Risk factors analysis and prediction of lymph node metastasis in early gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Nai , MA Yudong , MENG Fanchao , GONG Shuai , ZHANG Pengbo , ZHANG Yi ,  ZHANG Chong , ZHANG Xiuzhong , REN Zeqiang

Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

ZHANG Chong, Email: zc1604@126.com

Keywords：

early gastric cancer; lymph node metastasis; risk factors; prediction model

DOI：

10.7507/1007-9424.202009008

Video：

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Objective To explore the risk factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC), and try to establish a risk prediction model for LNM of EGC.Methods The clinicopathologic data of EGC patients who underwent radical gastrectomy and lymph node dissection from January 1, 2015 to December 31, 2019 in this hospital were retrospectively analyzed. Univariate analysis and logistic regression analysis were used to determine the risk factors for LNM of EGC, and the risk prediction model for LNM of EGC was established based on the multivariate results.Results A total of 311 cases of EGC were included in this study, and 60 (19.3%) cases had LNM. Univariate and multivariate analysis showed that age (younger), depth of tumor invasion (submucosa), vascular invasion, and undifferentiated carcinoma were the risk factors for LNM of EGC (P<0.05). The optimal threshold for predicting LNM of EGC was 0.158 (area under the receiver operating characteristic curve was 0.864), the sensitivity was 80.0%, and the specificity was 79.3%.Conclusions From results of this study, risk factors for LNM of EGC have age, depth of invasion, vascular invasion, and differentiation degree. Risk prediction model for LNM of EGC established on this results has high sensitivity and specificity, which could provide some references for treatment strategy of EGC.

Citation： WU Nai, MA Yudong, MENG Fanchao, GONG Shuai, ZHANG Pengbo, ZHANG Yi, ZHANG Chong, ZHANG Xiuzhong, REN Zeqiang. Risk factors analysis and prediction of lymph node metastasis in early gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(6): 727-731. doi: 10.7507/1007-9424.202009008 Copy

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5.	Noh SH, Hyung WJ, Cheong JH. Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol, 2005, 90(3): 188-193.
6.	Lee HH, Yoo HM, Song KY, et al. Risk of limited lymph node dissection in patients with clinically early gastric cancer: indications of extended lymph node dissection for early gastric cancer. Ann Surg Oncol, 2013, 20(11): 3534-3540.
7.	Na JE, Kim YG, Kim TJ, et al. Long-term safety of delayed surgery after upfront endoscopic resection for early gastric cancer: a propensity matched study. Ann Surg Oncol, 2020 Jun 26. Online ahead of print.
8.	国家卫生健康委员会. 胃癌诊疗规范(2018 年版). 中华消化病与影像杂志(电子版), 2019, 9(3): 118-144.
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13.	Gu L, Khadaroo PA, Chen L, et al. Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for early gastric cancer: a systematic review and meta-analysis. J Gastrointest Surg, 2019, 23(7): 1493-1501.
14.	Huang JY, Xu YY, Li M, et al. The prognostic impact of occult lymph node metastasis in node-negative gastric cancer: a systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(12): 3927-3934.
15.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer, 2020 Feb 14. Online ahead of print.
16.	Feng F, Tian Y, Xu G, et al. Diagnostic and prognostic value of CEA, CA19-9, AFP and CA125 for early gastric cancer. BMC Cancer, 2017, 17(1): 737.
17.	Saito T, Kurokawa Y, Takiguchi S, et al. Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer. Eur Radiol, 2015, 25(2): 368-374.
18.	Yin XY, Pang T, Liu Y, et al. Development and validation of a nomogram for preoperative prediction of lymph node metastasis in early gastric cancer. World J Surg Oncol, 2020, 18(1): 2.
19.	Kuroki K, Oka S, Tanaka S, et al. Clinical significance of endoscopic ultrasonography in diagnosing invasion depth of early gastric cancer prior to endoscopic submucosal dissection. Gastric Cancer, 2020 Jun 22. Online ahead of print.
20.	Tsuzuki T, Okada H, Kawahara Y, et al. Usefulness and problems of endoscopic ultrasonography in prediction of the depth of tumor invasion in early gastric cancer. Acta Med Okayama, 2011, 65(2): 105-112.
21.	Takatsu Y, Hiki N, Nunobe S, et al. Clinicopathological features of gastric cancer in young patients. Gastric Cancer, 2016, 19(2): 472-478.
22.	Lee JH, Nam BH, Ryu KW, et al. Tumor differentiation is not a risk factor for lymph node metastasis in elderly patients with early gastric cancer. Eur J Surg Oncol, 2014, 40(12): 1771-1776.
23.	Hsieh FJ, Wang YC, Hsu JT, et al. Clinicopathological features and prognostic factors of gastric cancer patients aged 40 years or younger. J Surg Oncol, 2012, 105(3): 304-309.
24.	Oh SY, Lee KG, Suh YS, et al. Lymph node metastasis in mucosal gastric cancer: reappraisal of expanded indication of endoscopic submucosal dissection. Ann Surg, 2017, 265(1): 137-142.
25.	Chen JN, Wang QW, Zhang QW, et al. Poorly differentiated is more significant than signet ring cell component for lymph node metastasis in mixed-type early gastric cancer: a retrospective study from a large-volume hospital. Surg Endosc, 2020 Apr 10. Online ahead of print.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Colquhoun A, Arnold M, Ferlay J, et al. Global patterns of cardia and non-cardia gastric cancer incidence in 2012. Gut, 2015, 64(12): 1881-1888.
3. The general rules for the gastric cancer study in surgery ad pathology. Part Ⅱ. Histological classification of gastric cancer. Jpn J Surg. 1981, 11(2): 140-145.
4. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer, 2000, 3(4): 219-225.
5. Noh SH, Hyung WJ, Cheong JH. Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol, 2005, 90(3): 188-193.
6. Lee HH, Yoo HM, Song KY, et al. Risk of limited lymph node dissection in patients with clinically early gastric cancer: indications of extended lymph node dissection for early gastric cancer. Ann Surg Oncol, 2013, 20(11): 3534-3540.
7. Na JE, Kim YG, Kim TJ, et al. Long-term safety of delayed surgery after upfront endoscopic resection for early gastric cancer: a propensity matched study. Ann Surg Oncol, 2020 Jun 26. Online ahead of print.
8. 国家卫生健康委员会. 胃癌诊疗规范(2018 年版). 中华消化病与影像杂志(电子版), 2019, 9(3): 118-144.
9. Matsumoto S, Yamasaki K, Tsuji K, et al. Results of mass endoscopic examination for gastric cancer in Kamigoto Hospital, Nagasaki Prefecture. World J Gastroenterol, 2007, 13(32): 4319-4320.
10. Katai H, Ishikawa T, Akazawa K, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100 000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer, 2018, 21(1): 144-154.
11. 韩文秀, 徐阿曼, 陈章明, 等. 早期胃癌患者淋巴结转移危险因素分析及风险预测模型的建立. 中华普通外科杂志, 2017, 32(4): 285-288.
12. Chen J, Zhao G, Wang Y. Analysis of lymph node metastasis in early gastric cancer: a single institutional experience from China. World J Surg Oncol, 2020, 18(1): 57.
13. Gu L, Khadaroo PA, Chen L, et al. Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for early gastric cancer: a systematic review and meta-analysis. J Gastrointest Surg, 2019, 23(7): 1493-1501.
14. Huang JY, Xu YY, Li M, et al. The prognostic impact of occult lymph node metastasis in node-negative gastric cancer: a systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(12): 3927-3934.
15. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer, 2020 Feb 14. Online ahead of print.
16. Feng F, Tian Y, Xu G, et al. Diagnostic and prognostic value of CEA, CA19-9, AFP and CA125 for early gastric cancer. BMC Cancer, 2017, 17(1): 737.
17. Saito T, Kurokawa Y, Takiguchi S, et al. Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer. Eur Radiol, 2015, 25(2): 368-374.
18. Yin XY, Pang T, Liu Y, et al. Development and validation of a nomogram for preoperative prediction of lymph node metastasis in early gastric cancer. World J Surg Oncol, 2020, 18(1): 2.
19. Kuroki K, Oka S, Tanaka S, et al. Clinical significance of endoscopic ultrasonography in diagnosing invasion depth of early gastric cancer prior to endoscopic submucosal dissection. Gastric Cancer, 2020 Jun 22. Online ahead of print.
20. Tsuzuki T, Okada H, Kawahara Y, et al. Usefulness and problems of endoscopic ultrasonography in prediction of the depth of tumor invasion in early gastric cancer. Acta Med Okayama, 2011, 65(2): 105-112.
21. Takatsu Y, Hiki N, Nunobe S, et al. Clinicopathological features of gastric cancer in young patients. Gastric Cancer, 2016, 19(2): 472-478.
22. Lee JH, Nam BH, Ryu KW, et al. Tumor differentiation is not a risk factor for lymph node metastasis in elderly patients with early gastric cancer. Eur J Surg Oncol, 2014, 40(12): 1771-1776.
23. Hsieh FJ, Wang YC, Hsu JT, et al. Clinicopathological features and prognostic factors of gastric cancer patients aged 40 years or younger. J Surg Oncol, 2012, 105(3): 304-309.
24. Oh SY, Lee KG, Suh YS, et al. Lymph node metastasis in mucosal gastric cancer: reappraisal of expanded indication of endoscopic submucosal dissection. Ann Surg, 2017, 265(1): 137-142.
25. Chen JN, Wang QW, Zhang QW, et al. Poorly differentiated is more significant than signet ring cell component for lymph node metastasis in mixed-type early gastric cancer: a retrospective study from a large-volume hospital. Surg Endosc, 2020 Apr 10. Online ahead of print.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk factors analysis and prediction of lymph node metastasis in early gastric cancer

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