Risk Factors of Lymph Node Metastasis and Its Prognostic Significance in Early Gastric Cancer: A Multicenter Study
Jinfeng Wang1, Liang Wang2, Sha Li1
1Department of Gastroduodenal and Pancreatic Surgery, Translational Medicine Research Center of Liver Cancer, Laboratory of Digestive Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine and Hunan Cancer Hospital (Hunan Cancer Institute), Central South University, Hunan Province Key Laboratory of Virology (Tumor Immunity), Changsha, China.
Frontiers in Oncology
|November 1, 2021
Summary
Identifying risk factors for lymph node metastasis (LNM) in early gastric cancer (EGC) is crucial for prognosis. This study found invasion depth, tumor type, size, ulceration, and lymphovascular invasion are key predictors of LNM in EGC patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Early gastric cancer (EGC) invades the submucosa and is primarily treated surgically.
- Minimally invasive surgery for EGC is advancing, but recurrence and survival remain concerns.
- Lymph node metastasis (LNM) is a critical prognostic indicator in gastric cancer, yet its patterns in EGC require further clarification.
Purpose of the Study:
- To identify clinicopathological risk factors associated with lymph node metastasis (LNM) in radically resected early gastric cancer (EGC).
- To guide treatment strategies by understanding the predictors of LNM in EGC.
- To analyze the prognostic significance of LNM in EGC patients.
Main Methods:
- Retrospective analysis of clinicopathological factors from 611 EGC patients across six hospitals (January 2010 - December 2016).
- Univariate and multivariate analyses were employed to assess the relationship between clinicopathological factors and LNM.
- Evaluation of the prognostic significance of identified risk factors and LNM status.
Main Results:
- The overall rate of LNM in EGC patients was 20.0%.
- Independent risk factors for LNM included depth of invasion, differentiation type, tumor diameter, morphological ulceration, and lymphovascular invasion (P<0.05).
- Tumor location in the proximal third and morphological ulceration were significant for group 2 LNM; survival rates decreased significantly with increasing numbers of positive lymph nodes.
Conclusions:
- Depth of invasion, differentiation, tumor size, ulceration, and lymphovascular invasion are significant risk factors for LNM in EGC.
- Extended lymph node dissection (D2+) is recommended for EGC with morphological ulceration or proximal third location due to high rates of group 2 LNM.
- LNM is a significant prognostic factor for EGC, influencing survival and potentially guiding adjuvant therapy decisions.
