Analysis of lymph node metastasis in early gastric cancer: a single institutional experience from China

Chen, Jinggui; Zhao, Guijuan; Wang, Yanong

doi:10.1186/s12957-020-01834-7

Cited by 36 publications

(34 citation statements)

References 30 publications

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“…The incidence of male GC is known to be higher than that of female GC, but the mortality rate of female patients with GC is higher than that of male patients ( 15 – 17 ). In this study, female patients with EGC had a higher LNM ratio than male patients (17.0% vs. 10.4%), which was consistent with previous studies ( 8 , 10 , 25 ). It is therefore necessary to analyze the risk factors for LNM in male and female patients with EGC separately.…”

Section: Discussionsupporting

confidence: 93%

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Nomograms for Predicting the Lymph Node Metastasis in Early Gastric Cancer by Gender: A Retrospective Multicentric Study

Sui

Chen

et al. 2021

Front. Oncol.

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BackgroundLymph node metastasis (LNM) has a significant impact on the prognosis of patients with early gastric cancer (EGC). Our aim was to identify the independent risk factors for LNM and construct nomograms for male and female EGC patients, respectively.MethodsClinicopathological data of 1,742 EGC patients who underwent radical gastrectomy and lymphadenectomy in the First Affiliated Hospital, Second Affiliated Hospital, and Fourth Affiliated Hospital of Anhui Medical University between November 2011 and April 2021 were collected and analyzed retrospectively. Male and female patients from the First Affiliated Hospital of Anhui Medical University were assigned to training sets and then from the Second and Fourth Affiliated Hospitals of Anhui Medical University were enrolled in validation sets. Based on independent risk factors for LNM in male and female EGC patients from the training sets, the nomograms were established respectively, which was also verified by internal validation from the training sets and external validation from the validation sets.ResultsTumor size (odd ratio (OR): 1.386, p = 0.030), depth of invasion (OR: 0.306, p = 0.001), Lauren type (OR: 2.816, p = 0.000), lymphovascular invasion (LVI) (OR: 0.160, p = 0.000), and menopause (OR: 0.296, p = 0.009) were independent risk factors for female EGC patients. For male EGC patients, tumor size (OR: 1.298, p = 0.007), depth of invasion (OR: 0.257, p = 0.000), tumor location (OR: 0.659, p = 0.002), WHO type (OR: 1.419, p = 0.001), Lauren type (OR: 3.099, p = 0.000), and LVI (OR: 0.131, p = 0.000) were independent risk factors. Moreover, nomograms were established to predict the risk of LNM for female and male EGC patients, respectively. The area under the ROC curve of nomograms for female and male training sets were 87.7% (95% confidence interval (CI): 0.8397–0.914) and 94.8% (95% CI: 0.9273–0.9695), respectively. For the validation set, they were 92.4% (95% CI: 0.7979–1) and 93.4% (95% CI: 0.8928–0.9755), respectively. Additionally, the calibration curves showed good agreements between the bias-corrected prediction and the ideal reference line for both training sets and validation sets in female and male EGC patients.ConclusionsNomograms based on risk factors for LNM in male and female EGC patients may provide new insights into the selection of appropriate treatment methods.

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Section: Discussionsupporting

confidence: 93%

“…Previous studies have explored the risk factors for LNM of EGC patients and established corresponding prediction models (8)(9)(10)(11). Previous study reported that the female sex is an independent risk factor for LNM in patients with EGC (12).…”

Section: Introductionmentioning

confidence: 99%

Nomograms for Predicting the Lymph Node Metastasis in Early Gastric Cancer by Gender: A Retrospective Multicentric Study

Sui

Chen

et al. 2021

Front. Oncol.

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“…According to previous studies, the incidence of LNM in patients with EGC regardless of T1a or T1b was 15-24% [28,29]. Recently, Chen et al reported that the LNM rate was 16.7% in EGC (8.7% in T1a, 24.6% in T1b) in their retrospective study that enrolled 1,033 patients with EGC [30]. In agreement with results of previously reported studies, our data showed that the incidence rates of LNM were 12.38% in T1a stage, 27.94% in T1b stage, and 18.36% in whole EGC.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Lymph Node Metastasis in Early Gastric Cancer Conforming to Indications of Endoscopic Resection and Pylorus-Preserving Gastrectomy: A Single-Center Retrospective Study

Wang

et al. 2020

Preprint

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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: Patients with EGC who underwent radical gastrectomy were enrolled. Their clinicopathological features, pathological reports, and prognostic data were collected and analyzed.Results: Three hundred fifty-four patients with EGC were enrolled. The incidence of LNM in patients with EGC was 18.36% (65/354). The rates of D1 and D2 station metastases were 12.1% (43/354) and 6.214% (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 EGC, 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). Five-year disease-free survival rates of patients with EGC 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 patients with EGC.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.

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“…With respect to exclusion of nodal disease prior to ER for EGC, the use of EUS has again been associated with variable accuracy. In a 2008 meta-analysis, the pooled sensitivity of EUS for N1 disease was as low as 58.2%[ 82 ]. More recent data have shown an improved sensitivity and specificity of 74%-83% and 67%-70% in detecting nodal positivity[ 75 , 83 , 84 ].…”

Section: Endoscopic Diagnosis Of Gastric Neoplasiamentioning

confidence: 99%

Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold

Young¹,

Philpott²,

Singh³

2021

WJG

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Gastric cancer accounts for a significant proportion of worldwide cancer-related morbidity and mortality. The well documented precancerous cascade provides an opportunity for clinicians to detect and treat gastric cancers at an endoscopically curable stage. In high prevalence regions such as Japan and Korea, this has led to the implementation of population screening programs. However, guidelines remain ambiguous in lower prevalence regions. In recent years, there have been many advances in the endoscopic diagnosis and treatment of early gastric cancer and precancerous lesions. More advanced endoscopic imaging has led to improved detection and characterization of gastric lesions as well as superior accuracy for delineation of margins prior to resection. In addition, promising early data on artificial intelligence in gastroscopy suggests a future role for this technology in maximizing the yield of advanced endoscopic imaging. Data on endoscopic resection (ER) are particularly robust in Japan and Korea, with high rates of curative ER and markedly reduced procedural morbidity. However, there is a shortage of data in other regions to support the applicability of protocols from these high prevalence countries. Future advances in endoscopic therapeutics will likely lead to further expansion of the current indications for ER, as both technology and proceduralist expertise continue to grow.

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Analysis of lymph node metastasis in early gastric cancer: a single institutional experience from China

Cited by 36 publications

References 30 publications

Nomograms for Predicting the Lymph Node Metastasis in Early Gastric Cancer by Gender: A Retrospective Multicentric Study

Nomograms for Predicting the Lymph Node Metastasis in Early Gastric Cancer by Gender: A Retrospective Multicentric Study

The Risk of Lymph Node Metastasis in Early Gastric Cancer Conforming to Indications of Endoscopic Resection and Pylorus-Preserving Gastrectomy: A Single-Center Retrospective Study

Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold

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