PREDICTIVE FACTORS FOR REGIONAL LYMPH NODE INVOLVEMENT IN EARLY GASTRIC CANCER PATIENTS
Abstract
Background. Number of endoscopically treated early gastric cancer (EGC) patients has been constantly growing. EMR is relatively simple, unexpensive, has low complication rate and offers substantially better quality of life than classical operative therapy.
Patients and methods. 158 EGC patients were treated in Clinical centre Ljubljana from Jan. 1st 1983 to Dec. 31st 1997; 156 patients were operated on, 2 were treated endoscopically. Importance of several clinico-pathological predictive factors for lymph node involvement was first tested by chi-square test and then included in multivariate model.
Results. 24 out of 156 (15.4%) resected patients had positive regional lymph nodes. Multivariate analysis proved the importance of depth of infiltration (p = 0.0005), of histological type by Lauren (p = 0.0087) and partly of the size of the lesion (p = 0.1355) as prognostic factors for regional lymph node involvement. Relative risk in submucosal EGC is 7.4 times greater than that in mucosal EGC. Diffuse type has 4.5 times and mixed 5.2 times the risk in intestinal type. Each cm in diameter increased the relative risk 1.2 times. Observed 5-year survival of our patients was 81.7% (85.7% in N0 and 53.3% in N+ patients).
Conclusions. EMR is the treatment of choice in patients with early gastric cancer and no regional lymph node metastases. Proper selection of patients by clinico-pathological predictive factors for regional lymph node metastases is essential. Beside two endoscopically treated patients, 12 patients were suitable for such a therapeutic procedure in our 15-year series.
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References
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