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

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.

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

2020 ◽  
Vol 13 ◽  
pp. 175628482093503
Author(s):  
Bolun Jiang ◽  
Li Zhou ◽  
Jun Lu ◽  
Yizhi Wang ◽  
Junchao Guo
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Early Gastric Cancer ◽  
Tumor Size ◽  
Meta Analysis ◽  
Residual Tumor ◽  
Node Metastasis

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.

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

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.

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

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.

scholarly journals Development of Nomograms for Predicting Lymph Node Metastasis and Distant Metastasis in Newly Diagnosed T1-2 Non-Small Cell Lung Cancer: A Population-Based Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Yiming Qi ◽  
Shuangshuang Wu ◽  
Linghui Tao ◽  
Yunfu Shi ◽  
Wenjuan Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Small Cell Lung Cancer ◽  
Distant Metastasis ◽  
Tumor Size ◽  
Small Cell ◽  
Small Cell Lung ◽  
Node Metastasis

BackgroundFor different lymph node metastasis (LNM) and distant metastasis (DM), the diagnosis, treatment and prognosis of T1-2 non-small cell lung cancer (NSCLC) are different. It is essential to figure out the risk factors and establish prediction models related to LNM and DM.MethodsBased on the surveillance, epidemiology, and end results (SEER) database from 1973 to 2015, a total of 43,156 eligible T1-2 NSCLC patients were enrolled in the retrospective study. Logistic regression analysis was used to determine the risk factors of LNM and DM. Risk factors were applied to construct the nomograms of LNM and DM. The predictive nomograms were discriminated against and evaluated by Concordance index (C-index) and calibration plots, respectively. Decision curve analysis (DCAs) was accepted to measure the clinical application of the nomogram. Cumulative incidence function (CIF) was performed further to detect the prognostic role of LNM and DM in NSCLC-specific death (NCSD).ResultsEight factors (age at diagnosis, race, sex, histology, T-stage, marital status, tumor size, and grade) were significant in predicting LNM and nine factors (race, sex, histology, T-stage, N-stage, marital status, tumor size, grade, and laterality) were important in predicting DM(all, P&lt; 0.05). The calibration curves displayed that the prediction nomograms were effective and discriminative, of which the C-index were 0.723 and 0.808. The DCAs and clinical impact curves exhibited that the prediction nomograms were clinically effective.ConclusionsThe newly constructed nomograms can objectively and accurately predict LNM and DM in patients suffering from T1-2 NSCLC, which may help clinicians make individual clinical decisions before clinical management.

scholarly journals Development and Validation a Nomogram for Predicting the Third Station Lymph Node Metastasis in Early Gastric Cancer

2021 ◽  
Author(s):  
Xiaoxiao Wang ◽  
Cong Li ◽  
Mengjie Fang ◽  
Liwen Zhang ◽  
Lianzhen Zhong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Validation Cohort ◽  
Predictive Accuracy ◽  
Clinical Risk Factors ◽  
Node Metastasis ◽  
Clinical Risk

Abstract Background:This study aimed to evaluate the value of radiomic nomogram in predicting lymph node metastasis in T1-2 gastric cancer according to the No. 3 station lymph nodes.Methods:A total of 159 T1-2 gastric cancer (GC) patients who had undergone surgery with lymphadenectomy between March 2012 and November 2017 were retrospectively collected and divided into a primary cohort (n = 80) and a validation cohort (n = 79). Radiomic features were extracted from both tumor region and No. 3 station lymph nodes (LN) based on computed tomography (CT) images per patient. Then, key features were selected using minimum redundancy maximum relevance algorithm and fed into two radiomic signatures, respectively. Meanwhile, the predictive performance of clinical risk factors was studied. Finally, a nomogram was built by merging radiomic signatures and clinical risk factors and evaluated by the area under the receiver operator characteristic curve (AUC) as well as decision curve.Results: Two radiomic signatures, reflecting phenotypes of the tumor and LN respectively, were significantly associated with LN metastasis. A nomogram incorporating two radiomic signatures and CT-reported LN metastasis status showed good discrimination of LN metastasis in both the primary cohort (AUC: 0.915; 95% confidence interval [CI]: 0.832-0.998) and validation cohort (AUC: 0.908; 95%CI: 0.814-1.000). The decision curve also indicated its potential clinical usefulness.Conclusions:The nomogram received favorable predictive accuracy in predicting No.3 station LN metastasis in T1-2 GC, and could assist the choice of therapy.

Risk Factors for Lymph Node Metastasis in Early Gastric Cancer with Signet Ring Cell Carcinoma

2015 ◽  
Vol 19 (11) ◽  
pp. 1958-1965 ◽  
Author(s):  
Chun Guang Guo ◽  
Dong Bing Zhao ◽  
Qian Liu ◽  
Zhi Xiang Zhou ◽  
Ping Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Early Gastric Cancer ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Node Metastasis ◽  
Signet Ring ◽  
Ring Cell

The Risk Factors of Lymph Node Metastasis in Early Gastric Cancer

2015 ◽  
Vol 21 (4) ◽  
pp. 941-946 ◽  
Author(s):  
Wen-Liang Fang ◽  
Kuo-Hung Huang ◽  
Yuan-Tzu Lan ◽  
Ming-Huang Chen ◽  
Yee Chao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Early Gastric Cancer ◽  
Node Metastasis

Mo1163 A Multicenter Study Evaluating Risk Factors of Lymph Node Metastasis in Early Gastric Cancer in the United States

2017 ◽  
Vol 85 (5) ◽  
pp. AB444
Author(s):  
Olaya Isabella Brewer Gutierrez ◽  
Alyssa Y. Choi ◽  
Peter V. Draganov ◽  
Lauren Khanna ◽  
Amrita Sethi ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Early Gastric Cancer ◽  
Multicenter Study ◽  
The United States ◽  
Node Metastasis

Risk factors for peritoneal recurrence in serosa-negative gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 19-19 ◽  
Author(s):  
Hayato Omori ◽  
Yuichiro Miki ◽  
Wataru Takagi ◽  
Fumiko Hirata ◽  
Taichi Tatsubayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Independent Risk Factor ◽  
Peritoneal Recurrence ◽  
Node Metastasis ◽  
Gastric Cancer Patients

19 Background: Peritoneal recurrence is often observed in gastric cancer patients without serosal invasion. It is difficult for pathologists to evaluate whether tumor cells penetrate serosa or not, because the subserosa layer is very thin. We evaluated the incidence and risk factors of peritoneal recurrence in serosa -negative gastric cancer patients to clarify the mechanism of peritoneal recurrence in these patients. Methods: A total of 1,745 gastric cancer patients underwent R0 resection from 2002 to 2009 were enrolled. The incidence of peritoneal recurrence according to tumor depth was analyzed. In serosa-nagative patients, the univariate and multivariate analysis were performed to identify the risk factors for peritoneal recurrence. Results: Peritoneal recurrence was observed in 64 (3.7 %) out of 1,745 patients. The incidence of peritoneal recurrence according to depth of tumor invasion was in 0 / 466 in T1a, 5 / 567 (0.88 %) in T1b, 4 / 187 (2.1 %) in T2, 31 / 360 (7.9 %) in T3, 20 / 108 (15.9 %) in T4a, and 4 / 12 (25 %) in T4b, respectively (p<0.001). As for the risk factor for peritoneal recurrence in T3 patients, histologically undifferentiated type, negative lymphatic invasion, scirrhous type, invasive infiltrating growth pattern were the significant factors identified by univariate analysis. Only the invasive infiltrating growth pattern (OR3.44 p0.038) was selected as significant independent risk factor for peritoneal recurrence by multivariate analysis. In T1b / T2 patients, massive lymph node metastasis (N3a, 3b), scirrhous type were the significant factor for peritoneal recurrence by univariate analysis. Only massive lymph node metastasis (OR25.1 p<0.001) was selected as the significant independent risk factor by multivariate analysis. Conclusions: The incidence of peritoneal recurrence increases in proportion to the tumor depth. Invasive infiltrating growth pattern was selected as an independent risk factor for peritoneal recurrence in T3 patients, while it was massive lymph node metastasis in T1b / T2 patients. The results suggest the possibility that microscopic serosal invasion in T3 tumor and lymphatic progression in T1b / T2 tumor may contribute to peritoneal recurrence in gastric cancer.

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