Clinicopathological features and risk factors analysis of lymph node metastasis and long-term prognosis in patients with synchronous multiple gastric cancer

Abstract Background As a common malignancy, gastric cancer (GC) remains an important threat to human’s health. The incidence of synchronous multiple gastric cancer (SMGC) has increased obviously with technical advances of endoscopic and pathological examinations. Several studies have investigated the relationship between SMGC and solitary gastric cancer (SGC). However, little is known about the relationship between early and advanced SMGCs, and the independent risk factors of lymph node metastasis and prognosis in SMGC patients remain unclear. Methods We retrospectively collected 57 patients diagnosed as SMGC and underwent radical gastrectomies from December 2011 to September 2019. Epidemiological data and clinicopathological characteristics of all patients were recorded. Postoperative follow-up was performed by telephone or outpatient service. Chi-square test or Fisher’s exact test was adopted in analysis of categorical data. Continuous data were analyzed by using unpaired t-test. Univariate and multivariate analyses were performed to investigate the independent risk factors of lymph node metastasis and tumor recurrence of SMGC. Results There were 45 males and 12 females. The average age was 62.1-year-old. There were 20 patients with early SMGC and 37 patients with advanced SMGC. Most of patients (91.2%) had two malignant lesions. Tumor recurrence occurred in 8 patients, among which 7 patients died from recurrence. The rates of total gastrectomy, tumor size ≥ 2 cm, poorly-differentiated type, lymph node metastasis, ulcer and nerve invasion and preoperative CEA level were significantly higher in advanced SMGC patients compared to those with early SMGC. Lymphovascular cancer plug and preoperative CA125 were the independent risk factors of lymph node metastasis in patients with SMGC. Lymph node metastasis, nerve invasion and preoperative AFP might be the risk factors of tumor recurrence of SMGC, but need further validation. Conclusions In patients with SMGC, the presence of tumor size ≥ 2 cm, poorly-differentiated type, lymph node metastasis, ulcer, nerve invasion and relatively high preoperative CEA level might make them more likely to be advanced SMGC. More attention should be paid to lymph node metastasis in SMGC patients with lymphovascular cancer plug and high preoperative CA125. Lymph node metastasis, nerve invasion and preoperative AFP might be associated with recurrence of SMGC.

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Clinicopathological features and risk factors analysis of lymph node metastasis and long-term prognosis in patients with synchronous multiple gastric cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02130-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Liang Chen ◽

Chao Yue ◽

Gang Li ◽

Xuezhi Ming ◽

Rongmin Gu ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Recurrence ◽

Node Metastasis ◽

Nerve Invasion ◽

Poorly Differentiated ◽

Multiple Gastric Cancer ◽

Independent Risk Factors

Abstract Background As a common malignancy, gastric cancer (GC) remains an important threat to human’s health. The incidence of synchronous multiple gastric cancer (SMGC) has increased obviously with technical advances of endoscopic and pathological examinations. Several studies have investigated the relationship between SMGC and solitary gastric cancer (SGC). However, little is known about the relationship between early and advanced SMGCs, and the independent risk factors of lymph node metastasis and prognosis in SMGC patients remain unclear. Methods We retrospectively collected 57 patients diagnosed as SMGC and underwent radical gastrectomies from December 2011 to September 2019. Epidemiological data and clinicopathological characteristics of all patients were recorded. Postoperative follow-up was performed by telephone or outpatient service. Chi-squared test or Fisher’s exact test was adopted in analysis of categorical data. Continuous data were analyzed by using unpaired t test. Univariate and multivariate analyses were performed to investigate the independent risk factors of lymph node metastasis and tumor recurrence of SMGC. Results There were 45 males and 12 females. The average age was 62.1 years old. There were 20 patients with early SMGC and 37 patients with advanced SMGC. Most of patients (91.2%) had two malignant lesions. Tumor recurrence occurred in 8 patients, among which 7 patients died from recurrence. The rates of total gastrectomy, tumor size ≥ 2 cm, poorly differentiated type, lymph node metastasis, ulcer and nerve invasion, and preoperative CEA level were significantly higher in advanced SMGC patients compared to those with early SMGC. Lymphovascular cancer plug and preoperative CA125 were the independent risk factors of lymph node metastasis in patients with SMGC. Lymph node metastasis, nerve invasion, and preoperative AFP might be the risk factors of tumor recurrence of SMGC, but need further validation. Conclusions In patients with SMGC, the presence of tumor size ≥ 2 cm, poorly differentiated type, lymph node metastasis, ulcer, nerve invasion, and relatively high preoperative CEA level might indicate the advanced SMGC. More attention should be paid to lymph node metastasis in SMGC patients with lymphovascular cancer plug and high preoperative CA125. Lymph node metastasis, nerve invasion, and preoperative AFP might be associated with recurrence of SMGC, needing further validation.

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Clinicopathological features and risk factors analysis of lymph node metastasis and long-term prognosis in patients with synchronous multiple gastric cancer

10.21203/rs.3.rs-68803/v2 ◽

2021 ◽

Author(s):

Liang Chen ◽

Chao Yue ◽

Gang Li ◽

Xuezhi Ming ◽

Rongmin Gu ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Recurrence ◽

Node Metastasis ◽

Nerve Invasion ◽

Poorly Differentiated ◽

Multiple Gastric Cancer ◽

Independent Risk Factors

Abstract Background As a common malignancy, gastric cancer (GC) remains an important threat to human’s health. The incidence of synchronous multiple gastric cancer (SMGC) has increased obviously with technical advances of endoscopic and pathological examinations. Several studies have investigated the relationship between SMGC and solitary gastric cancer (SGC). However, little is known about the relationship between early and advanced SMGCs, and the independent risk factors of lymph node metastasis and prognosis in SMGC patients remain unclear.Methods We retrospectively collected 57 patients diagnosed as SMGC and underwent radical gastrectomies from December 2011 to September 2019. Epidemiological data and clinicopathological characteristics of all patients were recorded. Postoperative follow-up was performed by telephone or outpatient service. Chi-square test or Fisher’s exact test was adopted in analysis of categorical data. Continuous data were analyzed by using unpaired t-test. Univariate and multivariate analyses were performed to investigate the independent risk factors of lymph node metastasis and tumor recurrence of SMGC.Results There were 45 males and 12 females. The average age was 62.1-year-old. There were 20 patients with early SMGC and 37 patients with advanced SMGC. Most of patients (91.2%) had two malignant lesions. Tumor recurrence occurred in 8 patients, among which 7 patients died from recurrence. The rates of total gastrectomy, tumor size ≥2 cm, poorly-differentiated type, lymph node metastasis, ulcer and nerve invasion and preoperative CEA level were significantly higher in advanced SMGC patients compared to those with early SMGC. Lymphovascular cancer plug and preoperative CA125 were the independent risk factors of lymph node metastasis in patients with SMGC. Lymph node metastasis, nerve invasion and preoperative AFP might be the risk factors of tumor recurrence of SMGC, but need further validation.Conclusions In patients with SMGC, the presence of tumor size ≥2 cm, poorly-differentiated type, lymph node metastasis, ulcer, nerve invasion and relatively high preoperative CEA level might indicate the advanced SMGC. More attention should be paid to lymph node metastasis in SMGC patients with lymphovascular cancer plug and high preoperative CA125. Lymph node metastasis, nerve invasion and preoperative AFP might be associated with recurrence of SMGC, needing further validation.

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

Frontiers in Oncology ◽

10.3389/fonc.2021.616951 ◽

2021 ◽

Vol 11 ◽

Author(s):

Wannian Sui ◽

Zhangming Chen ◽

Chuanhong Li ◽

Peifeng Chen ◽

Kai Song ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Depth Of Invasion ◽

Male And Female ◽

Node Metastasis ◽

Independent Risk Factors ◽

Medical University ◽

Training Sets

BackgroundLymph node metastasis (LNM) has a significant impact on the prognosis of patients with early gastric cancer (EGC). Our aim was to identify the independent risk factors for LNM and construct nomograms for male and female EGC patients, respectively.MethodsClinicopathological data of 1,742 EGC patients who underwent radical gastrectomy and lymphadenectomy in the First Affiliated Hospital, Second Affiliated Hospital, and Fourth Affiliated Hospital of Anhui Medical University between November 2011 and April 2021 were collected and analyzed retrospectively. Male and female patients from the First Affiliated Hospital of Anhui Medical University were assigned to training sets and then from the Second and Fourth Affiliated Hospitals of Anhui Medical University were enrolled in validation sets. Based on independent risk factors for LNM in male and female EGC patients from the training sets, the nomograms were established respectively, which was also verified by internal validation from the training sets and external validation from the validation sets.ResultsTumor size (odd ratio (OR): 1.386, p = 0.030), depth of invasion (OR: 0.306, p = 0.001), Lauren type (OR: 2.816, p = 0.000), lymphovascular invasion (LVI) (OR: 0.160, p = 0.000), and menopause (OR: 0.296, p = 0.009) were independent risk factors for female EGC patients. For male EGC patients, tumor size (OR: 1.298, p = 0.007), depth of invasion (OR: 0.257, p = 0.000), tumor location (OR: 0.659, p = 0.002), WHO type (OR: 1.419, p = 0.001), Lauren type (OR: 3.099, p = 0.000), and LVI (OR: 0.131, p = 0.000) were independent risk factors. Moreover, nomograms were established to predict the risk of LNM for female and male EGC patients, respectively. The area under the ROC curve of nomograms for female and male training sets were 87.7% (95% confidence interval (CI): 0.8397–0.914) and 94.8% (95% CI: 0.9273–0.9695), respectively. For the validation set, they were 92.4% (95% CI: 0.7979–1) and 93.4% (95% CI: 0.8928–0.9755), respectively. Additionally, the calibration curves showed good agreements between the bias-corrected prediction and the ideal reference line for both training sets and validation sets in female and male EGC patients.ConclusionsNomograms based on risk factors for LNM in male and female EGC patients may provide new insights into the selection of appropriate treatment methods.

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RA08.03: LYMPH NODE METASTASIS RISK IN SUPERFICIAL ESOPHAGOGASTRIC JUNCTIONAL ADENOCARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra08.03 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 38-38

Author(s):

Naoki Akazawa ◽

Akira Yamasaki ◽

Junko Fujisaki

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Conflicts Of Interest ◽

Biological Behavior ◽

Node Metastasis ◽

Additional Surgery ◽

Esophagogastric Cancer ◽

Poorly Differentiated

Abstract Background We have reported that lymph node metastasis risk in cases of superficial Barrett's esophageal cancer (BC) was of submucosal invasion within 500μm without other risk factors (lymphovascular involvement, a poorly differentiated component, and lesion size) through a multicenter retrospective study in 13 facilities. Cardiac cancer (CC) was included in the gastric cancer criteria of the Japanese Gastric Cancer Association. Since BC and CC near the esophagogastric junction (EGJ) show almost the same biological behavior, we elucidated the metastasis risk factors in patients with EGJ adenocarcinoma. Methods Patients who underwent ESD for superficial EGJ adenocarcinoma as Siewert typeII between January 2011 and April 2017 were included. Results A total of 120 patients were analyzed. Fifty-three patients (44.1%) had BC and 67 patients (55.8%) had CC. Of the 120 lesions, the median size was 16.7 ± 8.5 mm; 10 (8.3%; 4 BC, 6 CC) were greater than 30 mm in size. Thirty-five (29.1%; 17 BC, 18 CC) were submucosal (SM) cancers. Twenty-one (17.5%; 13 BC, 8 CC) had poorly differentiated components and 19 (15.8%; 14 BC, 5 CC) had lymphovascular involvement. Of the 19 cases with lymphovascular involvement, 11/22 (50%) were SM cancers with > 200μm of invasion, and 8/98 (8.1%) were mucosal (M)/SM cancers within SM200μm of invasion. Of the BCs with DMM invasion, 7/17 (41.1%) had lymphovascular involvement. Of the patients initially treated through ESD, 33 (27.5%) had lymphovascular involvement, positive horizontal/vertical margins, or SM > 200μm of invasion. Of these, 26 were treated with additional surgery. Metastasis was confirmed from 2 patients. Both were BCs, with SM > 501μm of invasion, positive lymphovascular involvement, and with poorly differentiated components. One was > 30 mm in size. Metastasis was not identified in CC and in cases with SM < 200μm of invasion. Conclusion For superficial esophagogastric cancer, we did not identify metastasis in patients with SM > 501 μm of invasion. There were no cases of metastasis in patients without risk factors. ESD might be indicated for lesions within SM 500μm of invasion without risk factors. Among DMM cases of BC, lymphovascular involvement was highly frequent. Therefore, histopathological surveillance for lymphovascular involvement is important. Disclosure All authors have declared no conflicts of interest.

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Lymph node metastasis in early gastric cancer

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/s0100-69912014000100004 ◽

2014 ◽

Vol 41 (1) ◽

pp. 11-17 ◽

Cited By ~ 16

Author(s):

Guilherme Pinto Bravo Neto ◽

Elizabeth Gomes Dos Santos ◽

Felipe Carvalho Victer ◽

Carlos Eduardo De Souza Carvalho

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Gastric Surgery ◽

Type Iii ◽

Node Metastasis ◽

Poorly Differentiated ◽

A Prospective Study

OBJECTIVE: to evaluate the incidence of lymph node metastasis in early gastric cancer, identifying risk factors for its development. METHODS: we conducted a prospective study of patients with gastric cancer admitted to the Section of the Esophago-Gastric Surgery of the Surgery of Service HUCFF-UFRJ, from January 2006 to May 2012. RESULTS: the rate of early gastric cancer was 16.3%. The incidence of nodal metastases was 30.8% and occurred more frequently in patients with tumors with involvement of the submucosa (42.9%), in those poorly differentiated (36.4%), in tumors larger than 2 cm (33.3%) and in type III ulcerated lesions (43.8%). CONCLUSION: the incidence of lymph node metastases in patients was very high and suggests that one should keep the radicality of resection in early gastric cancer, particularly in relation to D2 lymphadenectomy, recommended for advanced gastric cancer. Conservative resections, with lymphadenectomies smaller than D2, should be performed only in selected cases, well-studied as for the risk factors of lymph node metastasis. Despite the small number of cases did not permit to relate the rate of lymph node metastasis to the risk factors considered, we noted a strong tendency for the occurrence of these metastases in the poorly differentiated, type III, larger than 2 cm tumors, and in the Lauren diffuse types.

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Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer

Endoscopy ◽

10.1055/s-0029-1214758 ◽

2009 ◽

Vol 41 (06) ◽

pp. 498-503 ◽

Cited By ~ 44

Author(s):

C. Kunisaki ◽

M. Takahashi ◽

Y. Nagahori ◽

T. Fukushima ◽

H. Makino ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Node Metastasis ◽

Poorly Differentiated

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The Characteristics, Prognosis, and Risk Factors of Lymph Node Metastasis in Early Gastric Cancer

Gastroenterology Research and Practice ◽

10.1155/2018/6945743 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Xuan Li ◽

Shiyu Liu ◽

Jin Yan ◽

Lei Peng ◽

Meihong Chen ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Multivariate Analysis ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Depth Of Invasion ◽

Node Metastasis ◽

Independent Risk Factors ◽

Male Sex

Background. Lymph node metastasis (LNM) is the most important risk factor for endoscopic treatment in early gastric cancer (EGC) patients. We aimed to investigate the rate of LNM, the risk factors, and the prognosis of EGC patients with LMN. Methods. A total of 10,039 patients who underwent gastrectomy with lymphadenectomy were reviewed between January 2010 and December 2015 at Jiangsu Province Hospital in China. Among them, we identified 1004 (10%) EGCs. First, endoscopic and clinicopathological features related to LNM were analyzed, and then risk factors for LNM were identified using univariate and multivariate analysis. Finally, the short- and long-term outcomes were compared between the groups. Results. LNM occurred in 123 (12.3%) EGCs. Most of EGCs were male (n=720, 71.7%) and mean age was 59.65 ± 11.09 years. The rate of H. pylori infection was 78.0% (783/1004). LNM was significantly associated with age, sex, location, lesion size, macroscopic type, depth of invasion, differentiation type, histological morphology, lymphovascular invasion (LVI), and TMN stage. By multivariate analysis, significant independent risk factors for LNM in EGC were identified as following: male sex (OR 2.365, P=0.035), age ≦ 40 (OR 0.055, P=0.012), depressed type (OR 2.721, P=0.013), submucosa invasion (OR 2.987, P=0.032), LVI (OR 5.186, P=0.003), tumor located in corpora (OR 8.904, P=0.047), and in angle (OR 12.998, P=0.024). 86.5% were successfully followed up for 3 years. The overall 1- and 3-year survival rates in LNM group were 100% and 91.1%, respectively, and those with no LNM were 100% and 100%, respectively. Conclusion. EGCs were investigated in 10.0% of gastric cancer, which LNM occurred in 12.3% of EGC. Independent risk factors of LNM included male sex, age (>40), the depth of invasion, LVI, and tumor located in corpora or angle. The 3-year overall survival rate was greater in EGC patients without LNM.

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

10.21203/rs.3.rs-142894/v1 ◽

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.

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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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