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Background: Gastrectomy with lymph node (LN) dissection was considered as the gold standard for early gastric cancer (EGC) in the past. However, expansion of the criteria for endoscopic treatment has been currently proposed. This study aims to investigate the histopathologic determinants and outcomes of EGC in order to redefine the current treatment strategy.
Methods: The gastric cancer tumor registry at our institution was reviewed. Sixty-seven patients were identified who underwent either endoscopic mucosal resection (EMR) or gastrectomy for EGC or high grade dysplasia between 2006 and 2011. A retrospective analysis was performed on the medical records of these patients. Mean follow-up period was 21+/-18 (1-73) months.
Results: The study population consisted of 25 (37.9%) Asians, 24 (36.4%) Caucasians, 11 (16.7%) Hispanics, 7 (10.6%) African-Americans. The incidence of lymph node metastasis was 3.1% in Asians and 17.1% in non-Asians, respectively. Nine patients underwent EMR and 58 patients underwent gastrectomy with LN dissection. Among the latter group, eight (13.8%) patients had LN metastasis. Subgroup analysis comparing the histopathologic characteristics of T1b with T1a EGC was performed; nine (36.0%) patients with T1a and 11 (40.7%) patients with T1b had diffuse type histology (p=0.26). The incidence of lymph node metastasis was 4.0% with T1a in comparison to 25.9% with T1b (p=0.03). The survival rate for the T1b group (92.6%) did not differ significantly from that of the T1a group (93.5%) during the follow-up period.
Conclusions: EGC in Asian Americans is less likely to be associated with LN metastases than non-Asian EGC regardless of depth or histotype. In our small series with ethnic diversity, patients with T1b EGC had significantly higher LN metastasis rate but did not have a significantly different survival rate from those with T1a, indicating that gastrectomy with LN dissection should remain the standard strategy for T1b EGC.