Higher Lymph Node Metastasis Rate and Poorer Prognosis of Intestinal-Type Gastric Cancer Compared to Diffuse-Type Gastric Cancer in Early-Onset Early-Stage Gastric Cancer: A Retrospective Study

Background: The incidence of early-onset gastric cancer (GC) that was diagnosed at <50 years is increasing, but there is a knowledge gap on early-onset early-stage GC (EEGC) that was defined as early-onset GC limited to the mucosa or submucosa. Therefore, we comprehensively analysed the clinical features based on Lauren type.Methods: Logistic and Cox analyses were used to investigate risk factors for lymph node metastasis (LNM) and prognosis, respectively. Propensity score matching (PSM) was used to adjust confounding factors. Protein mass spectrometry analysis was used to explore the molecular mechanism of LNM.Result: Our study included 581 patients with EEGC from the Surveillance, Epidemiology, and End Results (SEER) database and 226 patients with EEGC from our own centre. We identified intestinal type, T1b stage, and tumour size (>3 cm) as risk factors for LNM using SEER and our own data. We also found that the prognosis of patients with intestinal-type EEGC was poorer than patients with diffuse-type EEGC, and T1b stage and positive LNM were hazard factors for survival. After analysing the expression of proteins between positive and negative LNM in the intestinal or diffuse type, we found no similar proteins between these groups. The differentially expressed genes (DEGs) in the intestinal type functioned as epithelial cell signalling in Helicobacter pylori. The DEGs in the diffuse type functioned in the tricarboxylic acid cycle (TCA cycle) and oxidative phosphorylation.Conclusion: For EEGC, our study was the first report to demonstrate that the intestinal type was a risk factor for LNM and survival compared to the diffuse type, and the oncogenic expression promoting the occurrence of LNM was different. These findings suggest that clinicians should pay more attention to intestinal-type EEGC than diffuse-type EEGC.

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Intestinal-type gastric cancer carries a better prognosis but a higher risk of lymph node metastasis than diffuse-type: a SEER study of nearly 28,000 patients

10.21203/rs.3.rs-27168/v1 ◽

2020 ◽

Author(s):

Chanqiong Zhang ◽

Guangyu Chen ◽

Haofeng Hong ◽

Jinbo Zhu ◽

Hongyuan Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Stage ◽

Intestinal Type ◽

Seer Database ◽

Diffuse Type ◽

Surgical Operation ◽

Node Metastasis ◽

The Impact

Abstract Background: The impact of Lauren type, namely intestinal and diffuse types, on prognosis and lymph node metastasis (LNM) for gastric cancer (GC), requires further exploration, since current samples are deficient and the results are inconsistent.We aimed to translate the widely used WHO classifications into Lauren types and analyze the impact with the largest sample size available.Methods: Corresponding Lauren types of the WHO classification system in the Surveillance, Epidemiology, and End Results (SEER) database were included to identify all patients with histological diagnoses of intestinal-type or diffuse-type GC.Results: 4,338 intestinal-type and 22,990 diffuse-type GC were included in our study. Compared with intestinal-type, diffuse-type had a relatively poor prognosis after adjustment for other risk factors (HR, 1.236; P<0.001). Similar to patients with all stages of GC, the prognosis of patients with early diffuse GC was also poor (HR, 1.295; P=0.001). Surgical operation and radiotherapy markedly improved the DSS for patients (P<0.05). To our surprise, the risk of intestinal LNM in all stages of GC was higher than that in the diffuse type (OR=0.891; P=0.036). Although, there was no positive correlation between LNM and Lauren’s GC (OR=1.096; P=0.467) in early stage.Conclusion: Intestinal-type GC carries a better prognosis but a higher risk of LNM than diffuse-type. Patients with intestinal-type GC are likely to gain a greater benefit from receiving surgical treatment, but it is worth noting that clinicians should pay more attention to their lymphatic metastasis.*Contributed equally.The first author: Chanqiong Zhang, Guangyu Chen

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A nomogram to predict lymph node metastasis risk for early esophageal squamous cell carcinoma

BMC Cancer ◽

10.1186/s12885-021-08077-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaofeng Duan ◽

Xiaobin Shang ◽

Jie Yue ◽

Zhao Ma ◽

Chuangui Chen ◽

...

Keyword(s):

Risk Factors ◽

Squamous Cell Carcinoma ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Early Stage ◽

Derivation Cohort ◽

Node Metastasis

Abstract Background A nomogram was developed to predict lymph node metastasis (LNM) for patients with early-stage esophageal squamous cell carcinoma (ESCC). Methods We used the clinical data of ESCC patients with pathological T1 stage disease who underwent surgery from January 2011 to June 2018 to develop a nomogram model. Multivariable logistic regression was used to confirm the risk factors for variable selection. The risk of LNM was stratified based on the nomogram model. The nomogram was validated by an independent cohort which included early ESCC patients underwent esophagectomy between July 2018 and December 2019. Results Of the 223 patients, 36 (16.1%) patients had LNM. The following three variables were confirmed as LNM risk factors and were included in the nomogram model: tumor differentiation (odds ratio [OR] = 3.776, 95% confidence interval [CI] 1.515–9.360, p = 0.004), depth of tumor invasion (OR = 3.124, 95% CI 1.146–8.511, p = 0.026), and tumor size (OR = 2.420, 95% CI 1.070–5.473, p = 0.034). The C-index was 0.810 (95% CI 0.742–0.895) in the derivation cohort (223 patients) and 0.830 (95% CI 0.763–0.902) in the validation cohort (80 patients). Conclusions A validated nomogram can predict the risk of LNM via risk stratification. It could be used to assist in the decision-making process to determine which patients should undergo esophagectomy and for which patients with a low risk of LNM, curative endoscopic resection would be sufficient.

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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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