Predictive Biomarkers of Lymph Node Metastasis in Early Gastric Cancer: A Reference of Clinicopathological Characteristics, Protein Expression, Epstein-Barr Virus Status, and Microsatellite Instability

Sun-Ju Byeon ¹, Mee Soo Chang ², Hye Eun Park ¹

⁰Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Anticancer Research +

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September 30, 2024

View abstract on PubMed

Summary

Predicting lymph node metastasis in early gastric cancer is vital. Stromal desmoplasia, submucosal invasion, and high VEGF-C expression are key indicators, with VEGF-C potentially aiding initial diagnosis.

Area Of Science

Oncology
Gastroenterology
Pathology

Background

Accurate prediction of lymph node metastasis (LNM) in early gastric cancer (EGC) is critical for guiding treatment decisions.
Identifying reliable risk factors and auxiliary biomarkers for LNM in EGC is an ongoing clinical challenge.

Purpose Of The Study

To confirm established risk factors for LNM in EGC.
To identify novel auxiliary biomarkers for predicting LNM in EGC, particularly for use in initial diagnostic biopsies.

Main Methods

A training set (n=337) and a test set (n=165) of EGC patients were analyzed.
Immunohistochemistry was performed for lymphangiogenic pathway components (e.g., VEGF-C, SMAD2/3) and other markers.
In situ hybridization and multiplex PCR were used to assess viral status and microsatellite instability.

Main Results

Independent risk factors for LNM in the training set included diffuse/mixed classification, stromal desmoplasia, submucosal invasion (≥500 μm), lymphatic invasion, and high VEGF-C/SMAD2/3 expression.
The test set confirmed stromal desmoplasia, submucosal invasion, and high VEGF-C expression as independent predictors.
Tumor cutoff size for LNM prediction was 2.65 cm.

Conclusions

Stromal desmoplasia, submucosal invasion, and high VEGF-C expression are significant potential biomarkers for LNM in EGC.
VEGF-C expression shows promise as an adjunct biomarker for predicting LNM from initial forceps-biopsy specimens.

Keywords:

Early gastric cancer VEGF-C biomarker lymph node metastasis