Intramucosal-lymphatic invasion has a slight impact on lymph node metastasis in patients with early gastric cancer

High risk factors related to lymph node metastasis in early gastric cancer: A retrospective observational study

Lymph node metastasis (LNM) is a key factor affecting the prognosis of patients with early gastric cancer. This is a retrospective study, conducted between January 20, 2010 and January 30, 2019 and included 402 patients with early-stage gastric cancer who underwent radical gastrectomy at The Affiliated People Hospital of Ningbo University. Clinical and pathological data including patients' gender, age, tumor location, gross typing, depth of invasion, tumor maximum diameter, type of differentiation, vascular invasion, presence or absence of signet ring cells, and LNM data were collected and analyzed. Univariate analysis identified positive relationships between patient gender, tumor invasion depth, tumor size, presence or absence of vascular involvement, and differentiation type with LNM (P < .05). Multivariate analysis subsequently confirmed tumor size (odds ratio [OR]: 2.38, 95% confidence interval [CI]:1.15-4.92, P = .02), vascular involvement (OR: 4.35, 95% CI: 2.00-9.47, P < .001), and depth of invasion (OR: 6.63, 95% CI: 2.19-20.06, P = .001) as independent risk factors for LNM (P < .05). Tumor size, vascular involvement, and depth of invasion are independent risk factors for LNM in cases of early-stage gastric cancer.

The risk of lymph node metastasis in gastric cancer conforming to indications of endoscopic resection and pylorus-preserving gastrectomy: a single-center retrospective study

Background

Lymph node metastasis (LNM) status is an important prognostic factor that strongly influences the treatment decision of early gastric cancer (EGC). This study aimed to evaluate the pattern and clinical significance of LNM in EGC.

Methods

A total of 354 patients with carcinoma in situ (n = 42), EGC (n = 312) who underwent radical gastrectomy were enrolled. Their clinicopathological features, pathological reports, and prognostic data were collected and analyzed.

Results

The incidence of LNM in all patients was 18.36% (65/354). The rates of D1 and D2 station metastases were 12.10% (43/354) and 6.21% (22/354), respectively. The rates of LNM in absolute indication of endoscopic resection and expanded indication were 3.27% (2/61) and 28.55% (4/14), respectively. Skip LNM was observed in 3.67% (13/354) of patients. For those with middle-third tumor, the metastasis rate of the No. 5 lymph node was 3.05% (5/164). The independent risk factors for LNM were tumors measuring > 30 mm, poorly differentiated tumors, and lymphovascular invasion (all P < 0.05; area under the curve, 0.783). The 5-year disease-free survival rates of patients with and without LNM were 96.26 and 79.17%, respectively (P = 0.011). Tumors measuring > 20 mm and LNM were independent predictive factors for poor survival outcome in all patients.

Conclusions

Patients with EGC conforming to expanded indications have a relatively high risk of LNM and may not be suitable for endoscopic submucosal dissection. Pylorus-preserving gastrectomy for patients with middle-third EGC remains controversial due to the high metastasis rate of the No. 5 lymph node.