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

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.

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Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: A meta-analysis

10.21203/rs.3.rs-37172/v1 ◽

2020 ◽

Author(s):

Jun Du ◽

Yangchao Shen ◽

Wenwu Yan ◽

Jinguo Wang

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Tumor Size ◽

Vascular Invasion ◽

Meta Analysis ◽

Splenic Hilum ◽

Node Metastasis

Abstract Background It remains controversial whether splenic hilum lymph nodes (SHLNs) should be excised in radical gastrectomy with D2 lymph node dissection. In this study, we evaluated the role of clinicopathological features in patients with gastric cancer in predicting splenic hilum lymph nodes metastasis.Methods We searched the Medline, Embase, PubMed and Web of Science databases from inception to May 2020 and consulted related references. 15 articles with a total of 4377 patients were included finally. The odds ratios (ORs) of each risk factor and the corresponding 95% confidence interval (CI) were determined using Revman 5.3 software. Results Meta-analysis showed that tumor size greater than 5 cm (p < 0.01), tumor localization in the greater curvature (p < 0.01), diffuse type (Lauren’s type) (p < 0.01), Borrman type 3–4 (p < 0.01), poor differentiation and undifferentiation (p < 0.01), depth of invasion T3–T4 (p < 0.01), number of lymph node metastases N2–N3 (p < 0.01), distance metastasis M1 (p < 0.01), TNM stage 3–4 (p < 0.01), vascular invasion (p = 0.01), and lymphatic invasion (p < 0.01) were risk factors of SHLNs metastasis. Moreover, No. 1-, 2-, 3-, 4sa-, 4sb-, 4d-, 6-, 7-, 9-, 11-, and 16-positive lymph node metastasis are strongly associated with splenic hilum lymph nodes metastasis.Conclusions Tumor size, tumor location, Lauren’s type, Borrman type, degree of differentiation, T stage, N stage, M stage, TNM stage, vascular invasion, lymphatic infiltration, and other positive lymph nodes metastasis were risk factors for SHLNs.

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Early Gastric Cancer Lymph Node Metastasis Model and Prognostic Survival Prediction Model in Western Population

10.21203/rs.3.rs-112129/v1 ◽

2020 ◽

Author(s):

Huakai Tian ◽

Zuo Zhang ◽

Zitao Liu ◽

Cegui Hu ◽

Jiang Liu ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Prediction Model ◽

Tumor Size ◽

Western Population ◽

Node Metastasis ◽

Cox Analysis

Abstract Objective This study analyzed the characteristics of early gastric cancer lymph node metastasis and survival prognosis after surgical resection in western population, and established a predictive model.MethodsPatients with stage T1a and T1b gastric cancer from 2010 to 2015 were screened from the surveillance, epidemiology and final outcome databases. Patients with multiple in situ tumors, distant metastases, and incomplete data were excluded. The risk factors for lymph node metastasis in early gastric cancer were analyzed by binary logistic regression and the chi-square test. Multivariate Cox analysis and the Kaplan-Meier test were used to evaluate the prognostic factors and survival rates of patients with early gastric cancer after surgical resection. The prediction model of lymph node metastasis and survival rate of early gastric cancer was established and verified by R software.ResultsIn 2294 patients, the lymph node metastasis rate was 14.5% (333/2294). Binary logistic multivariate regression analysis showed that tumor size (>2cm), tumor grade (III/IV), and stage T1b were risk factors for lymph node metastasis of early gastric cancer. Area under the curve (AUC) is 0.782.A predictive model was developed based on risk factors, and the model C index was 0.771, indicating that the model has good predictive ability. In addition, survival analysis of 2294 patients showed that the 5-year OS and CSS (75.4% and 88.7%) in patients without EGC were significantly higher than those with lymph node metastasis (64.3% and 72.8%) (P<0.05). Multivariate COX analysis showed that age, sex, race, tumor size, submucosal invasion and lymph node metastasis were independent factors influencing the prognosis of early gastric cancer. A cancer-specific survival (CSS) prediction model was constructed based on prognostic risk factors. The 3-year area under the CSS curve (AUC) was 0.706, and the 5-year area under the CSS curve (AUC) was 0.710. The prediction model is more consistent with the actual situation.ConclusionsWe established a reliable prediction model for lymph node metastasis of early gastric cancer and a prognostic model for early gastric cancer, which provided a good basis for clinical treatment decision.

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Risk Factors Associated with Lymph Node Metastasis for Early Gastric Cancer Patients Who Underwent Non-curative Endoscopic Resection: a Systematic Review and Meta-analysis

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-018-3924-5 ◽

2018 ◽

Vol 23 (7) ◽

pp. 1318-1328 ◽

Cited By ~ 10

Author(s):

Bochao Zhao ◽

Jingting Zhang ◽

Jiale Zhang ◽

Rui Luo ◽

Zhenning Wang ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Systematic Review ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Meta Analysis ◽

Factors Associated ◽

Node Metastasis ◽

Gastric Cancer Patients

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Prevalence and risk factors for lymph node metastasis after noncurative endoscopic resection for early gastric cancer: a systematic review and meta-analysis

Journal of Gastroenterology ◽

10.1007/s00535-020-01685-9 ◽

2020 ◽

Vol 55 (8) ◽

pp. 742-753

Author(s):

Waku Hatta ◽

Takuji Gotoda ◽

Takeshi Kanno ◽

Yuhong Yuan ◽

Tomoyuki Koike ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Systematic Review ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Endoscopic Resection ◽

Meta Analysis ◽

Node Metastasis

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Mo1171 The Incidence of Lymph Node Metastasis in Early Gastric Cancer According to the Expanded Criteria in Comparison to the Absolute Criteria. A Systemic Review and Meta-Analysis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.1042 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB448 ◽

Cited By ~ 1

Author(s):

Mohamed M. Abdelfatah ◽

Mohamed Barakat ◽

Mohamed O. Othman

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Meta Analysis ◽

Systemic Review ◽

Node Metastasis ◽

Expanded Criteria ◽

The Absolute

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Indications of Lymph Node Metastasis and Survival Analysis in T1N+M0 Gastric Cancer: a Population-Based Study

10.21203/rs.3.rs-36648/v1 ◽

2020 ◽

Author(s):

Peng Jin ◽

Yang Li ◽

Shuai Ma ◽

Wenzhe Kang ◽

Hao Liu ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Survival Analysis ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Size ◽

Multivariate Analyses ◽

Invasion Depth ◽

Node Metastasis ◽

Definition Of

Abstract Background Since the definition of early gastric cancer (EGC) was first proposed in 1971, the treatment of gastric cancer with or without lymph node metastasis (LNM) has changed a lot. The present study aims to identify risk factors for LNM and prognosis, and to further evaluate the indications for adjuvant chemotherapy (AC) in T1N + M0 gastric cancer. Methods A total of 1291 patients with T1N + M0 gastric cancer were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to identify risk factors for LNM. The effect of LNM on overall survival (OS) and cancer-specific survival (CSS) was compared with patients grouped into T1N0-1 and T1N2-3, as the indications for AC. Results The rate of LNM was 19.52%. Multivariate analyses showed age, tumor size, invasion depth, and type of differentiation and retrieved LNs were associated with LNM (p < 0.05). Cox multivariate analyses indicated age, sex, tumor size, N stage were independent predictors of OS and CSS (p < 0.05), while race was indicator for OS (HR 0.866; 95%CI 0.750–0.999, p = 0.049), but not for CSS (HR 0.878; 95% CI 0.723–1.065, p = 0.187). In addition, survival analysis showed the proportion of patients in N+/N0 was better distributed than N0-1/N2-3b. There were statistically significant differences in OS and CSS between patients with and without chemotherapy in pT1N1M0 patients (p༜0.05). Conclusions Both tumor size and invasion depth are associated with LNM and prognosis. LNM is an important predictor of prognosis. pT1N + M0 may be appropriate candidates for AC. Currently, the treatment and prognosis of T1N0M0/T1N + M0 are completely different. An updated definition of EGC, taking into tumor size, invasion depth and LNM, may be more appropriate in an era of precision medicine.

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