조기위암의 림프절 전이에 따른 치료성적 및 예후인자

Abstract

Purpose: Lymph node (LN) metastasis and depth of invasion are known to be prognostic factors in early gastric cancer (EGC). This study was designed to determine the clinicopathoiogical features of EGC wth and without LN metastasis and an appropriate procedure for EGC. Methods: The authors retrospectively reviewed 489 patients with EGC who underwent curative resection with LN dissection between January 1990 and December 1997 at the Department of Surgery, Keimyung University Dong San Medical Center. The authors divided the 489 patients into two groups. Group 1: EGC witti LN metastasis, Group 2: EGC without LN metastasis. We analyzed and compared the dinicopathologic features (age, sex, tumor location and size, gastric resection and LN dissection, macroscopic type, depth of invasion, histological type, Lauren classification and lym-phatic and vascular invasion) of the two groups. Results: The incidence of EGC among all gastric cancer was 29.1% and increased annually (19.1% in 1990, 31.5% in 1994 and 40.2% in 1997), The incidence of LN metastasis was 16.2% (79/489) with 7.2% in mucosal cancer and 26.7% in submucosal cancer. Univariate analysis of 12 prognostic factors revealed only 4 factors, that were statistically significant: deptii of invasion, tumor size, histologic type and lymjrfiatic invasion. Multivariate analysis of these 4 significant prognostic factors did not yield significant results but the risk ratio revealed depth of invasion, tumor size, his-tologteal type and lymphatic invasion occurred in order of decreasing frequency. The five-year survival rate of EGC was 90.83% (91.82% in EGC with LN metastasis and 85.80% in EGC without LN metastasis, p=0.0242). The relationship between the depth of invasion, macroscopic type, tumor size and LN metastasis reveled there was no LN met^tasis in tumors of less than 2.0 cm in size in the elevated type (both in mucosal and submucosal cancer) and less ttian 1.0 cm in the size in the depressed type (only in mucosal cancer). Conclusion: Gastrectomy without LN dissection can be applied for EGC less than 2.0 cm in size in elevated types (both in mucosal and submucosal cancer) and less than 1.0 cm in size in depressed types (only in mucosal cancer). Conventtonal gastrectomy with LN dissection is recommended in other early g^tric cancer.