Morphological predictors of lymph node metastasis in early gastric cancer

The ability to predict the presence of lymph node metastasis has gained significant importance in recent years due to changes in treatment strategies. Ensuring the absence of lymph node metastasis is crucial in the management of early gastric cancer. This consideration can help avoid radical treatments and facilitate organ-sparing approaches. This study aimed to retrospectively evaluate early gastric adenocarcinoma (T1a-b) cases treated with radical surgery and identify the factors that affect lymph node metastasis.

A retrospective analysis was performed on 360 patients who underwent surgery for gastric adenocarcinoma were reviewed, and 41 patients diagnosed with early gastric cancer were included in the study. The relationship between patient age, gender, tumor stage, tumor size, tumor location, histological subtype, lymphovascular invasion, perineural invasion, ulceration, tumor-infiltrating lymphocytes, and lymph node metastases was analyzed. A cumulative risk score was developed using significant predictors to stratify patients into risk groups.

The study cohort consisted of 41 patients, with a mean age of 63 years and 66% male. Notably, none of the 14 patients with T1a exhibited lymph node metastasis, whereas 10 of 27 (37%) patients with T1b presented with lymph node metastasis. Univariate analysis revealed that tumor stage (p = 0.009), tumor differentiation (p = 0.043), and lymphovascular invasion (p = 0.006) were significant predictors of lymph node metastasis. Multivariate analysis identified a significant association between lymphovascular invasion (p = 0.024) and tumor size (p = 0.05) with lymph node metastasis. The proposed risk scoring system effectively stratified patients into low, intermediate, and high-risk groups.

Examination of radical surgical specimens suggests that organ-preserving methods based on expanded ESD criteria could be a viable option for our population. Tumor stage, histological subtype, tumor size, and lymphovascular invasion were identified as factors influencing the incidence of lymph node metastasis, with tumor stage and lymphovascular invasion emerging as primary determinants. The exploratory scoring model may aid in risk-based clinical decision-making, particularly in selecting candidates for non-surgical treatment.