Significance of Lymph Node Micrometastasis in Early Differentiated-type Gastric Carcinoma with Submucosal Invasion

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  • KATO Masanori
    Megumi Clinic Meguro
  • YAMAZAKI Kimiyasu
    Department of Surgery, Division of General and Gastroenterological Surgery, Showa University School of Medicine
  • OTSUKA Koji
    Department of Surgery, Division of General and Gastroenterological Surgery, Showa University School of Medicine
  • MURAKAMI Masahiko
    Department of Surgery, Division of General and Gastroenterological Surgery, Showa University School of Medicine
  • TAJIMA Yusuke
    Department of Surgery, Kanto Rosai Hospital, Japan Organization of Occupational Health and Safety

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Other Title
  • 粘膜下層浸潤を伴う分化型胃癌におけるリンパ節微小転移（LNMM；lymph node micrometastasis）の意義
  • ネンマク カソウ シンジュン オ トモナウ ブンカガタ イガン ニ オケル リンパセツ ビショウ テンイ(LNMM ; lymph node micrometastasis)ノ イギ

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Abstract

Accurate prediction of the metastatic status of lymph nodes is clinically important for selecting treatment strategies in patients with early gastric carcinoma with submucosal invasion （GCSM）. However, theclinicopathological significance of lymph node micrometastasis （LNMM） remains unclear. In this study, we aimed to determine the clinicopathological risk factors for LNMM in patients with early differentiated-type GCSM. A total of 2,773 lymph nodes resected from 103 patients with early differentiated-type GCSM who underwent curative gastrectomy from 1994 to 2006 at Showa University Hospital, were immunostained with CAM 5.2 monoclonal antibody to detect LNMM. The tumor differentiation phenotype was determined by examining the expression of human gastric mucin （HGM）, MUC6, MUC2 and CD10 in all tumors. Clinicopathological risk factors for LNMM were analyzed by univariate and multivariate logistic regression analysis. Also, the association between tumor differentiation phenotype and the status of LNMM was investigated. LNMM was detected in 14 patients （13.6％）. As a result, lymph node metastasis, including LNMM, was detected in 20 patients （19.4％） of the 103 patients. A multivariate analysis revealed that a mixed-type histology （odds ratio＝6.862） and the presence of lymphatic vessel invasion detected using D2-40 immunostaining （odds ratio＝8.907） were independent risk factors for LNMM. There was no correlation between tumor differentiation phenotype and the status of LNMM. A mixed-type histology and lymphatic vessel invasion are important risk factors for predicting the presence of LNMM in patients with early differentiated-type GCSM.

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