Prediction of risk factors for lymph node metastasis in early gastric cancer

doi:10.3748/wjg.v19.i20.3096

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. May 28, 2013; 19(20): 3096-3107
Published online May 28, 2013. doi: 10.3748/wjg.v19.i20.3096

Table 1 Demographics of 202 patients with early gastric cancer

	Patients (n = 202)
Age
< 60 yr	109
≥ 60 yr	93
Sex
Male	132
Female	70
Tumor site
Upper	25
Middle	98
Lower	79
Size of tumor
≤ 2 cm	97
> 2 cm	105
No. of resected nodes
< 15	114
≥ 15	88
Tumor depth
Mucosal	122
Submucosal	80
Macroscopic type
Elevated	25
Flat	21
Depressed	156
Histologic type
Differentiated	121
Undifferentiated	81
Lyphovessel ambolus
+	2
-	200
Vessel ambolus
+	5
-	197
Nerve invasion
+	0
-	202
CEA
+	1
-	201

CEA: Carcinoembryonic antigen.

Table 2 Univariate analysis of lymph node metastases in early gastric cancer and clinicopathological factors n (%)

Clinicopathological factors	LN (+)	LN (-)	P¹
The entire study population
Age			0.887
< 60 yr	16 (14.7)	93 (85.3)
≥ 60 yr	13 (14.0)	80 (86.0)
Sex			0.213
Male	16 (12.1)	116 (87.9)
Female	13 (18.6)	57 (81.4)
Tumor site			0.001
Upper	2 (8.0)	23 (92.0)
Middle	15 (15.3)	83 (84.7)
Lower	12 (15.2)	67 (84.8)
Size of tumor			0.240
≤ 2 cm	11 (11.3)	86 (88.7)
> 2 cm	18 (17.1)	87 (82.9)
No. of resected nodes			0.580
< 15	15 (13.2)	99 (86.9)
≥ 15	14 (15.9)	74 (84.1)
Tumor depth			0.008^a
Mucosal	11 (9.0)	111 (91.0)
Submucosal	18 (22.5)	62 (77.5)
Macroscopic type			0.001^a
Elevated	4 (16)	21 (84)
Flat	3 (14.3)	18 (85.7)
Depressed	22 (14.1)	134 (85.9)
Histologic type			0.332
Differentiated	15 (12.4)	106 (87.6)
Undifferentiated	14 (17.3)	67 (82.7)
Lyphovessel ambolus			0.149
+	1 (50.0)	1 (50.0)
-	28 (14.0)	172 (86.0)
Vessel ambolus			0.003^a
+	3 (60.0)	2 (40.0)
-	26 (13.2)	171 (86.8)
Nerve invasion			N
+	0 (0)	0 (0)
-	29 (14.4)	173 (85.6)
CEA			0.681
+	0 (0)	1 (100)
-	29 (14.4)	173 (85.6)
Mucosa cancer
Age			0.234
< 60 yr	8 (11.8)	60 (88.2)
≥ 60 yr	3 (5.6)	51 (94.4)
Sex			0.578
Male	6 (7.9)	70 (92.1)
Female	5 (10.9)	41 (89.1)
Tumor site			0.976
Upper	1 (10.0)	9 (90.0)
Middle	6 (9.4)	58 (90.6)
Lower	4 (8.3)	44 (91.7)
Size of tumor			0.142
≤ 2 cm	3 (5.1)	56 (94.9)
> 2 cm	8 (12.7)	55 (87.3)
No. of resected nodes			0.580
< 15	7 (10.3)	61 (89.7)
≥ 15	4 (7.4)	50 (92.6)
Macroscopic type			0.539
Elevated	2 (11.1)	16 (88.9)
Flat	0 (0)	11 (100)
Depressed	9 (9.7)	84 (90.3)
Histologic type			0.073
Differentiated	4 (5.3)	71 (94.7)
Undifferentiated	7 (14.9)	40 (85.1)
Lyphovessel ambolus			N
+	0 (0)	0 (0)
-	11 (9.0)	111 (91.0)
Vessel ambolus			N
+	0 (0)	0 (0)
-	11 (9.0)	111 (91.0)
Nerve invasion			N
+	0 (0)	0 (0)
-	11 (9.0)	110 (91.0)
CEA			0.752
+	0 (0)	1 (100)
-	11 (9.1)	110 (90.9)
Submucosal cancer
Age			0.512
< 60 yr	8 (19.5)	33 (80.5)
≥ 60 yr	10 (25.6)	29 (74.4)
Sex			0.129
Male	10 (17.9)	46 (82.1)
Female	8 (33.3)	16 (66.7)
Tumor site			0.265
Upper	1 (6.7)	14 (93.3)
Middle	9 (26.5)	25 (73.5)
Lower	8 (25.8)	23 (74.2)
Tumor size			0.768
≤ 2 cm	8 (21.1)	30 (78.9)
> 2 cm	10 (23.8)	32 (76.2)
No. of resected nodes			0.203
< 15	8 (17.4)	38 (82.6)
≥ 15	10 (29.4)	24 (70.6)
Macroscopic type			0.742
Elevated	2 (28.6)	5 (71.4)
Flat	3 (30.0)	7 (70.0)
Depressed	13 (20.6)	50 (79.4)
Histologic type			0.725
Differentiated	11 (23.9)	35 (76.1)
Undifferentiated	7 (20.6)	27 (79.4)
Lyphovessel ambolus			0.346
+	1 (50.0)	1 (50.0)
-	17 (21.8)	61 (78.2)
Vessel ambolus			0.038^a
+	3 (60.0)	2 (40.0)
-	15 (20.0)	60 (80.0)
Nerve invasion			N
+	0 (0)	0 (0)
-	18 (22.5)	62 (77.5)
CEA			N
+	0 (0)	0 (0)
-	18 (22.5)	62 (77.5)

¹Statistically significant. Tumor site: middle and lower vs upper; Tumor depth: submucosa vs mucosa; Macroscopic type: flat and depressed vs elevated; Vessel ambolus: + (present) vs - (absent),

^aP < 0.05. In patients with mucosal cancers, no significant differences in the occurrence of lymph node metastases were found in relation to the clinicopathological factors. CEA: Carcinoembryonic antigen.

Table 3 Multivariate analysis of lymph node metastases in early gastric cancer for the entire study population

	RR	95%CI	P¹
Tumor site	1.159	0.84-1.478	0.644
Invasion depth	2.744	2.316-3.172	0.018^a
Macroscopic type	0.864	0.57-1.158	0.620
Vessel amblous	4.147	3.242-5.052	0.116
Constant term	0.037	-2.568	0.010

¹Statistically significant, invasion depth: submucosa vs mucosa,

^aP < 0.05.

Table 4 Number of retrieved lymph nodes and lymph node metastasis ratios for involved lymph nodes at each nodal station in early gastric cancer

Node group	No. of dissected nodes	No. of metastasis nodes	Incidence of lymphnode metastasis (%)
No. 1	165	1	0.6
No. 2	27	3	11.1
No. 3	861	41	4.8
No. 4	670	23	3.4
No. 5	78	2	2.6
No. 6	358	21	5.9
No. 7	263	4	1.5
No. 8	120	3	2.5
No. 9	134	3	2.2
No. 10	16	0	0.0
No. 11	27	1	3.7
No. 12	108	0	0.0
No. 13	58	0	0.0
No. 14	23	8	34.8
No. 15	13	0	0.0
No. 16	5	0	0.0
Total	2926	110	3.8

Table 5 Lymph node metastasis ratios and incidence at each station in upper third, middle third and lower third gastric cancers

Node group	Upper			Middle			Lower
	pN category	Incidence	Ratio	pN category	Incidence	Ratio	pN category	Incidence	Ratio
No. 1	pN1	0.0 (0/52)	0.0 (0/25)	pN1	7.4 (1/73)	1.0 (1/98)	pN2	0.0 (0/40)	0.0 (0/79)
No. 2	pN1	5.3 (1/19)	4.0 (1/25)	pN3	28.6 (2/7)	1.0 (1/98)	M	0.0 (0/1)	0.0 (0/79)
No. 3	pN1	5.5 (7/128)	8.0 (2/25)	pN1	3.8 (17/445)	9.2 (9/98)	pN1	5.9 (17/288)	8.9 (7/79)
No. 4	pN1	1.6 (1/62)	4.0 (1/25)	pN1	4.3 (15/347)	5.1 (5/98)	pN1	2.7 (7/261)	6.3 (5/79)
No. 5	pN3	0.0 (0/6)	0.0 (0/25)	pN1	2.6 (1/38)	1.0 (1/98)	pN1	2.9 (1/34)	1.3 (1/79)
No. 6	pN3	0.0 (0/21)	0.0 (0/25)	pN1	2.2 (4/182)	2.0 (2/98)	pN1	11.0 (17/155)	8.9 (7/79)
No. 7	pN2	0.0 (0/21)	0.0 (0/25)	pN2	0.0 (0/141)	0.0 (0/98)	pN2	4.0 (4/101)	1.3 (1/79)
No. 8	pN2	16.7 (2/12)	4.0 (1/25)	pN2	1.6 (1/63)	1.0 (1/98)	pN2	0.0 (4/45)	0.0 (0/79)
No. 9	pN2	0.0 (0/5)	0.0 (0/25)	pN2	3.5 (3/85)	3.1 (3/98)	pN2	0.0 (4/44)	0.0 (0/79)
No. 10	pN2	0.0 (0/2)	0.0 (0/25)	pN3	0.0 (0/3)	0.0 (0/98)	M	0.0 (0/11)	0.0 (0/79)
No. 11	pN2	0.0 (0/4)	0.0 (0/25)	pN2	7.1 (1/14)	1.0 (1/98)	pN2	0.0 (0/9)	0.0 (0/79)
No. 12	pN3	0.0 (0/6)	0.0 (0/25)	pN2	0.0 (0/61)	0.0 (0/98)	pN2	0.0 (0/41)	0.0 (0/79)
No. 13	M	0.0 (0/10)	0.0 (0/25)	pN3	0.0 (0/31)	0.0 (0/98)	pN3	0.0 (0/17)	0.0 (0/79)
No. 14	M	0.0 (0/2)	0.0 (0/25)	pN3	41.2 (7/17)	1.0 (1/98)	pN2	25.0 (1/4)	1.3 (1/79)
No. 15	M	0.0 (0/1)	0.0 (0/25)	M	0.0 (0/9)	0.0 (0/98)	M	0.0 (0/3)	0.0 (0/79)
No. 16	M	0.0 (0/0)	0.0 (0/25)	pN3	0.0 (0/5)	0.0 (0/98)	pN3	0.0 (0/0)	0.0 (0/79)

Table 6 Correlation between lymph node metastases at pN1 and pN2 and clinicopathological factors

	pN1			pN2
	-	+	P	-	+	P
Tumor size (cm)			0.24			0.295
≤ 2.0	86 (88.7)	11 (11.3)		95 (97.9)	2 (2.1)
> 2.0	87 (82.9)	18 (17.1)		100 (95.2)	5 (4.8)
Macroscopic type			0.969			0.259
Elevated	21 (84.0)	4 (16.0)		24 (96.0)	1 (4.0)
Flat	18 (85.7)	3 (14.3)		19 (90.5)	2 (9.5)
Depressed	134 (85.9)	22 (14.1)		152 (97.4)	4 (2.6)
Invasion depth			0.008			0.334
Mucosal	111 (91.0)	11 (9.0)		119 (97.5)	3 (2.5)
Submucosal	62 (77.5)	18 (22.5)		76 (95.0)	4 (5.0)
Differentiate			0.332			0.349
Differentiated	106 (87.6)	15 (12.4)		118 (97.5)	3 (2.5)
Undifferentiated	67 (82.7)	14 (17.3)		77 (95.1)	4 (4.9)
Lymphovascular invasion			0.126			0.804
No	174 (87.0)	26 (13.0)		194 (97.0)	6 (3.0)
Yes	1 (50.0)	1 (50.0)		2 (100.0)	0 (0.0)

Citation: Ren G, Cai R, Zhang WJ, Ou JM, Jin YN, Li WH. Prediction of risk factors for lymph node metastasis in early gastric cancer. World J Gastroenterol 2013; 19(20): 3096-3107
URL: https://www.wjgnet.com/1007-9327/full/v19/i20/3096.htm
DOI: https://dx.doi.org/10.3748/wjg.v19.i20.3096