School of Medicine, Nankai University, Tianjin, China.
Medical School of Chinese PLA, Beijing, China.
World J Surg. 2024 Jan;48(1):151-162. doi: 10.1002/wjs.12024. Epub 2023 Dec 13.
This study was designed to explore the risk factors of lymph node metastasis (LNM) in distal gastric cancer with early stage, and to provide reference for the choice of treatment protocols.
In this retrospective observational study, 824 early distal gastric cancer (EDGC) cases who treated at our unit from 2010 to 2020 were selected as research objects. Subsequently, univariate and multivariate logistic regression analyses were conducted to investigate the associations between LNM and clinicopathological features.
Of these 824 EDGC cases, 140 (17.0%) developed LNM, including 72 N1 stage and 68 N2-3 stage LNM. Multivariate logistic regression analysis identified the tumor diameter ≥1.75 cm (odds ratio (OR) = 2.361, p < 0.001), tumor location (OR = 1.552, p = 0.046), histological classification (p = 0.004), tumor infiltration depth (OR = 2.154, p = 0.001), and vascular infiltration (OR = 4.354, p < 0.001) as independent predictors for LNM. Logistic regression analyses based on 756 N0-1 LNM cases identified the smoking history (OR = 0.507, p = 0.043), tumor diameter ≥1.75 cm (OR = 2.265, p = 0.010), tumor location (OR = 1.834, p = 0.036), histological classification (p = 0.018), tumor infiltration depth (OR = 1.939, p = 0.034), and vascular infiltration (OR = 3.225, p < 0.001) as independent predictors for N1 LNM. Moreover, preoperative hypoalbuminemia (OR = 7.087, p = 0.015), significant preoperative weight loss (OR = 2.724, p = 0.023), tumor diameter ≥1.75 cm (OR = 5.484, p = 0.001), multiple tumors (OR = 9.986, p = 0.038), histological classification (p = 0.029), and vascular infiltration (OR = 33.704, p < 0.001) were proved to be associated with LNM for T1a tumors.
The tumor diameter, location and infiltration depth, histological classification, and vascular infiltration were expected to be used as predictors of LNM in EDGC, and preoperative hypoalbuminemia, significant weight loss, tumor diameter and number, histological classification, and vascular infiltration were associated with LNM for T1a tumors.
本研究旨在探讨早期远端胃癌（EDGC）发生淋巴结转移（LNM）的危险因素，为治疗方案的选择提供参考。
本回顾性观察性研究纳入了 2010 年至 2020 年在我院治疗的 824 例早期远端胃癌（EDGC）患者作为研究对象。随后，采用单因素和多因素 logistic 回归分析探讨 LNM 与临床病理特征之间的关系。
在这 824 例 EDGC 患者中，140 例（17.0%）发生了 LNM，包括 72 例 N1 期和 68 例 N2-3 期 LNM。多因素 logistic 回归分析确定肿瘤直径≥1.75 cm（比值比（OR）=2.361，p<0.001）、肿瘤位置（OR=1.552，p=0.046）、组织学分类（p=0.004）、肿瘤浸润深度（OR=2.154，p=0.001）和血管浸润（OR=4.354，p<0.001）是 LNM 的独立预测因素。对 756 例 N0-1 LNM 病例进行的 logistic 回归分析确定，吸烟史（OR=0.507，p=0.043）、肿瘤直径≥1.75 cm（OR=2.265，p=0.010）、肿瘤位置（OR=1.834，p=0.036）、组织学分类（p=0.018）、肿瘤浸润深度（OR=1.939，p=0.034）和血管浸润（OR=3.225，p<0.001）是 N1 LNM 的独立预测因素。此外，术前低白蛋白血症（OR=7.087，p=0.015）、显著术前体重减轻（OR=2.724，p=0.023）、肿瘤直径≥1.75 cm（OR=5.484，p=0.001）、多个肿瘤（OR=9.986，p=0.038）、组织学分类（p=0.029）和血管浸润（OR=33.704，p<0.001）与 T1a 肿瘤的 LNM 相关。
肿瘤直径、位置和浸润深度、组织学分类和血管浸润有望成为 EDGC 患者 LNM 的预测因素，术前低白蛋白血症、显著体重减轻、肿瘤直径和数量、组织学分类和血管浸润与 T1a 肿瘤的 LNM 相关。
