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. 2021 Nov 27;21(1):1280.
doi: 10.1186/s12885-021-09008-8.

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

Wu Yanzhang #  1 , Li Guanghua #  1 , Zhou Zhihao  1 , Wang Zhixiong  2 , Wang Zhao  3
Affiliations

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

Wu Yanzhang et al. BMC Cancer. .

Abstract

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.

Keywords: Early gastric cancer; Lymph node metastasis; Lymphatic invasion; Predictive model; Skip metastasis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Inclusion criteria for study participants. LNM-, absence of lymph node metastasis; LNM+, presence of lymph node metastasis
Fig. 2
Fig. 2
ROC curve of the multivariable model for predicting LNM. ROC, receiver operating characteristic; LNM, lymph node metastasis
Fig. 3
Fig. 3
Nomogram for the prediction of lymph node metastasis
Fig. 4
Fig. 4
Kaplan–Meier curve of cumulative survival of patients with LNM+ (green) and LNM- (blue). LNM, lymph node metastasis; LNM-, absence of lymph node metastasis; LNM+, presence of lymph node metastasis; X-axis represents the survival time; Y-axis represents the survival rate
See this image and copyright information in PMC

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