How useful is sentinel lymph node biopsy for the status of lymph node metastasis in cT1N0M0 gastric cancer? A systematic review and meta-analysis

Yun

Contrast Media & Molecular Imaging

2022

Objective. To explore the clinical value of the gastric ultrasonic filling method in evaluating the condition of patients with gastric tumors and guiding the selection of treatment methods, provide data support for clinical gastric filling ultrasonography in the evaluation of gastric cancer patients, and provide the basis for the choice of surgical treatment. Methods. This study retrospectively analyzed 50 patients with gastric cancer treated in our hospital from April 2017 to January 2022. All 50 patients were examined by the gastric ultrasound filling method. The TNM staging results of gastric cancer were analyzed with the results of gastroscopic biopsy or postoperative pathological examination as the diagnostic gold standard. Results. The ultrasonic detection rate of 50 patients with gastric cancer was 94.00% (47/50). Among them, 3 cases missed diagnosis were of early intramucosal carcinoma, which were only diagnosed as erosive gastritis. 1 case was located in the gastric body, and the other 2 cases were located in the gastric antrum. Ultrasound assessment of gastric mucosal thickness in T1-T2 stage was 9.8 mm, which was significantly lower than that in T3-T4 stage, which was 17.0 mm ( p < 0.05). The diagnostic accuracy of the gastric ultrasound filling method in the diagnosis of T1, T2, T3, and T4 was 41.67%, 57.14%, 96.00%, and 83.33%, respectively. The total diagnostic accuracy of T-stage was 76.00% (38/50). The total judgment rate of too shallow and too deep was 10.00% and 14.00%, respectively. The diagnostic accuracy of the gastric ultrasound filling method was 88.89%, 81.81%, 70.00%, and 82.00%, respectively. The diagnostic accuracy of the gastric ultrasound filling method in the diagnosis of M0 and M1 stages was 100.00%, and the total diagnostic accuracy of the M-stage was 100.00%. The ROC curve drawn by GFUS in the diagnosis of T-stage of gastric cancer had three components: the specificity was the horizontal axis, the sensitivity was the vertical axis, and the area under the curve was 0.978. The difference was statistically significant ( p < 0.05). Conclusion. Before the operation of patients with gastric cancer, using the gastric ultrasonic filling method and ultrasonic examination method to diagnose them can timely clarify the clinical stage of patients, so that clinicians can choose the most appropriate operation method according to their clinical stage, which is worthy of popularization and application in clinic.

Section: Discussionmentioning

confidence: 99%

Clinical Study on the Evaluation of the Condition of Patients with Gastric Tumors and the Choice of Surgical Treatment by Gastric Ultrasonic Filling Method

Yun

Contrast Media & Molecular Imaging

2022

“…A lymph node metastasis diagnosis based on the sentinel lymph node biopsy (SLNB) of patients with a significant risk of LNM after ESD could theoretically avoid unnecessary gastrectomy and/or radical lymphadenectomy. Several meta-analyses have evaluated the diagnostic accuracy of SLNB [ 101 , 102 , 103 , 104 , 105 ]. The identification rate of sentinel nodes varied between 93.7–99.0%, and sensitivity varied between 76.9–92.0%.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…False negative rates of up to nearly 25% seem unreasonable considering the prognosis of GC patients with LNM. Sensitivity seems to be higher in earlier T stages, with a meta-analysis of cT1N0M0 gastric cancer reporting a sensitivity of 92% [ 104 ], and a cohort of two randomized controlled trials reporting a pooled sensitivity of 97.7% for pT1 tumors after subgroup analysis [ 106 ]. A single-arm study of the long-term oncologic outcomes of SLNB in cT1 gastric cancer cases, incorporating 100 patients and employing a median follow-up period of 47.5 months, showed a 3-year recurrence-free survival rate of 96.0% (95%CI 92.2–100.0%) and an OS of 98.0% (95%CI 95.2–100.0%) [ 107 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions

Vasconcelos¹,

Dinis-Ribeiro

Libânio

2023

Cancers

Early gastric cancer comprises gastric malignancies that are confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic resection is currently pivotal for the management of such early lesions, and it is the recommended treatment for tumors presenting a very low risk of lymph node metastasis. In general, these lesions consist of two groups of differentiated mucosal adenocarcinomas: non-ulcerated lesions (regardless of their size) and small ulcerated lesions. Endoscopic submucosal dissection is the technique of choice in most cases. This procedure has high rates of complete histological resection while maintaining gastric anatomy and its functions, resulting in fewer adverse events than surgery and having a lesser impact on patient-reported quality of life. Nonetheless, approximately 20% of resected lesions do not fulfill curative criteria and demand further treatment, highlighting the importance of patient selection. Additionally, the preservation of the stomach results in a moderate risk of metachronous lesions, which underlines the need for surveillance. We review the current evidence regarding the endoscopic treatment of early gastric cancer, including the short-and long-term results and management after resection.

World J Gastrointest Surg

“…Lymph node metastasis is an important sign of gastric cancer progression, which means that cancer cells enter lymphatic vessels from the primary site, reach lymph nodes, and continue to grow and spread. The occurrence and degree of lymph node metastasis have important influences on the prognosis of gastric cancer patients[ 8 - 10 ]. With the progress of medical technology, the diagnosis rate of EGC has improved, but lymph node metastasis is still a key factor affecting the prognosis of patients[ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of lymph node metastasis and survival prognosis in early gastric cancer patients: A retrospective study

Liu,

Hu,

Zhou

et al. 2024

BACKGROUND Early gastric cancer (EGC) is a common malignant tumor of the digestive system, and its lymph node metastasis and survival prognosis have been concerning. By retrospectively analyzing the clinical data of EGC patients, we can better understand the status of lymph node metastasis and its impact on survival and prognosis. AIM To evaluate the prognosis of EGC patients and the factors that affect lymph node metastasis. METHODS The clinicopathological data of 1011 patients with EGC admitted to our hospital between January 2015 and December 2023 were collected in a retrospective cohort study. There were 561 males and 450 females. The mean age was 58 ± 11 years. The patient underwent radical gastrectomy. The status of lymph node metastasis in each group was determined according to the pathological examination results of surgical specimens. The outcomes were as follows: (1) Lymph node metastasis in EGC patients; (2) Analysis of influencing factors of lymph node metastasis in EGC; and (3) Analysis of prognostic factors in patients with EGC. Normally distributed measurement data are expressed as mean ± SD, and a t test was used for comparisons between groups. The data are expressed as absolute numbers or percentages, and the chi-square test was used for comparisons between groups. Rank data were compared using a nonparametric rank sum test. A log-rank test and a logistic regression model were used for univariate analysis. A logistic stepwise regression model and a Cox stepwise regression model were used for multivariate analysis. The Kaplan-Meier method was used to calculate the survival rate and construct survival curves. A log-rank test was used for survival analysis. RESULTS Analysis of influencing factors of lymph node metastasis in EGC. The results of the multifactor analysis showed that tumor length and diameter, tumor site, tumor invasion depth, vascular thrombus, and tumor differentiation degree were independent influencing factors for lymph node metastasis in patients with EGC (odds ratios = 1.80, 1.49, 2.65, 5.76, and 0.60; 95%CI: 1.29–2.50, 1.11–2.00, 1.81–3.88, 3.87-8.59, and 0.48-0.76, respectively; P < 0.05). Analysis of prognostic factors in patients with EGC. All 1011 patients with EGC were followed up for 43 (0–13) months. The 3-year overall survival rate was 97.32%. Multivariate analysis revealed that age > 60 years and lymph node metastasis were independent risk factors for prognosis in patients with EGC (hazard ratio = 9.50, 2.20; 95%CI: 3.31-27.29, 1.00-4.87; P < 0.05). Further analysis revealed that the 3-year overall survival rates of gastric cancer patients aged > 60 years and ≤ 60 years were 99.37% and 94.66%, respectively, and the difference was statistically significant (P < 0.05). The 3-year overall survival rates of patients with and without lymph node metastasis were 95.42% and 97.92%, respectively, and the difference was statistically significant (P < 0.05). CONCLUSION The lymph node metastasis rate of EGC patients was 23.64%. Tumor length, tumor site, tumor infiltration depth, vascular cancer thrombin, and tumor differentiation degree were found to be independent factors affecting lymph node metastasis in EGC patients. Age > 60 years and lymph node metastasis are independent risk factors for EGC prognosis.