Clinicopathological Study of Lymph Node Metastasis for Early Gastric Cancer

Tokio Okusa, Yasushi Nakane, Syunichirou Okumura, Keiji Akehira, Sigeo Okamura, Tsunehide Boku, Kanji Tanaka, Koshiro Hioki, Akiharu Okamura*

Second Department of Surgery and Department of Surgicalpathology*, Kansai Medical University

We investigated the indications for conservative surgery in 351 early gastric cancers according to the relationship between lymph node metastasis and the clinicopathological factotrs. The incidence of lymph nodes metastasis in cases of mucosal cancer (m ca.) and submucosal cancer (sm ca.) were 5.4% and 18.0%, respectively. The rate of lymph node metastasis of sm ca. was slightly higher than that of m ca. for each clinicopathological factor. Furthermore, the presence of lymph node metastasis was determined by multivariate analysis using the type II quantification method. Lymph node metastasis of gastric cancer had a closer relationship to histological type, tumor size and gross findings than to depth of invasion, location of the tumor, or preoperative CEA value. The rates of lymph node metastasis were significantly higher for tumors 4 cm or larger, por on histological type, advanced type and elevated + depressed type on the gross findings. Rates were lower for the flat type on gross findings, and for tumors less than 3 cm in diameter. The accuracy rate in discriminating between the two groups was 71.7%. Conservative surgery is performed on cases that scored lower than the cutoff point. However, when the score is below the cutoff point in cases involving por or UI (+), findings should be reviewed carefully. This analysis may be useful for predicting the presence of lymph node metastasis before surgery, and helpful in determining whether to perform conservative surgery.

Key words
indication of limited operation for early gastric cancer, lymph node metastasis of early gastric cancer, multivariate analysis

Reprint requests
Tokio Okusa The Second Department of Surgery, Kansai Medical University
1 Fumizono, Moriguchi, Osaka 570 JAPAN

Accepted
November 9, 1994

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