ABSTRACT
AIM: To study how lymph node metastasis (LNM) risk is stratified in undifferentiated-type early gastric cancer (undiff-EGC) dependent on combinations of risk factors. METHODS: Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively. Using clinicopathological factors of patient age, location, size, an endoscopic macroscopic tumor form, ulceration, depth, histology, lymphatic involvement (LI) and venous involvement (VI), LNM risk was examined and stratified by conventional statistical analysis and data-mining analysis. RESULTS: LNM was positive in 44 of 567 cases (7.8%). Univariate analysis revealed > 2 cm, protrusion, submucosal (sm), mixed type, LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis. In preoperatively evaluable factors excluding LVI, sm and > 2 cm were independent factors. According to the depth and size, cases were categorized into the low-risk group [m and ≤ 2 cm, 0% (LNM incidence)], the moderate-risk group (m and > 2 cm, 5.6%; and sm and ≤ 2 cm, 6.0%), and the high-risk group (sm and > 2 cm, 19.3%). On the other hand, LNM occurred in 1.4% in all LI-negative cases, greatly lower than 28.2% in all LI-positive cases, and LNM incidence was low in LI-negative cases even in the moderate- and high-risk groups. CONCLUSION: LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively. Among these factors, LI was the most significantly correlated factor.
Subject(s)
Cell Differentiation , Lymph Nodes/pathology , Stomach Neoplasms/pathology , Algorithms , Chi-Square Distribution , Data Mining , Decision Trees , Early Detection of Cancer , Female , Gastrectomy , Humans , Japan , Logistic Models , Lymph Node Excision , Lymph Nodes/surgery , Lymphatic Metastasis , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , Stomach Neoplasms/surgeryABSTRACT
A 65-year-old woman was referred to us for treatment of an aneurysm, found incidentally by abdominal ultrasonography. Angiography demonstrated a saccular aneurysm of the gastroduodenal artery and absence of blood flow from the celiac axis. The blood flow in the hepatic artery, splenic artery, and other arteries originating from the celiac axis was supplied by the superior mesenteric artery through one dilated and elongated pancreaticoduodenal artery and the gastroduodenal artery. The aneurysm was resected, and the inflow and outflow arteries were reconstructed with end-to-end anastomoses. Pathologic examination of the aneurysm sac showed diffuse intimal thickening with focal atheromas. We speculate that the increased blood flow compensating for the absence of blood flow from the celiac axis was an etiologic factor predisposing to the formation of this gastroduodenal artery aneurysm.
