Clinical Research Papers:

Histology-based prediction of lymph node metastases in early gastric cancer as decision guidance for endoscopic resection

Ulrich Ronellenfitsch, Christiane Lippert, Rainer Grobholz, Siegfried Lang, Stefan Post, Georg Kähler and Timo Gaiser _

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Oncotarget. 2016; 7:10676-10683. https://doi.org/10.18632/oncotarget.7221

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Ulrich Ronellenfitsch1,*, Christiane Lippert2,*, Rainer Grobholz3, Siegfried Lang4, Stefan Post1, Georg Kähler1 and Timo Gaiser2

1 Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

2 Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

3 Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland

4 First Department of Medicine, Division of Biostatistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

* These authors have contributed equally to this work

Correspondence to:

Timo Gaiser, email:

Keywords: early gastric cancer, lymph node metastases, histopathological risk factors, endoscopic treatment, Western study population

Received: October 21, 2015 Accepted: January 24, 2016 Published: February 06, 2016


Background: Selected cases of early gastric cancer (EGC) can be successfully treated by endoscopic therapy if the risk of concurrent lymph node metastases (LNM) is negligible. Criteria for endoscopic resection based on risk factor analyses for LNM have been established mainly in Asia. However, it is not clear to what extent these recommendations can be transferred to Western collectives. The aim of this study was to analyze predictors for LNM in EGC in a Western study population.

Methods: From our institutional archive, we selected all patients with gastric adenocarcinoma who had undergone gastrectomy with lymphadenectomy (1972 – 2005). Among 1970 patients 275 cases with EGC were identified. Clinical and pathological data were collected and logistic regression analyses performed.

Results: LNM were present in 36/275 (13.1%) patients. With deeper invasion proportion of LNM increased. At submucosa level (sm1), patients were almost five times more likely to have LNM than at mucosa levels.

Multivariable logistic regression analysis revealed lymphovascular invasion, diffuse- and mixed-type, and invasion depth as significant independent histopathological predictors of LNM. In patients with intestinal type according to Lauren and no lymphovascular invasion, we found only one LNM-positive case out of 43 patients in the pT1b (sm1 and sm2) groups.

Conclusions: Our results underline the recommendation of most guidelines that endoscopic resection is sufficient for pT1a ECG because of the low incidence of LNM in this group. However, there seems also a role for endoscopic therapy in cases of pT1b (sm1/2) EGC with intestinal type differentiation and no lymphovascular invasion.

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