조기위암에서 맥관 침습의 의의

Abstract

Purpose: Various types of minimally invasive therapy have been attempted for early gastric cancer (EGC) patients. However, minimally invasive therapy can not fully evaluate the nodal status which has been suggested as an important prognostic factor for EGC patients. This study was conducted to evaluate the clinical implications and prognostic impact of lymphatic or blood vessel invasion (LBVI) in EGC patients in the era of minimally invasive therapy.

Methods: A total of 566 EGC patients who had undergone gastrectomy with D2 or more extended lymphadenectomy between July 1993 and December 1997 were retrospectively reviewed. The risk factors that determine LBVI and the clinicopathological features, recurrence rates, and prognoses according to LBVI were investigated by univariate and multivariate analyses.

Results: Lymphatic vessel invasion was noted in 59 patients (10.4%); blood vessel invasion in 13 patients (2.3%); LBVI in 61 patients (10.8%). LBVI was associated with submucosal invasion, larger tumor size, and elevated macroscopic type (P<0.05). LBVI and lymph node metastasis were found to be significantly correlated. LBVI was an independent risk factor for lymph node metastasis (relative risk 26.56, 95% confidence interval 12.77∼55.23). Patients with LBVI had a recurrence rate of 15.3% while patients without LBVI had a 3.7% recurrence rate (P＜0.01). The overall and disease-specific 5-year survival rates were 79.9 and 85.9% for patients with LBVI whereas they were 93.4 and 97.5% for patients without LBVI (P＜0.01, respectively). On multivariate analysis, LBVI was an independent risk factor for poor prognosis (relative risk 2.38, 95% confidence interval 1.15∼4.93).

Conclusion: Lymphatic or blood vessel invasion is an adverse prognostic indicator for EGC patients. Considering the low rate of lymph node metastasis and recurrence in patients with LBVI negative EGC, minimally invasive therapy can be regarded as curative when LBVI is negative.