老年未分化型早期胃癌淋巴结转移的危险因素分析

目的总结老年患者未分化型早期胃癌（early gastric cancers,EGCs）的临床病理特征,分析未分化型EGCs淋巴结转移的危险因素。方法纳入2010年1月—2019年8月在北京协和医院行根治性胃癌切除+淋巴结清扫术,手术病理诊断符合EGCs的老年（≥65岁）患者,以分化型EGCs为对照,比较分析未分化型EGCs（即印戒细胞癌和低分化腺癌）的临床病理特征。用Logistic回归对老年未分化型EGCs淋巴结转移风险进行多因素分析。结果纳入老年EGCs共165例,其中未分化型EGCs 82例（印戒细胞癌11例,低分化腺癌 71例）,分化型EGCs 83例。淋巴结转移率方面,老年EGCs淋巴结转移率为9.1%（15/165）,分化型EGCs淋巴结转移率为4.8%（4/83）,未分化型EGCs淋巴结转移率为13.4%（11/82）。未分化型EGCs中,低分化腺癌淋巴结转移率为15.5%（11/71）,印戒细胞癌11例均无淋巴结转移。单因素分析提示浸润深度（P=0.019)、病变大小（P=0.006）、合并溃疡（P=0.006）、凹陷型（P=0.003）与老年未分化型EGCs淋巴结转移相关。多因素分析提示黏膜下层浸润（OR=11.98,95%CI:1.17~122.84,P=0.037 ）、病变直径＞2 cm（OR=11.95,95%CI:1.88~76.07,P=0.009)是老年未分化型EGCs淋巴结转移的独立危险因素。所有满足扩大适应证的老年未分化型EGCs无淋巴结转移。结论黏膜下层浸润、病变直径＞2 cm是老年未分化型EGCs淋巴结转移的独立危险因素。满足扩大适应证的老年未分化型EGCs患者适合内镜黏膜下剥离术治疗。     

早期胃癌的内镜诊断和治疗

早期胃癌(EGC)定义为垂直方向的浸润不超过黏膜下层而无论有无转移的胃癌，即早期胃癌=黏膜癌(M癌) 黏膜下层癌(SM癌)。内镜下早期胃癌可分为(肉眼分类)Ⅰ型(隆起型)、Ⅱ型(平坦型)、Ⅲ型(陷凹型)，其中Ⅱ型可进一步细分为Ⅱa型(平坦隆起型)，Ⅱb型(平坦型)，Ⅱc型(平坦凹陷型)。一般EGC直径1～4cm，小于0．5cm者称微小胃癌。     

内镜黏膜下剥离术对治疗早期胃癌的临床应用价值

目的 评估我院内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌(early gastric cancer,EGC)的有效性及临床应用价值.方法 对2006年11月-2013年2月内镜下发现的370例早期胃癌临床资料进行分析,共切除病变386个.其中212个是不典型增生,158个是黏膜内癌,16个是黏膜下癌.位于上段胃81个,中段胃122个,下段胃183个.内镜分型包括23个Ⅰ型,148个Ⅱa型,20个Ⅱb型,114个Ⅱc型,70个Ⅱa+Ⅱc型,11个Ⅱc+Ⅱa型.结果 完整性切除率及治愈性切除率分别为93.8％、90.9％.切除黏膜平均最大径是3.2 cm(1.5～8.0 cm).非治愈性切除35例,包括32例R1切除,3例Rx切除.术中出血2例,迟发出血2例.结论 对于在适应证范围内的早期癌,ESD能达到很高的完整切除率及治愈性切除率,是治疗EGC的有效方法.     

早期胃癌的影象学诊断

目的论述各型早期胃癌影象学表现的特征性.方法随机选取经病理证实,胃低张多相钡剂造影资料完好的隆起型(Ⅰ型)和凹陷型(Ⅱc型和Ⅲ型)早期胃癌各15例,对照分析术后病理标本与双对比图象,提出早期胃癌及隆起型、凹陷型早癌三者的共有X线表现,以探讨X线双对比造影对早期胃癌的诊断价值.结果在充盈相或双对比相中显示胃壁局限性张缩异常、腔壁平直、内凹、毛糙、复线征等表现,有助于早期胃癌的发现.隆起型(Ⅰ型)早期癌病变正面观大多呈半球型、平皿型,≤2.0 cm,隆起肿块边缘清楚,表面光滑或呈颗粒样改变;切线位时病灶大多呈山田Ⅱ型和Ⅲ型,隆起肿块基底部胃壁内凹.双对比相上凹陷型早期癌(Ⅱc,Ⅲ型)其病变的边缘凹面向外,不规则形态的凹陷边界清楚者常为分化不良或低分化癌,反之则为分化较好或高分化癌;Ⅱc型癌凹陷病灶通常浅而大,Ⅲ型癌则凹陷较深;正面观凹陷表面可呈现高低不平,大小不一,分布不规则的颗粒样改变,为增生的癌组织残留或再生的粘膜上皮所组成;凹陷病变周围纠集的粘膜皱襞可呈锥状、杵状、中断和融合等;癌性皱襞更具有粗细不匀及阶梯样改变的特性,可与良性病变的粘膜纠集鉴别.结论良好的胃双对比检查能较客观地反映胃癌的大体病理形态,在早期胃癌病例的发现和诊断中具有特异性.     

早期胃癌临床病理特征与淋巴结转移范围的关系

回顾性研究132例早期胃癌病例的临床病理特征与淋巴结转移范围的关系.发现癌灶＞2 cm、癌细胞低分化、大体分型为凹陷型三个临床病理特征是早期胃癌淋巴结转移的独立危险因素(P＜0.05).同上述三个特征的早期胃癌无淋巴结转移,同时具备者第二站淋巴结转移率为18.75%.提示癌灶大小、癌细胞分化程度、大体分型对正确判断早期胃癌淋巴结转移和指导手术治疗有重要意义.     

255例早期胃癌临床病理及蓝激光成像结合放大内镜下的特征分析

目的 探讨早期胃癌的临床生物学特点及蓝激光成像结合放大内镜（BLI-ME）的诊断价值。 方法 2014年1月到2017年1月,复旦大学附属华山医院手术病理确诊的255例早期胃癌病例纳入回顾性研究,包括33例手术前行BLI-ME精查者。依据日本胃癌学会2010年指南将胃癌病理组织学分为分化型和未分化型早期胃癌,比较分析其临床特点、内镜下特征、病理分型、淋巴结转移情况及BLI-ME下的病变特点。 结果 255例早期胃癌中,男164例（63.31％）,＞40岁者242例（94.90％）,分化型182例（71.37％）,病变位于胃窦93例（36.47％）,内镜下0-Ⅱc型92例（36.08％）;发生淋巴结转移37例（14.51％）,对比分析发现,淋巴结转移率黏膜内癌明显低于黏膜下癌［5.04％（7／139）比25.86％（30／116）,χ2=22.109,P=0.000］,分化型癌明显低于未分化型癌［9.89％（18／182）比26.03％（19／73）,χ2=10.938,P=0.002］,病灶最大径≤2.0 cm明显低于＞2.0 cm［9.88％（16／162）比22.58％（21／93）,χ2=7.687,P=0.009］。33例行BLI-ME精查者中,分化型早期胃癌以FNP（13.64％,3／22）、ILL-1（59.09％,13／22）、ILL-2（22.73％,5／22）为主,未分化型早期胃癌可见ILL-2（45.45％,5／11）、CSP（54.55％,6／11）。 结论 早期胃癌发病率男性多于女性,大多数患者年龄在40岁以上,好发于胃窦部,内镜下形态以0-Ⅱc型居多。癌灶＞2.0 cm或侵及黏膜下层,以及未分化型癌易发生淋巴结转移。临床行BLI-ME精查,对黏膜异常微血管形态及异常微腺管结构进行观察,有助于判断早期胃癌的病理分型。     

黏膜内早期胃癌淋巴结转移危险因素以及内镜下治疗适应证的探讨

背景:内镜黏膜下剥离术已成为部分无淋巴结转移的早期胃癌的首选治疗手段,不同病理类型黏膜内早期胃癌的内镜下治疗适应证仍有争议。目的:探讨黏膜内早期胃癌淋巴结转移与临床病理因素的关系,以及不同病理类型的内镜下治疗适应证。方法:回顾性分析2009年3月—2016年12月于安徽省立医院行胃癌根治术的325例黏膜内早期胃癌患者的临床资料,采用单因素和二分类Logistic回归分析探讨黏膜内早期胃癌淋巴结转移的危险因素,并分析不同病理类型早期胃癌的淋巴结转移风险。结果:肿瘤直径 2 cm、病理类型为未分化型或混合型、存在溃疡、脉管浸润是黏膜内早期胃癌淋巴结转移的独立危险因素。无溃疡或肿瘤直径≤3 cm、有溃疡的分化型黏膜内早期胃癌的淋巴结转移风险均小于1%。肿瘤直径≤2 cm、无溃疡的未分化型黏膜内早期胃癌的淋巴结转移风险为2. 7%,其他未分化型和混合型黏膜内早期胃癌的淋巴结转移风险较高(8. 6%～22. 2%)。结论:临床病理因素对早期胃癌淋巴结转移具有预测价值,无溃疡或肿瘤直径≤3 cm、有溃疡的分化型黏膜内早期胃癌的淋巴结转移风险极低,或可成为内镜黏膜下剥离术的绝对适应证。     

22例早期胃癌内镜、病理及临床资料分析

目的探讨早期胃癌内镜、病理及临床特点。方法回顾分析我们近3年内22例确诊为早期胃癌的临床、内镜及病理资料。结果其中中青年人患者(年龄≤60)15例,老年患者7例;女性13例,男性9例;发生部位胃窦12例、胃角6例、胃体4例;Ⅰ型病灶3例,Ⅱa型3例,Ⅱb+Ⅱa型5例,IⅡa+Ⅱc型6例,Ⅱc型2例,Ⅲ型3例;病理分型印戒细胞癌10例,粘液癌6例,管状腺癌6例。结论中青年患者早期胃癌检出比例高于老年患者,胃镜联合超声胃镜将病灶切除后进行组织学检查是诊断早期胃癌的有效方法。     

分化不良型早期胃癌淋巴结转移的危险因素分析

目的评估分化不良型早期胃癌患者淋巴结转移的危险因素,探讨其内镜治疗的可能性。方法回顾性分析2002年9月-2008年12月经手术证实的100例分化不良型早期胃癌患者,对其年龄、性别、肿瘤大小、部位、大体类型、溃疡、组织学类型、浸润深度及淋巴管肿瘤浸润与淋巴结转移的关系进行单因素和多因素分析。结果分化不良型早期胃癌的淋巴结转移率达18．00％。多变量分析显示肿瘤大小（〉2cm）、侵犯至黏膜下层、淋巴管肿瘤浸润均是分化不良型早期胃癌淋巴结转移的独立危险因素（P〈0．05）。肿瘤大小和淋巴管肿瘤浸润是分化不良型黏膜内早期胃癌的淋巴结转移的独立危险因素。在直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内早期胃癌中未发现淋巴结转移。结论直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内癌患者可考虑内镜治疗,术后需密切随访。     

早期胃癌淋巴结转移规律及其影响因素分析

目的 探讨早期胃癌淋巴结转移规律及其影响因素,为选择合适的治疗方法提供依据.方法 对北京大学第三医院1988年3月-2009年3月于外科行胃癌根治术治疗的103例早期胃癌患者临床资料进行回顾性研究,对患者的年龄、性别,肿瘤的大小、部位、大体类型、分化程度及浸润深度与淋巴结转移的关系进行单因素及多因素分析.结果 早期胃癌的淋巴结转移率为17.5%(18/103),其中黏膜内癌的淋巴结转移率为4.1%(2/49),黏膜下层癌的淋巴结转移率为29.6%(16/54).logistic回归分析显示,浸润至黏膜下层(P=0.001)及肿瘤>2 cm(P=0.003)为早期胃癌淋巴结转移的独立危险因子.黏膜内癌发生淋巴结转移的2例均为直径>2 cm的印戒细胞癌;黏膜下层癌中,≤2 cm肿瘤的淋巴结转移率为16.1%(5/31),>2 cm肿瘤的淋巴结转移率高达47.8%(11/23)(P=0.012).高分化程度的早期胃癌的淋巴结转移率为0(0/13),中分化癌转移率为18.2%(4/22),低分化癌转移率为16.7%(5/30),印戒细胞癌转移率为23.7%(9/38),各组间差异无统计学意义(P=0.294).患者的年龄、性别、肿瘤部位(胃上部、中部、下部)和大体分型(隆起型、平坦型和凹陷型)与淋巴结转移无相关性.结论 肿瘤大小和浸润深度与早期胃癌淋巴结转移相关,决定早期胃癌治疗方案时,可参考上述因素判断淋巴结转移风险.     

Clinicopathologic factors and molecular markers related to lymph node metastasis in early gastric cancer

AIM: To analyze predictive factors for lymph node metastasis in early gastric cancer.METHODS: We analyzed 1104 patients with early gastric cancer(EGC) who underwent a gastrectomy with lymph-node dissection from May 2003 through July 2011. The clinicopathologic factors and molecular markers were assessed as predictors for lymph node metastasis. Molecular markers such as microsatellite instability, human mut L homolog 1, p53, epidermal growth factor receptor(EGFR) and human epidermal growth factor receptor 2(HER2) were included. The χ2 test and logistic regression analysis were used to determine clinicopathologic parameters.RESULTS: Lymph node metastasis was observed in 104(9.4%) of 1104 patients. Among 104 cases of lymph node positive patients, 24 patients(3.8%) were mucosal cancers and 80 patients(16.7%) were submucosal. According to histologic evaluation, the number of lymph node metastasis found was 4(1.7%) for well differentiated tubular adenocarcinoma, 45(11.3%) for moderately differentiated tubular adenocarcinoma, 36(14.8%) for poorly differentiated tubular adenocarcinoma, and 19(8.4%) for signet ring cell carcinoma. Of 690 EGC cases, 77 cases(11.2%) showed EGFR overexpression. HER2 overexpression was present in 110 cases(27.1%) of 406 EGC patients. With multivariate analysis, female gender(OR = 2.281, P = 0.009), presence of lymphovascular invasion(OR = 10.950, P 0.0001), diameter(≥ 20 mm, OR = 3.173, P = 0.01), and EGFR overexpression(OR = 2.185, P = 0.044) were independent risk factors for lymph node involvement.CONCLUSION: Female gender, tumor size, lymphovascular invasion and EGFR overexpression were predictive risk factors for lymph node metastasis in EGC.     

Clinicopathological study of lymph-node metastasis in 1,389 patients with early gastric cancer: assessment of indications for endoscopic resection

BACKGROUND: The endoscopic resection of early gastric cancers (EGC) is a standard technique in Japan and is increasingly used throughout the world. Further experience in the treatment of EGC and a clearer delineation of the factors related to lymph‐node metastasis would permit a more accurate assessment of endoscopic resection. METHODS: The study group comprised 1389 patients with EGC who underwent gastrectomy with lymph‐node dissection. We evaluated the relations of lymph‐node metastasis to clinicopathological factors. RESULTS: Of the 718 patients with intramucosal carcinomas, 14 (1.9%) had lymph‐node metastasis. All cases of lymph‐node metastasis were associated with ulceration. No lymph‐node metastasis was found in patients with intramucosal carcinomas without ulceration, irrespective of tumor size and histological type. Lymph‐node metastasis was present in 14 (4.7%) of the 296 patients who had cancer with a submucosal invasion depth of less than 500 μm (sm1). Significantly increased rates of lymph‐node metastasis were associated with undifferentiated types, ulcerated lesions and lymphatic invasion. No lymph‐node metastasis was found in patients with differentiated sm1 carcinomas 30 mm or less in diameter without ulceration. Lymph‐node metastasis occurred in 29% of the patients who had cancer with a submucosal invasion depth of 500 μm or more (sm2). CONCLUSION: This large series of patients with EGC provides further evidence supporting the expansion of indications for endoscopic treatment, as well as warns against potential risks.     

早期胃癌淋巴结转移的临床病理特征分析

背景：淋巴结转移是影响早期胃癌（EGC）预后的首要因素。目的：探讨EGC淋巴结转移的危险因素,为制定合理的治疗方案提供临床依据。方法：回顾性分析南京鼓楼医院2002年9月～2008年12月经手术病理证实的250例EGC患者,分别采用单因素和多因素分析探讨性别、年龄、肿瘤大小、肿瘤部位、大体类型、溃疡、组织学类型、浸润深度、淋巴管肿瘤浸润以及神经侵犯与淋巴结转移的关系。结果：EGC淋巴结转移率达14．0％。单因素分析显示性别、肿瘤大小、浸润深度、淋巴管肿瘤浸润和神经侵犯与EGC淋巴结转移相关（P〈0．05）。多因素分析显示女性、肿瘤大小（〉2cm）、黏膜下层浸润和淋巴管肿瘤浸润是EGC淋巴结转移的独立危险因素（P〈0．05）。在肿瘤直径≤2cm且分化良好的黏膜内EGC患者中未发现淋巴结转移。结论：评估EGC淋巴结转移与临床病理特征的关系具有重要的临床意义。肿瘤直径≤2cm且分化良好的黏膜内EGC可行内镜治疗。     

Tis期结直肠癌内镜下非治愈性切除后追加外科手术的临床分析

目的探讨Tis期结直肠癌内镜下非治愈性切除的临床特点及外科手术的应用价值。 方法通过回顾性收集2013年1月至2021年12月期间在广东省中医院胃肠肿瘤中心行内镜下非治愈性切除后接受补救手术治疗的34例Tis期结直肠癌患者的临床资料,总结患者的内镜治疗情况、补救手术指征、术后病理等,并分析导致补救手术实施的主要原因。 结果全组34例患者中,男性18例,女性16例,中位年龄58（30~78）岁,病变位于右半结肠6例、左半结肠17例、直肠11例。内镜下观察息肉形态属山田Ⅰ型7例、山田Ⅱ型8例、山田Ⅲ型17例、山田Ⅳ型2例;内镜切除方法包括内镜下黏膜切除术（EMR）20例、内镜黏膜下剥离术（ESD）6例、内镜下黏膜分块切除术（EPMR）以及圈套器套扎切除术各4例。追加外科手术的指征包括可疑黏膜下浸润21例（61.8%）、基底切缘距离肿瘤＜1 mm 21例（61.8%）、基底切缘或侧切缘阳性10例（29.4%）、分块切除8例（23.5%）。息肉病理中判断为肿瘤侵犯黏膜肌层24例（70.6%）,无患者出现淋巴脉管侵犯或肿瘤出芽。内镜切除与手术切除间隔中位时间为14 d。术后病理结果：共10例（29.4%）患者出现癌残留,包括黏膜内癌残留8例（23.5%）和T1期腺癌残留2例（5.9%）;中位淋巴结检出数12（3~34）枚,无患者出现区域淋巴结转移。癌残留的危险因素包括切缘阳性和分块切除,非可疑黏膜下浸润患者均未出现T1期腺癌残留。 结论Tis期CRC内镜下切除后病理诊断的不明确性是导致追加补救手术的主要原因,外科治疗决策中可能高估了Tis期CRC发生黏膜下浸润的风险。对于具有手术指征的Tis期结直肠癌患者,手术治疗的肿瘤学获益并不大,定期内镜复查可能是更加安全的选择。     

Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma

AIM: The prognosis of early gastric carcinoma (EGC) is generally excellent after surgery. The presence or absence of lymph node metastasis in EGC is an important prognostic factor. The survival and recurrence rates of node-negative EGC are much better than those of node-positive EGC. This study examined the factors related to lymph node metastasis in EGC to determine the appropriate treatment for EGC. METHODS: We investigated 748 patients with EGC who underwent surgery between January 1985 and December 1999 at the Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hospital. Several clinicopathologic factors were investigated to analyze their relationship to lymph node metastasis: age, sex, tumor location, tumor size, gross type, histologic type, depth of invasion, extent of lymph node dissection, type of operation, and DNA ploidy. RESULTS: Lymph node metastases were found in 75 patients (10.0%). Univariate analysis showed that male sex, tumor size larger than 2.0 cm, submucosal invasion of tumor, histologic differentiation, and DNA ploidy pattern were risk factors for regional lymph node metastasis in EGC patients. However, a multivariate analysis showed that three risk factors were associated with lymph node metastasis: large tumor size, undifferentiated histologic type and submucosal invasion. No statistical relationship was found for age, sex, tumor location, gross type, or DNA ploidy in multivariate analysis. The 5-year survival rate was 94.2% for those without lymph node metastasis and 87.3% for those with lymph node metastasis, and the difference was significant (P<0.05). CONCLUSION: In patients with EGC, the survival rate of patients with positive lymph nodes is significantly worse than that of patients with no lymph node metastasis. Therefore, a standard D2 lymphadenectomy should be performed in patients at high risk of lymph node metastasis: large tumor size, undifferentiated histologic type and submucosal invasion.     

Clinicopathological investigation of early gastric carcinoma; is less invasive surgery right for early gastric carcinoma?

BACKGROUND/AIMS: The detection of early gastric carcinoma (EGC) has increased worldwide in recent years due to advances in endoscopic techniques and equipment. The objectives of this study were to compare the clinicopathological findings of patients with N1 node-negative and positive EGC, and then consider the treatment options. METHODOLOGY: A total of 814 cases of gastric carcinoma in patients who underwent surgical procedures between 1981 and 1999 at Kochi Medical School were studied. In 375 patients with EGC, surgicopathological parameters were analyzed. RESULTS: Lymph node metastasis was observed in 28 patients (7.4%) with EGC. EGC of the flat type with submucosal invasion, lymphatic permeation, and tumor size larger than 4 cm was associated with higher risk factors of lymph node metastasis. In this study, the location and histological classification of EGC were not related to lymph node metastasis. However, lymph node metastasis was not recognized in submucosal invasive gastric carcinomas less than 1 cm in size. CONCLUSIONS: In the EGC limited to the mucosa or smaller than 1 cm, when the tumor infiltrated the submucosal layer, it could be managed by less invasive surgery without standard lymphadenectomy, and gastrectomy with lymphadenectomy was necessary for patients with EGC who had a high risk of lymph node metastasis.     

Study on the risk factors of lymphatic metastasis and the indications of less in vasive operations in early gastric cancer

The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.     

Predictive factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on the surgical strategy

AIM： To identify the predictive clinicopathological factors for lymph node metastasis （LNM） in poorly differentiated early gastric cancer （EGC） and to further expand the possibility of using endoscopic mucosal resection （EMR） for the treatment of poorly differentiated EGC. METHODS： Data were collected from 85 poorly- differentiated EGC patients who were surgically treated. Association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. RESULTS： Univariate analysis showed that tumor size （OR = 5.814, 95% CI = 1.050 - 32.172, P = 0.044）, depth of invasion （OR = 10.763, 95% CI = 1.259 - 92.026, P = 0.030） and lymphatic vessel involvement （OR = 61.697, 95% CI = 2.144 - 175.485, P = 0.007） were the significant and independent risk factors for LNM. The LNM rate was 5.4%, 42.9% and 50%, respectively, in poorly differentiated EGC patients with one, two and three of the risk factors, respectively. No LNM was found in 25 patients without the three risk factors. Forty-four lymph nodes were found to have metastasis, 29 （65.9%） and 15 （34.1%） of the lymph nodes involved were within N1 and beyond N1, respectively, in 12 patients with LNM. CONCLUSION： Endoscopic mucosal resection alone may be sufficient to treat poorly differentiated intramucosal EGC （≤ 2.0 cm in diameter） with no histologically-confirmed lymphatic vessel involvement. When lymphatic vessels are involved, lymph node dissection beyond limited （D1） dissection or D1＋ lymph node dissection should be performed depending on the tumor location.     

Predictive factors for lymph node metastasis and endoscopic treatment strategies for undifferentiated early gastric cancer

Background and Aim: Although more than 80% of undifferentiated early gastric cancers (EGC) are not associated with lymph node metastasis, endoscopic mucosal resection is not generally accepted as a means of curative treatment because of an abundance of conflicting data concerning clinicopathological characteristics and prognoses. The aim of this study was to define a subgroup of undifferentiated EGC that could be cured by endoscopic treatment without the risk of lymph node metastasis. Method: A total of 591 patients surgically resected for undifferentiated EGC between January 1999 and March 2005 were reviewed. Associations between various clinicopathological factors and the presence of lymph node metastasis were analyzed to identify the risk factors of lymph node metastasis. Results: Lymph node metastasis was found in 79 patients (13.4%). By multivariate logistic regression analysis, a tumor diameter 2.5 cm or larger, invasion into the middle third of the submucosal layer or deeper, and lymphatic involvement were identified as independent risk factors of lymph node metastasis (P < 0.001, respectively). Lymph node metastasis was not found in any patient with undifferentiated EGC smaller than 2.5 cm confined to the mucosa or upper third of the submucosal layer without lymphatic involvement. Conclusions: Undifferentiated intramucosal EGC smaller than 2.5 cm without lymphatic involvement was not associated with lymph node metastasis. Thus, we propose in this circumstance that endoscopic mucosal resection could be considered a definitive treatment without compromising the possibility of cure.