Lymph node metastasis in early gastric cancer

OBJECTIVE: to evaluate the incidence of lymph node metastasis in early gastric cancer, identifying risk factors for its development. METHODS: 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.

研究目的：评估早期胃癌的淋巴结转移发生率，并明确其发生的危险因素。
研究方法：本研究为前瞻性队列研究，纳入2006年1月至2012年5月期间，巴西里约热内卢联邦大学（UFRJ）克莱门蒂诺·弗拉加·菲略大学附属医院（HUCFF）食管胃外科收治的胃癌住院患者。
研究结果：早期胃癌占纳入研究病例的比例为16.3%。淋巴结转移总发生率为30.8%，且在以下亚组中更为高发：肿瘤侵犯黏膜下层的患者（42.9%）、低分化肿瘤患者（36.4%）、肿瘤直径大于2cm的患者（33.3%）以及Ⅲ型溃疡性病变患者（43.8%）。
研究结论：早期胃癌患者的淋巴结转移发生率较高，提示针对早期胃癌仍需遵循根治性切除原则，尤其是针对晚期胃癌推荐的D2淋巴结清扫术。仅在经过严格筛选、经充分评估淋巴结转移危险因素的病例中，方可采取保守性切除且淋巴结清扫范围小于D2的手术方案。尽管本研究病例数较少，无法将淋巴结转移率与所纳入的危险因素进行关联分析，但我们观察到，低分化肿瘤、Ⅲ型病变、肿瘤直径大于2cm以及Lauren弥漫型（Lauren diffuse type）的患者，其淋巴结转移发生风险呈现显著升高趋势。