Nodal metastatic pattern in gastric cancer: A descriptive study of a single institution cohort

Gastric cancer exhibits diverse patterns of lymph node (LN) metastasis, yet the relationship between LN stations and tumor location, histological subtype and pT-stage remains unclear. This study aims to describe nodal metastatic drainage patterns in gastric adenocarcinoma and potential predictive factors.

Between May 2016 and December 2022, 86 patients undergoing total or subtotal gastrectomy for gastric cancer were included. Retrieved LN stations were analyzed.

Positive LN metastasis was observed in 42 patients (49%). The median number of harvested LNs was 44 (IQR, 34.75-58.50), with a mortality rate of 0%. Middle tumors had the highest prevalence of LN metastasis (53%), followed by proximal (48%) and distal tumors (45%). Proximal tumors primarily metastasized to LN stations 2, 6 (16%; 16%) and 9 (12%), while middle third tumors at LN stations 3 and 7 (21%; 21%). Distal tumors showed the highest frequency of metastasis in distal LN stations 4d (8%) and 6 (15%). Diffuse (50%) and mixed type (72%) gastric cancers exhibited higher LN metastases compared to intestinal-type tumors (42%). Larger tumor size (p = 0.002), advanced pT-stage (p < 0.001), and lymphatic or vascular invasion (p < 0.001) significantly correlated with increased metastases. Multivariate analysis revealed a significant correlation between positive LN metastasis and advanced pT-stage (p = 0.011).

Patterns of LN metastasis are influenced by tumor location, but can also occur at any LN station, irrespective of tumor location, pT-stage, or histological subtype. Higher pT-stage significantly increases the likelihood for LN metastases.