Risk factors of lymph node metastasis in 734 early gastric carcinoma radical resections in a Chinese population

Du, Ming Zhan; Gan, Wen Juan; Jiang, Yu; Liu, Wei; Zhan, Sheng Hua; Huang, Shan; Huang, Ren Peng; Guo, Ling; Huang, Qin

doi:10.1111/1751-2980.12670

Cited by 17 publications

(19 citation statements)

References 26 publications

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“…Therefore, a detailed measurement of invasion depth is truly necessary during the pathological evaluation of endoscopic-resected specimens[16]. Regarding lesion size, we found that larger tumor size was a significant predictor of regional LNM in our patients with EGC, which is similar to the conclusions of many other investigators[7,9,17-19]. However, the cut-off values varied among these studies, which increased the difficulty in determining a uniform standard.…”

Section: Discussionsupporting

confidence: 84%

Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer

Chu

Xue

et al. 2019

WJG

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BACKGROUNDEndoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection. The indications for ESD have been recently expanded to include larger, ulcerated, and undifferentiated mucosal lesions, and differentiated lesions with slight submucosal invasion. The risk of lymph node metastasis (LNM) is the most important consideration when deciding on a treatment strategy for EGC. Despite the advantages over surgical procedures, lymph nodes cannot be removed by ESD. In addition, whether patients who meet the expanded indications for ESD can be managed safely remains controversial.AIMTo determine whether the ESD indications are applicable to Chinese patients and to investigate the predictors of LNM in EGC.METHODSWe retrospectively analyzed 12552 patients who underwent surgery for gastric cancer between June 2007 and December 2018 at the Affiliated Hospital of Qingdao University. A total of 1262 (10.1%) EGC patients were eligible for inclusion in this study. Data on the patients’ clinical, endoscopic, and histopathological characteristics were collected. The absolute and expanded indications for ESD were validated by regrouping the enrolled patients and determining the positive LNM results in each subgroup. Predictors of LNM in patients were evaluated by univariate and multivariate analyses.RESULTSLNM was observed in 182 (14.4%) patients. No LNM was detected in the patients who met the absolute indications (0/90). LNM occurred in 4/311 (1.3%) patients who met the expanded indications. According to univariate analysis, LNM was significantly associated with positive tumor marker status, medium (20-30 mm) and large (>30 mm) lesion sizes, excavated macroscopic-type tumors, ulcer presence, submucosal invasion (SM1 and SM2), poor differentiation, lymphovascular invasion (LVI), perineural invasion, and diffuse and mixed Lauren’s types. Multivariate analysis demonstrated SM1 invasion (odds ration [OR] = 2.285, P = 0.03), SM2 invasion (OR = 3.230, P < 0.001), LVI (OR = 15.702, P < 0.001), mucinous adenocarcinoma (OR = 2.823, P = 0.015), and large lesion size (OR = 1.900, P = 0.006) to be independent risk factors.CONCLUSIONThe absolute indications for ESD are reasonable, and the feasibility of expanding the indications for ESD requires further investigation. The predictors of LNM include invasion depth, LVI, mucinous adenocarcinoma, and lesion size.

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Section: Discussionsupporting

confidence: 84%

Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer

Chu

Xue

et al. 2019

WJG

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“…Tumor differentiation has been suggested to be an independent risk factor of LNM in several studies [ 7 , 17 ] which was not consistent with our results. In our study, we found that patients with differentiated tumor (10 out of 180 patients) had lower risk of LNM than those with undifferentiated tumor (42 out of 201).…”

Section: Discussioncontrasting

confidence: 96%

“…However, LNM is a crucial factor for the prognosis of EGC patients, therefore, an accurate prediction of the risk of LNM is very important when considering treatment options of EGC. In our study, the rate of LNM was 13.65% for our patients in Wannan region in Anhui Province, which was a similar rate reported in other provinces in China [ 7 , 8 , 11 ].…”

Section: Discussionsupporting

confidence: 87%

“…Several studies [ 7 , 16 ] reported that tumor size was one of the independent risk factors for LNM. However, our study failed to find a similar result.…”

Section: Discussionmentioning

confidence: 99%

“…However, we did not find that the tumor gross type was one of significant risk factors for LNM in EGC. Meanwhile, other research [ 7 ] showed that the endoscopic flat type was a significant risk factor for LNM in EGC in patients from the Sunan region of China. Therefore, multicenter studies in different regions of China are needed to explore the risk of LNM in EGC, and further develop regional practice guidelines for a better therapeutic strategy.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic Characteristics and Risk Factors of Lymph Node Metastasis in Patients with Early Gastric Cancer in the Wannan Region

Liu

Wang

et al. 2020

Med Sci Monit

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Concurrent lymphovascular and perineural invasion after preoperative therapy for gastric adenocarcinoma is associated with decreased survival

Blumenthaler

Newhook

Ikoma

et al. 2021

Journal of Surgical Oncology

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Background and Objectives We sought to evaluate the impact of lymphovascular invasion (LVI) and perineural invasion (PNI) on survival outcomes in gastric cancer patients treated with preoperative therapy. Methods Patients with gastric cancer treated with preoperative therapy and potentially curative resection were stratified according to the presence of LVI, PNI, or both. Kaplan–Meier and Cox regression analyses were used to evaluate the impact on overall survival (OS) and disease‐free survival (DFS). Results The study included 281 patients, of whom 93 (33%) had LVI, 69 (25%) had PNI, 51 (18%) had both LVI and PNI, and 170 (61%) had neither. LVI and PNI were each associated with higher ypT and ypN categories and more positive lymph nodes (all p < .001), associations that were emphasized with both factors present. On multivariable analyses, ypN (p < .001) and concurrent LVI/PNI (hazard ratio [HR]: 2.62; 95% confidence interval [CI]: 1.55–4.45; p = .001) were predictive of OS and DFS (ypN: p < .001; both LVI/PNI: HR: 2.27; 95% CI: 1.34–3.82; p = .002). Conclusions Gastric cancer patients with concurrent LVI and PNI after preoperative therapy have more advanced disease and worse survival outcomes than patients with neither or only one of these factors.

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Risk factors of lymph node metastasis in 734 early gastric carcinoma radical resections in a Chinese population

Abstract: Independent risk factors for LNM in EGC include tumor size ≥3.0 cm, SM2 invasion, moderate/poor differentiation, LVI and tumor necrosis. Early cardiac carcinoma had a significantly lower risk of LNM than non-cardiac EGC.

Cited by 17 publications

References 26 publications

Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer

Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer

Clinicopathologic Characteristics and Risk Factors of Lymph Node Metastasis in Patients with Early Gastric Cancer in the Wannan Region

Concurrent lymphovascular and perineural invasion after preoperative therapy for gastric adenocarcinoma is associated with decreased survival

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