Lymph Node Metastasis Rates and Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Lymphoepithelioma-like Carcinoma

Aims Lymphoepithelioma-like carcinoma (LELC) is a rare subtype of gastric cancer. We aimed to examine the rate of lymph node metastases (LNM) in early LELC patients treated surgically and the outcomes of early LELC patients who underwent endoscopic submucosal dissection (ESD).

Methods We compared the clinicopathological characteristics of 116 early gastric LELC patients and 5,753 early gastric well- or moderately differentiated (WD or MD) tubular adenocarcinoma patients treated by gastrectomy (1994-2018). Outcomes of 37 patients with 38 LELC lesions undergoing ESD were also analyzed (2001-2023).

Results Compared to WD or MD early gastric cancer (EGC) patients, early LELC patients were younger and had a higher prevalence of proximally located tumors. Despite more frequent deep submucosal invasion (86.2% versus 29.8%), lymphatic invasion was less frequent (6.0% versus 16.2%) in early LELC patients than in WD or MD EGC patients. Overall rate of LNM in early LELC patients was 8.6% (10/116). Risk of LNM in patients with mucosal, shallow submucosal invasive, or deep submucosal invasive LELC was 0% (0/6), 0% (0/10), and 10% (10/100), respectively. The mean follow-up duration in patients who did not undergo surgery after ESD was 43 months (standard deviation: 11 months). In 8 patients with 9 lesions confined to the mucosa, no extra-gastric or local recurrences were found during the follow-up period. In 29 patients with 29 LELCs with submucosal invasion, there was no LNM in those who underwent additional surgery (n=17) and no extra-gastric or local recurrences among those who only underwent surveillance after ESD (n=8).

Conclusions Early LELC is a distinct subtype of EGC with more frequent deep submucosal invasion but less lymphatic invasion than WD or MD EGCs. Additional surgery may be unnecessary for patients with early LELC confined to mucosa or shallow submucosa, given its negligible rate of LNM and its good outcomes after ESD.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025