In gastric cancer, lymphovascular invasion and other factors predict the likelihood of lymph node metastasis. For patients who consider  endoscopic resection as a therapeutic option, with early gastric cancer, the possibility of lymph node metastasis remains an important factor.

The patients with early gastric cancer who have been considered for the endoscopic resection as a therapeutic option, for those patients, the possibility of lymph node metastasis remains an important prognostic factor.

The patients with a high risk of lymph node involvement might require endoscopic resection . T stage, lymphovascular invasion, and other factors predict the likelihood of lymph node metastasis in patients with T1 gastric cancer.

Dr. George A. Poultsides from Stanford Cancer Institute, California, and his colleagues sought to identify predictors of lymph node metastasis in patients with T1 gastric cancer.

They have also developed a clinicopathologic risk score to determine the risk of lymph node metastasis preoperatively. Of the 176 patients with T1 tumors, 38 (21.6%) had lymph node metastasis on pathology after curative gastrectomy .

Factors independently associated with lymph node involvement in multivariate analysis included poor differentiation, tumor size> 2 cm, tumor invading the muscularis mucosa (T1b), and the presence of lymphovascular invasion (LVI).

The researchers developed a clinicopathologic score by assigning three points each for poor differentiation, T1b tumors, and lymphovascular invasion, and 2 points for tumor size more than 2 cm had been assigned.

A score higher than 3 points was 100% sensitive in detecting lymph node metastasis , whereas no lymph node involvement was present between patients with scores of 0 or 2 points, no patient in the study had scored 1 point.

Incrementally greater scores correlated with a higher incidence of lymph node metastasis so that 77% of patients with the highest score of 11 points showed evidence of lymph node involvement.

"Although operative resection remains the gold standard for early gastric cancer, there might be a role for endoscopic resection in high-risk patients with a low score to obviate the morbidity associated with gastrectomy," the note.

"If 2 or more of the factors mentioned above were present, the risk of lymph node metastasis appears to be high, and endoscopic resection alone does not appear to be an appropriate treatment strategy oncologically," the researchers noted.

Further study would be needed to validate the findings in Western patients with early gastric cancer. The long-term effects, cost-effectiveness, and validation of the survey of Asian population are yet to be explored.