Shizuki Sugita1,2,3, Takahiro Kinoshita4, Takeshi Kuwata2,5, Masanori Tokunaga1, Akio Kaito1, Masahiro Watanabe1,3, Akiko Tonouchi1, Reo Sato1, Masato Nagino3. 1. Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. 2. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan. 3. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 4. Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. takkinos@east.ncc.go.jp. 5. Exploratory Oncology Research and Clinical Trial Center (EPOC), National Cancer Center, Kashiwa, Japan.
Abstract
PURPOSE: Lymphatic invasion (LI) is associated with lymph node metastasis (LNM) and a poor prognosis in patients with early gastric cancer (EGC). Although the impact of the LI volume on LNM has been described, no reports have assessed the impact of its depth on LNM. METHODS: A total of 360 EGC patients with pathologically proven LI who underwent radical gastrectomy with lymphadenectomy between January 2005 and June 2018 at our institution were extracted from our database. Patients were divided into 2 groups: the mLI group, in which LI was limited to the muscularis mucosae (n = 34); and the smLI group, in which LI reached the submucosal region (n = 326). Clinicopathological features, including the LNM incidence, were compared between the groups. RESULTS: LNM was recognized in 3 patients (9%) in the mLI group and 101 (31%) in the smLI group (P = 0.005). In the mLI group, LNM was not recorded in any patients who met the curative criteria of ESD other than mLI. CONCLUSIONS: LI limited to the mucosal region does not seem to be a strong indicator for LNM. When pathological findings of an endoscopic submucosal dissection specimen show only mLI as a non-curative criterion, the probability of LNM may be very low.
PURPOSE: Lymphatic invasion (LI) is associated with lymph node metastasis (LNM) and a poor prognosis in patients with early gastric cancer (EGC). Although the impact of the LI volume on LNM has been described, no reports have assessed the impact of its depth on LNM. METHODS: A total of 360 EGC patients with pathologically proven LI who underwent radical gastrectomy with lymphadenectomy between January 2005 and June 2018 at our institution were extracted from our database. Patients were divided into 2 groups: the mLI group, in which LI was limited to the muscularis mucosae (n = 34); and the smLI group, in which LI reached the submucosal region (n = 326). Clinicopathological features, including the LNM incidence, were compared between the groups. RESULTS: LNM was recognized in 3 patients (9%) in the mLI group and 101 (31%) in the smLI group (P = 0.005). In the mLI group, LNM was not recorded in any patients who met the curative criteria of ESD other than mLI. CONCLUSIONS: LI limited to the mucosal region does not seem to be a strong indicator for LNM. When pathological findings of an endoscopic submucosal dissection specimen show only mLI as a non-curative criterion, the probability of LNM may be very low.
Authors: Byung-Hoon Min; Sun-Ju Byeon; Jun Haeng Lee; Kyoung-Mee Kim; Ji Yeong An; Min Gew Choi; Jun Ho Lee; Tae Sung Sohn; Jae Moon Bae; Sung Kim Journal: Gastric Cancer Date: 2017-12-26 Impact factor: 7.370