The Characteristics, Prognosis, and Risk Factors of Lymph Node Metastasis in Early Gastric Cancer

Li, Xuan; Liu, Shiyu; Jin, Yan; Peng, Lei; Chen, Meihong; Yang, Jiajia; Zhang, Guoxin

doi:10.1155/2018/6945743

Cited by 30 publications

(33 citation statements)

References 28 publications

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“…In the present study, the infiltration depth, gross type and intravascular cancer embolus were independent risk factors for lymph node metastasis in patients with Siewert II/III AEG. Previous studies have reported that the LNM rate was significantly increased following an increase in the tumor infiltration [30]. The present study indicated similar outcomes demonstrating that the LNM rate was increased from 0 to 88.1% when the tumor infiltrated deeper gradually.…”

Section: Discussionsupporting

confidence: 88%

Assessment of risk factors of lymph node metastasis and prognosis of Siewert II/III adenocarcinoma of esophagogastric junction: a retrospective study

Zheng¹,

Zhang²,

Xu³

et al. 2020

Preprint

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Background Adenocarcinoma of esophagogastric junction (AEG) has a high incidence, while the extent of lymph node dissection (LND) and prognosis are still controversial. The present study aimed to explore the risk factors of lymph node metastasis (LNM) and prognosis in Siewert II/III AEG patients. Methods A total of 134 patients who underwent surgical operation between July 2013 and December 2019 at the Beijing Friendship Hospital were retrospectively reviewed. The patients were followed up until January 2020. The data were analyzed using logistic regression. Survival analyses were performed using Cox regression. Results Multivariate analysis revealed that the parameters infiltration depth (OR=4.341, 95%CI: 2.498-7.545, P=0.000), gross type (OR=3.626, 95% CI: 1.425-9.228, P=0.007) and intravascular cancer embolus (OR=2.888, 95%CI: 1.106-7.544, P=0.030) correlated with LNM. For all patients, the lymph nodes No. 1, 2, 3, 4, 7, 11 indicated higher lymph node metastatic rate in the abdominal cavity. However, No.5 and No. 6 indicated different tendency, which was higher in Siewert III AEG and lower in Siewert II AEG patients. Mediastinal LNM of Siewert II AEG mainly occurred in No. 110 and No. 111 cases corresponding to 7.1 and 3%, respectively, compared with those noted in Siewert III AEG patients. The 3-year overall survival analysis revealed that LNM ( P= 0.046) and chemotherapy ( P= 0.007) exhibited significant differences. Conclusion The infiltration depth, gross type and intravascular cancer embolus were independent risk factors of LNM. For Siewert II AEG patients, it is reasonable to remove both celiac and mediastinal lymph nodes. This was noted notably for No.1, 2, 3, 4, 7, 11, 110 and No.111. For No.5 and No.6 lymph nodes dissection was not required. For Siewert III AEG patients, mediastinal LND was not required. However, it was necessary to perform pyloric lymphadenectomy, which was performed for No.5 and No.6 lymph nodes. In addition, patients with LNM exhibited worse long-term prognosis. The data indicated that perioperative chemotherapy could improve the prognosis of AEG patients.

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Section: Discussionsupporting

confidence: 88%

Assessment of risk factors of lymph node metastasis and prognosis of Siewert II/III adenocarcinoma of esophagogastric junction: a retrospective study

Zheng¹,

Zhang²,

Xu³

et al. 2020

Preprint

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“…demonstrated that tumor size, histological type, presence of ulcerative finding and presence of lymphovascular involvement were independent risk factors of LNM (19). Other studies also revealed that overexpression of CD44v6, increased tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, CA125], gender, age at diagnosis were also associated with LNM (20-23). However, most of these risk factors mentioned above were postoperative findings which were not available before treatment.…”

Section: Discussionmentioning

confidence: 99%

Construction and external validation of a nomogram that predicts lymph node metastasis in early gastric cancer patients using preoperative parameters

Zhang

Liu²,

Zhang

et al. 2018

Chinese Journal of Cancer Research

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ObjectiveTo create a nomogram to predict the incidence of lymph node metastasis (LNM) in early gastric cancer (EGC) patients and to externally validate the nomogram.MethodsTo construct the nomogram, we retrospectively analyzed a primary cohort of 272 EGC patients. Univariate analysis and a binary logistic regression were performed. A nomogram predicting the incidence of LNM in EGC patients was created. The discrimination ability of the nomogram was measured using the concordance index (c-index), and the nomogram was also calibrated. Then, another prospective cohort of 81 patients was analyzed to validate the nomogram.ResultsIn the primary cohort, LNM was pathologically confirmed in 37 (13.6%) patients. In multivariate analysis, the presence of an ulcer, the maximum lesion diameter observed via gastroscopy, the thickness of the lesion observed via endoscopic ultrasonography, and the presence of enlarged lymph nodes on computed tomography (CT) were independent risk factors for LNM. A nomogram was then created based on the regression model with the c-index of 0.905, and the calibration curve of the nomogram fell approximately on the ideal 45-degree line. The cut-off score of the nomogram was 110, and the sensitivity, specificity, positive predictive and negative predictive values of the nomogram in the primary cohort were 81.1%, 86.0%, 47.6% and 96.7%, respectively, and in the prospective validation cohort were 75.0%, 91.0%, 60.0% and 95.5%, respectively. The calibration curve of the external validation cohort was almost on the 45-degree line.ConclusionsWe developed an effective nomogram predicting the incidence of LNM for EGC patients.

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“…Researchers have previously concluded that the overall 3-year survival rate was higher in patients without LNM and that patients with LNM had a higher rate of tumor recurrence[25]. Several factors are associated with an increased rate of LNM.…”

Section: Discussionmentioning

confidence: 99%

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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The Characteristics, Prognosis, and Risk Factors of Lymph Node Metastasis in Early Gastric Cancer

Cited by 30 publications

References 28 publications

Assessment of risk factors of lymph node metastasis and prognosis of Siewert II/III adenocarcinoma of esophagogastric junction: a retrospective study

Assessment of risk factors of lymph node metastasis and prognosis of Siewert II/III adenocarcinoma of esophagogastric junction: a retrospective study

Construction and external validation of a nomogram that predicts lymph node metastasis in early gastric cancer patients using preoperative parameters

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

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