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

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.

Prevalence of nodal metastases in the individual lymph node stations for different T-stages in gastric cancer: a systematic review

“…In addition, this is crucial to determine whether a D1 LND is justified for early, T1-stage GC and whether a D2 LND is justified for more advanced gastric carcinomas. This review is consistent with previous literature studies reporting the metastases rate for the different T-stages [12,24,25]. These studies similarly show an overall low metastases rate in the early carcinomas and an overall high prevalence in the more advanced carcinomas.…”

Research trends in endoscopic applications in early gastric cancer: A bibliometric analysis of studies published from 2012 to 2022

“…After non-curative resection, it is vital to confirm that LNM is absent, as this will determine whether or not additional surgery for post-ER patients is required. A recently published meta-analysis indicated that the risk of LNM was significantly increased in tumors that were > 30 mm in size, had an invasion depth of ≥ 500 μm, flat or elevated tumor macroscopic appearance, and were of the undifferentiated histopathological type, after resection, had positive vertical margins and indications of lymphovascular invasion (LVI) ( 94 ). Another meta-analysis reached similar conclusions and specifically pointed out that lymphatic invasion and vascular invasion individually, rather than LVI, should be assessed, because vascular invasion did not show a significant statistical difference ( 95 ).…”

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

“…Multiple studies have addressed factors to stratify the risk of LNM or residual tumour in patients who have had non-curative ESD. In regard to LNM, lymphovascular invasion (LVI) and depth of submucosal invasion histologically are reported to be the most consistent predictors[ 135 , 136 ]. Goto et al [ 134 ] reported that the presence of depth of invasion > SM1 or LVI was 100% sensitive and 86% specific for the presence of LNM[ 135 ].…”