Background Lymph node metastasis (LNM) status is an important prognostic factor that strongly influences the treatment decision of early gastric cancer (EGC). This study aimed to evaluate the pattern and clinical significance of LNM in EGC. Methods A total of 354 patients with carcinoma in situ (n = 42), EGC (n = 312) who underwent radical gastrectomy were enrolled. Their clinicopathological features, pathological reports, and prognostic data were collected and analyzed. Results The incidence of LNM in all patients was 18.36% (65/354). The rates of D1 and D2 station metastases were 12.10% (43/354) and 6.21% (22/354), respectively. The rates of LNM in absolute indication of endoscopic resection and expanded indication were 3.27% (2/61) and 28.55% (4/14), respectively. Skip LNM was observed in 3.67% (13/354) of patients. For those with middle-third tumor, the metastasis rate of the No. 5 lymph node was 3.05% (5/164). The independent risk factors for LNM were tumors measuring > 30 mm, poorly differentiated tumors, and lymphovascular invasion (all P < 0.05; area under the curve, 0.783). The 5-year disease-free survival rates of patients with and without LNM were 96.26 and 79.17%, respectively (P = 0.011). Tumors measuring > 20 mm and LNM were independent predictive factors for poor survival outcome in all patients. Conclusions Patients with EGC conforming to expanded indications have a relatively high risk of LNM and may not be suitable for endoscopic submucosal dissection. Pylorus-preserving gastrectomy for patients with middle-third EGC remains controversial due to the high metastasis rate of the No. 5 lymph node.

BackgroundLymph node metastasis of rectal neuroendocrine tumors (RNETs) predicts poor prognosis. However, the assessment of lymph node metastasis remains a challenge. It has been reported that 68Ga-DOTANOC and 18F-FDG PET-CT scans could be employed in the work-up of rectal neuroendocrine tumors (RNETs). This study aimed to assess both tracers’ ability to identify primary tumors and lymph node (LN) metastasis in RNETs.MethodsA total of 537 patients with RNETs were enrolled from January 2014 to January 2021. Both 68Ga-DOTANOC and 18F-FDG PET-CT scans were used to evaluate primary tumors and LN group metastasis. PET images were evaluated through visual and semiquantitative assessment. Receiver Operating Characteristics (ROC) curve analysis was used to investigate the performance of SUVmax of 68Ga-DOTANOC and 18F-FDG PET in predicting LN group metastasis.ResultsFifty-two patients with preoperative 68Ga-DOTANOC with 18F-FDG PET-CT scans underwent endoscopic biopsy or dissection of the primary tumor, while 11 patients underwent rectal surgery together with regional LN dissection. For primary tumors, 68Ga-DOTANOC had a sensitivity of 89.58% and a positive predictive value (PPV) of 95.56% through visual assessment, while 18F-FDG PET-CT showed 77.08% sensitivity and 97.37% PPV. For the prediction of LN group metastasis, 68Ga-DOTANOC PET-CT had 77.78% sensitivity and 91.67% specificity, while 18F-FDG PET-CT had 38.89% sensitivity and 100% specificity according to visual assessment. The area under the ROC curves (AUC) for 68Ga-DOTANOC PET/CT was 0.852 (95%CI:0.723-0.981) with an optimal SUVmax cut-off value of 2.25, while the AUC for 18F-FDG PET were 0.664 (95%CI:0.415-0.799) with an optimal SUVmax cut-off value of 1.05.ConclusionsThis study showed that 68Ga-DOTANOC PET-CT was a promising tool for detecting LN metastasis in RNETs with high sensitivity and specificity in visual assessment and semiquantitative assessment, which was better than 18F-FDG PET-CT.

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Background: Lymph node metastasis (LNM) status is an important prognostic factor that strongly influences the treatment decision of early gastric cancer (EGC). This study aimed to evaluate the pattern and clinical significance of LNM in EGC.Methods: Patients with EGC who underwent radical gastrectomy were enrolled. Their clinicopathological features, pathological reports, and prognostic data were collected and analyzed.Results: Three hundred fifty-four patients with EGC were enrolled. The incidence of LNM in patients with EGC was 18.36% (65/354). The rates of D1 and D2 station metastases were 12.1% (43/354) and 6.214% (22/354), respectively. The rates of LNM in absolute indication of endoscopic resection and expanded indication were 3.27% (2/61) and 28.55% (4/14), respectively. Skip LNM was observed in 3.67% (13/354) of patients. For those with middle-third EGC, the metastasis rate of the No. 5 lymph node was 3.05% (5/164). The independent risk factors for LNM were tumors measuring >30 mm, poorly differentiated tumors, and lymphovascular invasion (all P < 0.05，area under the curve = 0.783). Five-year disease-free survival rates of patients with EGC with and without LNM were 96.26% and 79.17%, respectively (P = 0.011). Tumors measuring >20 mm and LNM were independent predictive factors for poor survival outcome in patients with EGC.Conclusions: Patients with EGC conforming to expanded indications have a relatively high risk of LNM and may not be suitable for endoscopic submucosal dissection. Pylorus-preserving gastrectomy for patients with middle-third EGC remains controversial due to the high metastasis rate of the No. 5 lymph node.

Background: Since Epstein-Barr virus (EBV)-encoded small RNAs (EBER) has become the standard for detection of EBV, the prognostic role of EBV infection in gastric cancer (GC) remains controversial. The main aim of this meta-analysis was to determine the correlation between EBV infection and the prognosis of GC.Methods: We systematically searched PubMed and EMBASE to identify eligible studies to review up to June 23,2021. Pooled hazard ratios with 95% confidence intervals were calculated using the fixed effects model or random-effects model for overall survival (OS). Sensitivity and subgroup analyses were also performed, and publication bias was assessed by using Stata 14.0.Results: 35 studies comprising 26163 patients with GC were included in this meta-analysis. After pooling all studies, EBV-positive patients were noted to have better OS than EBV-negative patients (HR: 0.72, 95% CI: 0.59-0.84, P < 0.001), though with high heterogeneity (I2: 51.7%). In subgroup analysis, similar conclusion can be drawn for patients in Asian and American, while for patients in Europe EBV infection is not a prognostic indicator. Apart from that, studies conducted in Asia and Europe, statistical method of multivariate analysis, high quality score, all had significant heterogeneity. Pooled data based on sensitivity analyses did not change the conclusion.Conclusions: EBV infection was associated with better OS in patients with GC. These results differed between studies due to differences in region, which need further study to clarify its prognostic significance.Prospero registration number: CRD42021262332.