Sex-specific differences in risk factors of lymph node metastasis in patients with early gastric cancer

Abstract

Accurate prediction of lymph node status is of crucial importance in the appropriate treatment planning for patients with early gastric cancer (EGC). Some studies have examined factors predicting lymph node metastasis (LNM) in EGC; however, these studies did not consider sex-specific differences. This study aimed to investigate sex-specific differences in predictive risk factors of LNM in EGC based on surgical specimens. Patients who underwent surgical treatment for EGC between January 2003 and February 2016 were retrospectively evaluated. Patients who underwent previous gastric surgery or treatment for gastric neoplasms were excluded. Finally, 1076 patients treated for EGC were included in the analysis. We analyzed risk factors of LNM by dividing patients into male and female groups. Of 1076 patients (mean age 59.6 years), 69% were men. The overall LNM rate was 9.4%. The LNM rate was lower in men (7.8%) than in women (12.9%). Multivariate analysis showed that elevated type (odds ratio [OR], 2.084; 95% confidence interval [CI]: 1.053–4.125; P = 0.035), submucosal invasion (OR, 2.162; 95% CI: 1.018–4.595; P = 0.045), undifferentiated type (OR, 2.044; 95% CI: 1.107–3.772; P = 0.022), and lymphovascular invasion (LVI) (OR, 7.210; 95% CI: 3.835–13.554; P<0.001) were independent predictive risk factors of LNM in EGC in men. However, only submucosal invasion (OR, 8.772; 95% CI: 2.823–27.259; P<0.001) and LVI (OR, 8.877; 95% CI: 3.861–20.410; P<0.001) were independent predictive risk factors of LNM in EGC in women. Submucosal invasion and LVI were risk factors of LNM in both men and women. However, elevated and undifferentiated types were risk factors in men but not in women. Clinicians should consider these sex-specific differences with regard to individualized management.

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

“…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.…”

Gender and Age Differences in Risk Factors of Lymph Node Metastasis in Patients With Early Gastric Cancer and Analysis Prognosis of Early Gastric Cancer

“…A number of researchers have found that female sex is an independent risk factor for lymph node metastasis in EGC. The estrogen signaling pathway in women affects the generation and development of breast cancer and endometrial cancer; it has also been shown to affect the occurrence and development of gastric cancer [6,29,30]. Our research did not nd that gender affects the lymph node metastasis of EGC.…”

HER2 as a potential biomarker of lymph node metastasis in undifferentiated early gastric cancer

“…Expanded criteria have shown an effort to broaden the scope of endoscopic resection using histologic differentiation, size, presence of ulcers, and depth of submucosal invasion. To date, vague pathological and clinical factors have been mainly used [12][13][14] . Recently, there was a concern that use of expanded criteria may lead to a higher rate of LNM in EGC 13,15 .…”