Lymph node metastasis in early gastric cancer

we conducted a prospective study of patients with gastric cancer admitted to the Section of the Esophago-Gastric Surgery of the Surgery of Service HUCFF-UFRJ, from January 2006 to May 2012.

RESULTS:

the rate of early gastric cancer was 16.3%. The incidence of nodal metastases was 30.8% and occurred more frequently in patients with tumors with involvement of the submucosa (42.9%), in those poorly differentiated (36.4%), in tumors larger than 2 cm (33.3%) and in type III ulcerated lesions (43.8%).

CONCLUSION:

the incidence of lymph node metastases in patients was very high and suggests that one should keep the radicality of resection in early gastric cancer, particularly in relation to D2 lymphadenectomy, recommended for advanced gastric cancer. Conservative resections, with lymphadenectomies smaller than D2, should be performed only in selected cases, well-studied as for the risk factors of lymph node metastasis. Despite the small number of cases did not permit to relate the rate of lymph node metastasis to the risk factors considered, we noted a strong tendency for the occurrence of these metastases in the poorly differentiated, type III, larger than 2 cm tumors, and in the Lauren diffuse types.

Stomach neoplasms; Lymphatic metastasis; Gastrectomy; Lymph node excision; Risk factors

Operable Patients	N (%)		Surgery	Performed
Local advanced disease without possibility of	30	(24%)	Palliative Resection
R0 resection
Operable with possibility of R0 resection	83	(66.4%)	Gastrectomy with D2 lymphadenectomy
Early tumors without lymph node metastasis	12 (9,6%)		Atypical	Gastrectomy with limited
			lymphadenectomy

	T4 (14)	T3 (59)	T2 (17)	T1b (14)	T1a (12)
N 0	7,1%	15,2%	41,2%	57,1%	83,4%
N 1	28,6%	11,9%	23,5%	14,3%	8,3%
N 2	7,1%	25,4%	23,5%	21,4%	8,3%
N 3 a	28,6%	32,2%	11,8%	7,1%	0%
N 3 b	28,6%	15,2%	0%	0%	0%
N +	92,9 %*	84,8 %*	58,8 %*	42,9 %*	16,7 %*

Patient	T 1	Size(cm)	Macro Classif.	Lauren	Degree of Differentiation	N
1	b	1.6	III	Intestinal	Moderately Differentiated	0
2	a	3.5	IIb	Diffuse	Poorly Differentiated	0
3	a	0.5	I	Intestinal	Well Differentiated	0
4	b	2.2	III	Intestinal	Well Differentiated	0
5	b	1.8	IIa + IIc	Intestinal	Moderately Differentiated	0
6	a	1.5	IIc + III	Diffuse	Poorly Differentiated	0
7	b	1.5	III	Diffuse	Poorly Differentiated	0
8	a	3.0	IIa	Intestinal	Well Differentiated	0
9	a	1.7	I	Intestinal	Well Differentiated	0
1 0	b	1.5	IIa	Diffuse	Poorly Differentiated	0
1 1	b	2.2	III	Diffuse	Poorly Differentiated	0
1 2	a	3.0	IIb	Diffuse	Poorly Differentiated	0
1 3	a	3.0	IIa + IIb	Diffuse	Poorly Differentiated	0
1 4	b	3.5	IIb	Intestinal	Moderately Differentiated	0
1 5	a	2.0	III	Intestinal	Well Differentiated	0
1 6	b	1.8	III	Intestinal	Well Differentiated	0
1 7	a	4.3	IIa + III	Intestinal	Well Differentiated	0
1 8	a	2.0	IIa + III	Intestinal	Moderately Differentiated	0
1 9	b	2.2	III	Intestinal	Well Differentiated	2
2 0	b	0.8	IIc	Diffuse	Poorly Differentiated	2
2 1	a	3.5	III	Diffuse	Poorly Differentiated	2
2 2	a	3.5	III	Diffuse	Moderately Differentiated	1
2 3	b	0.4	III	Intestinal	Moderately Differentiated	2
2 4	b	1.5	III	Diffuse	Poorly Differentiated	3a
2 5	b	2.0	III	Intestinal	Moderately Differentiated	1
2 6	b	6.0	III + IIb	Diffuse	Poorly Differentiated	1

T			N +		N 1		N 2		N 3
T1a		2/12	(16.7%)	1/12	(8.3%)	1/12	(8.3%)	0
T1b		6/14	(42.9%)	2/14	(14.3%)	3/14	(21.4%)	1/14	(7.1%)
Size of the	lesion
< ou = 2cm		4/14	(28.6%)	1/14	(7.1%)	2/14	(14.3%)	1/14	(7.1%)
> 2cm		4/12	(33.3%)	2/12	(16.7%)	2/12	(16.7%)	0
Macrosc. Classif.
Types I and II		1/10	(10%)	0		1/10	(10%)	0
Type III		7/16	(43.8%)	3/16	(18.8%)	3/16	(18.8%)	1/16	(6.2%)
Degree of Diferent.
Well Dif.		1/8	(12.5%)	0		1/8	(2.5%)	0
Mod. /Poorly Dif.		7/18	(38.9%)	3/18	(16.7%)	3/18	(16.7%)	1/18	(5.5%)
Classif. of	Lauren
Intestinal		3/14	(21.4%)	1/14	(7.1%)	2/14	(14.3%)	0
Diffuse		5/12	(41.7%)	2/12	(16.7%)	2/12	(16.7%)	1/12	(8.3%)

		T 1 a	T 1 b	T1 a<or= 2cm	T1 a> 2cm	T1 b<ou= 2cm	T1b> 2cm
Size of the	lesion
< or = 2cm		0 / 5	4/9	-	-	-	-
> 2cm		2/7	2/5	-	-	-	-
Macrosc. Classif.
Types I / II		0 / 6	1/4	0 / 2	0 / 4	1/3	0/1
Type III		2/6	4/10	0 / 3	2/3	3/6	2/4
Degree of Diferent.
Well Dif.		0 / 5	1/3	0 / 3	0 / 2	0/1	1/2
Mod. /Poorly Dif.		2/7	5/11	0 / 2	2/5	4/8	1/3
Classif. of	Lauren
Intestinal		0 / 6	3/8	0 / 4	0 / 2	2/5	1/3
Diffuse		2/6	3/6	0 / 1	2/5	2/4	1/2

Variable	positive	(n=8)	negative	(n=18)	p value^a
	n	%	n	%
T
T1a	2	25.0	10	55.6	0.15
T1b	6	7 5 . 0	8	4 4 . 4
Size (cm) ^b	2.1 (0.4 – 6.0)	2.0 (0.5 – 4.3)	0.18 ^b
	average = 2.5 cm	average = 2.2cm
< ou = 2cm	4	50.0	10	55.6	0.56
> 2cm	4	50.0	8	44.4
Macrosc. Classif.
Types I e II	1	12.5	9	50.0	0.081
Type III	7	8 7 . 5	9	5 0 . 0
Degree of Difer.
WellDif.	1	12.5	7	38.9	0.45
Mod. /poorly Dif.	7	8 7 . 5	11	6 1 . 1
Lauren
Intestinal	3	37.5	11	61.1	0.24
Difuso	5	6 2 . 5	7	3 8 . 9

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