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. 2020 Jun 23:13:1756284820935033.
doi: 10.1177/1756284820935033. eCollection 2020.

Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis

Bolun Jiang  1 , Li Zhou  1 , Jun Lu  1 , Yizhi Wang  1 , Junchao Guo  2
Affiliations

Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis

Bolun Jiang et al. Therap Adv Gastroenterol. .

Abstract

Background: It is challenging to identify the prevalence of lymph node metastasis (LNM) and residual tumor in patients with early gastric cancer (EGC) who underwent noncurative endoscopic resection (ER). This present meta-analysis was aimed to establish imperative potential predictive factors in order to select the optimal treatment method.

Methods: A systematic literature search of PubMed, Embase, and Cochrane Library databases was performed through 1 February 2019 to identify relevant studies, which investigated risk factors for LNM and residual tumor in patients with EGC who underwent noncurative ER. Eligible data were systematically reviewed through a meta-analysis.

Results: Overall, 12 studies investigating the risk factor of LNM were included, totaling 3015 patients, 7 of which also involved cancer residues. After the present meta-analysis, six predictors, including tumor size >30 mm, tumor invasion depth (⩾500 μm from the muscularis mucosae), macroscopic appearance, undifferentiated histopathological type, positive vertical margin, and presence of lymphovascular invasion (including lymphatic invasion and vascular invasion) were significantly associated with LNM, whereas tumor size >30 mm, positive horizontal margin, and positive vertical margin were identified as significant predictors for the risk of residual tumor. No evidence of publication bias was observed.

Conclusions: Six and three variables were established as significant risk factors for LNM and residual tumor in patients with EGC who underwent noncurative ER, respectively. Patients with EGC who present these risk factors after noncurative ER are strongly suggested to receive additional surgery, while others might be suitable for strict follow-up. This might shed some new light on the selection of follow-up treatment for noncurative ER.

Keywords: early gastric cancer; lymph node metastasis; noncurative endoscopic resection; residual tumor; risk factor.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart of study selection for the meta-analysis.
Figure 2.
Figure 2.
Forest plot for the relationship between LNM and tumor size, tumor invasion depth, macroscopic appearance, histopathological type and vertical margin, respectively. LNM, lymph node metastasis.
Figure 3.
Figure 3.
Forest plot for the relationship between LNM and lymphovascular invasion, lymphatic invasion, and vascular invasion, respectively. LNM, lymph node metastasis.
Figure 4.
Figure 4.
Forrest plot for the relationship between residual tumor and tumor size, horizontal margin, and vertical margin, respectively.
See this image and copyright information in PMC

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