Impact of malignant ulcer size on lymph node stages in gastric cancer with ulcerative growth

Although malignant ulcers have been documented in gastric cancer, the specific relationship between ulcer size and lymph node stages in gastric cancer remains uncertain. The aim of this study was to investigate the relationship between ulcer size and lymph node stages in gastric cancer patients.

The diameter of the malignancy ulcer was measured, the patients were divided into three groups based on the presence of ulcer and its median size: U0 no ulcer; U1 ulcer size 0-3cm, U2 the ulcer size >3cm. Univariate and multivariate analyses were performed.

The distribution of lymph node stages differed significantly between U0 and U1+U2 (p<0.001), and the similar difference was present between U1 and U2 (p<0.001). In all patients, the presence of ulcer correlated with lymph node stages (pN- vs. pN+). In ulcerative gastric cancer patients the stage pN2-3 was more common in patients with U2 (14.1%, 19/135) than in U1 (6.4%, 12/188; p< 0.001). A logistic regression model revealed that lymph node metastases were associated with presence of malignant ulcer (p=0.002), and the ulcer size still emerges as a significant variable ulcer size in ulcerative cancer (p=0.022).

For gastric cancer patients, the presence of ulcer and ulcer size might be a potential biomarker of lymph node metastasis.