Risk of lymph node metastasis in early gastric cancer for a Western population

Abstract

Introduction: Endoscopic resection (ER) of early gastric cancer (EGC) is increasingly used in Eastern countries due to their low rates of lymph node metastasis (LNM); however, there is a paucity of evidence in Western countries. We investigated LNM and its effect on overall survival (OS) in Western patients with EGC.Methods: Patients diagnosed with T1 gastric cancer between 2000 and 2017 were retrospectively evaluated. Univariate Kaplan-Meier, multivariate logistic and Coxregression models were used to assess the associations between clinical characteristics, LNM, and OS.Results: Among 86 patients, median age was 68 years and 72% were male. Node positivity was 30%. Two percent of patients met the classical guidelines for ER and all were node-negative, while 16% met expanded criteria of which 14% were nodepositive. T1b disease (odds ratio [OR] 41.2 [95% confidence interval [CI] 1.62-1048], p = 0.02) and lymphovascular/perineural invasion (OR 18.0 [95% CI 2.41 -134], p = 0.01) were predictive of node positivity. The 5-year OS for nodenegative and node-positive patients was 84% and 53% (p = 0.004), respectively. Conclusions:The risk of LNM in Western patients with EGC is higher; therefore, generalizability of the expanded criteria for ER should be interpreted with caution.

Risk Factors for Lymph Node Metastasis in a Western Series of Patients with Distal Early Gastric Cancer

“…Thus, we suggest that submucosal cancer with a diameter greater than 3.0 cm is a risk factor for LNM. It has been observed that LNM starts with deep mucosal infiltration and as the invasion depth increases, the rate of LNM rises [3,8,13,14,22,31,33]. Our results agree that depth of invasion is one of the most important risk factors for LNMs.…”

“…It has been suggested that ulcerative findings, a depressed appearance, diffuse type, and undifferentiated lesions are risk factors for LNM in EGC [5,8,13,17,22]. Depressed types tend to have higher rates of LNM in T1b cancer.…”

“…The removal of at least 16 LNs would allow the N stage to be precisely defined. A lymphadenectomy of at least 16 LNs would not lead to an increase in postoperative mortality [6,13,25,30,34,42]. The number of retrieved LNs serves as prognostic factor for gastric cancer, despite the fact that the optimal number of retrieved LNs remains controversial.…”

“…In this scenario, a preoperative assessment of risk factors for LNM based on clinicopathological factors may be useful for optimal treatment planning [3,9,12]. It is a significant prognostic factor for EGC, because the disease is believed to be curable [2,13,14]. Although there has been substantial research on the prediction of risk factors for LNMs in EGC, no definitive criteria are available [15].…”

Lymph node metastasis patterns and prognosis of early gastric cancer

“…Lymph node metastasis patterns in early gastric cancer depend on primary tumor location and characteristic lymphatic drainage pathways within the stomach [7,8]. The incidence of lymph node metastasis differs based on tumor histology as well [9]. Clarifying high-risk lymph node stations in early gastric cancer can optimize surgical planning and improve prognosis.…”