| Objective: Surgery is the preferred treatment of early gastric cancer(EGG),and the occurance of lymph node metastasis(LNM)is a significant prognostic factor for patients with EGC.Lymph node dissection might reduce the risk of postoperative recurrence and distant metastases,however,excessive lymph node dissection would damage the life quality of patients with EGC.To explore clinicopathological risk factors for lymph node metastases in early gastric cancer and to provide the personalized treatment and confirm the appropriate range of lymph node dissection.Methods: A total of 147 patients with early gastric cancer who underwent curative gastrectomy with lymphadenectomy in the Department of General Surgery,The Second People’s Hospitalof Wuhu affiliated with Wannan medical college between November2006 and July 2015,were retrospectively reviewed.Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines.The macroscopic type was classified as elevated(type Ⅰ or Ⅱa),flat(Ⅱb),or depressed(Ⅱc or Ⅲ).Histopathologically,papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas,and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas.The data of patients including gender,age,tumor size,tumor number,general classification,differentiation degree,invasion depth,ulcer in tumor,nerve invasion,and lymphatic tumor cell embolus were analyzed.Chi square test was performed to analyze the correlation between clinicopathological features and lymph node metastasis in EGC.Logistic regression analysis was used to analyze the independent risk factor of lymph node metastasis in EGC.Results : The lymph node metastases was observed in 25 of 147 patients(17.0%),and6(7.7%)in 65 mucosal lesions and20(24.4%)in 82 submueosal lesions.Total number of harvesting lymph node was 2171.The number of mestastastic lympn node was110.There were 14 patients had lympn node metastasis in the first tier alone.4 patients had skipped metastasis,and 3 patients had LNM in the first,second ties.Only one had metastasis in third ties.The lymph node metastasis was identified in 1 8 patients at the first tier with groups 7 and 3 being the most common,7 patients at the second tier(4patients in group 8a and 3 in group 9),and 2 patients at the third tier(one 16 b,and one4sa).Tumor size and depth of tumor invasion for signet ring cell cancers were significantly different from differentiated cancers and poorly differentiated cancers.The incidence of LNM for signet ring cell carcinoma was lower than poorly differentiated carcinoma(P<0.05),but not significantly different compared to differentiated cancers(P>0.05).Univariate analysis showed an obvious correlation between lymph node metastases and depth of invasion,gender and venous invasion(χ 2 = 7.163,P =0.007;χ 2 = 6.13,P = 0.013;χ 2 = 8.687,P =0.003,respectively).In patients with submucosal cancers,the lymph node metastases rate in patients with venous invasion(60%,3/5)was higher than in those without invasion(20%,15/75)(χ 2 = 4.301,P =0.038).Multivariate logistic regression analysis revealed that the depth of invasion and venous invasion were the independent risk factor for lymph node metastases in EGC(P=0.016,OR=2.841;P = 0.006,OR= 3.768].Among the patients with lymph node metastases,25 cases(14.4%)were at N1,seven cases were at N2(3.5%),and two cases were at N3(1.0%).Conclusion : The presence of lymph node,tumor size,depth of invasion and histological type of EGC can be defined by preoperative endoscopic ultrasound,CT and biopsy histology.The risk of lymphatic metastasis of early gastric cancer is low in those with intramucosal tumors and without vascular involvement.Based on these examinations,the status of lymph node metastasis might be evaluated,which will be helpful for choosing appropriate operation scheme and extent of lymph node dissection.Risk factors for metastases should be considered when selecting surgery for EGC. |
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