BACKGROUND: Although regional lymph-ode metastasis from early gastric cancer (EGC) is rare, it is well known that EGC patients with lymph-ode metastasis constitute a high-isk group for recurrence. Thus, it is important to clarify the characteristics of patients having lymph-ode metastasis in order to ascertain the optimal therapy. METHODS: We analyzed the clinical aspects of 34 cases of node-ositive EGC and compared them to 197 cases of node-egative EGC. All patients were operated on from June 1994 to December 1997 at Ajou University Hospital. Also, by using immunohistochemical staining, we examined the expression of cathepsin D in the tumors to identify its significance in EGC. RESULTS: Lymph-ode involvement correlated significantly with deeper tumor invasion, severity of lymphatic invasion, and larger tumor size. Age, sex, histologic type, location, gross appearance, and serum carcinoembryonic antigen (CEA) level were unrelated to lymph-ode involvement. Positive cytoplasmic staining for cathepsin D was detected in 100% of the tumors, and strongly positive staining was found in 33.3%. Also, strong positivity was found more frequently in tumors with lymph-ode involvement. CONCLUSION: Prophylactic lymph-ode dissection may be necessary for patients with EGC with submucosal invasion, lymphatic invasion, and larger tumor size. Also, cathepsin D can be a useful tool for understanding the pathophysiology of early gastric cancer.