Feasible endoscopic therapy for early gastric cancer

AIM To analyze the relationship between lymphnode metastasis and clinical pathology of early gastriccancer （EGC） in order to provide criteria for a feasibleendoscopic therapy.METHODS： Clinical data of the 525 EGC patients whounderwent surgical operations between January 2009and March 2014 in the West China Hospital of SichuanUniversity were analyzed retrospectively. Clinicalpathological features were compared between differentEGC patients with or without lymph node metastasis,and investigated by univariate and multivariate analysesfor possible relationships with lymph node metastasis.RESULTS： Of the 2913 patients who underwentgastrectomy with lymph node dissection, 529 caseswere pathologically proven to be EGC and 525 caseswere enrolled in this study, excluding 4 cases of gastricstump carcinoma. Among 233 patients with mucosalcarcinoma, 43 （18.5%） had lymph node metastasis.Among 292 patients with submucosal carcinoma,118 （40.4%） had lymph nodemetastasis. Univariateanalysis showed that gender, tumor size, invasiondepth, differentiation type and lymphatic involvementcorrelated with a high risk of lymph node metastasis.Multivariate analysis revealed that gender （OR = 1.649,95%CI： 1.091-2.492, P = 0.018）, tumor size （OR =1.803, 95%CI： 1.201-2.706, P = 0.004）, invasiondepth （OR = 2.566, 95%CI： 1.671-3.941, P = 0.000）,histological differentiation （OR = 2.621, 95%CI：1.624-4.230, P = 0.000） and lymphatic involvement（OR = 3.505, 95%CI： 1.590-7.725, P = 0.002） were independent risk factors for lymph node metastasis.Comprehensive analysis showed that lymph nodemetastasis was absent in patients with tumor that waslimited to the mucosa, size ≤ 2 cm, differentiated andwithout lymphatic involvement.CONCLUSION： We propose an endoscopic therapyfor EGC that is limited to the mucosa, size ≤ 2 cm,differentiated and without lymphatic involvement.