifferentiated histologic type, and lymphovascular invasion. The incidence of LN metastasis was 1.87 % (95 % confidence interval 0.23-6.59 %) within tumors invading the MM that met the expanded criterion for endoscopic resection of differentiated histologic type of size 3 cm or smaller with ulceration. LN metastasis was not found in tumors meeting the absolute criteria for endoscopic resection. CONCLUSIONS:EGCs invading the MM had a higher rate of lymph node metastasis than those confined to the LP. Further study is needed to evaluate whether different curative treatment criteria are needed for LP-confined and MM-invading EGCs.
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Authors: Jong Yeul Lee; Il Ju Choi; Soo-Jeong Cho; Chan Gyoo Kim; Myeong-Cherl Kook; Jun Ho Lee; Keun Won Ryu; Young-Woo Kim Journal: J Gastric Cancer Date: 2012-06-27 Impact factor: 3.720
Authors: Young-Il Kim; Myeong-Cherl Kook; Jee Eun Choi; Jong Yeul Lee; Chan Gyoo Kim; Bang Wool Eom; Hong Man Yoon; Keun Won Ryu; Young-Woo Kim; Il Ju Choi Journal: J Gastric Cancer Date: 2020-04-06 Impact factor: 3.720