School of Medicine, Nankai University, Tianjin, China; Medical School of Chinese People's Liberation Army, Beijing, China; Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
First Department of Liver Disease/Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing You'an Hospital, Capital Medical University, Beijing, China.
J Gastrointest Surg. 2024 Aug;28(8):1242-1249. doi: 10.1016/j.gassur.2024.05.014. Epub 2024 May 12.
The identification of risk factors associated with lymph node metastasis (LNM) in gastric cancer will establish a crucial foundation for the implementation of endoscopic operation and multidisciplinary treatment programs.
A total of 5606 patients with gastric cancer with comprehensive clinicopathologic data were enrolled through systematic searching and rigorous screening. Of the 5606 patients, 1438 were diagnosed with early gastric cancer (EGC), which would be used for further analysis. Subsequently, univariate and multivariate logistic regression analyses were performed to identify the risk factors.
The rates of LNM in T1a, T1b, T2, T3, T4a, and T4b stage gastric cancer were 7.0%, 19.4%, 48.4%, 77.1%, 83.8%, and 89.6%, respectively. Female (odds ratio [OR], 1.559; P = .032), lower tumor location (OR, 1.773; P = .023), tumor size of >2 cm (OR, 2.007; P < .001), mixed (OR, 2.371; P = .001) and undifferentiated histologic types (OR, 2.952; P < .001), T1b stage (OR, 2.041; P < .001), presence of ulceration (OR, 1.758; P = .027), and lymphovascular invasion (OR, 5.722; P < .001) were identified as independent risk factors for LNM in EGC. A nomogram was constructed using appropriate predictors to preoperatively predict the risk of LNM in patients with EGC.
This study identified the clinicopathologic factors associated with LNM in patients with EGC and developed a prediction model, thereby facilitating the integration of diverse treatment modalities in managing patients with EGC.
确定与胃癌淋巴结转移（LNM）相关的风险因素将为内镜手术和多学科治疗方案的实施奠定重要基础。
通过系统检索和严格筛选，共纳入 5606 例具有全面临床病理数据的胃癌患者。其中，1438 例被诊断为早期胃癌（EGC），将进一步进行分析。随后，进行单因素和多因素 logistic 回归分析以确定风险因素。
T1a、T1b、T2、T3、T4a 和 T4b 期胃癌的 LNM 发生率分别为 7.0%、19.4%、48.4%、77.1%、83.8%和 89.6%。女性（比值比 [OR]，1.559；P=0.032）、肿瘤位置较低（OR，1.773；P=0.023）、肿瘤大小>2cm（OR，2.007；P<0.001）、混合（OR，2.371；P=0.001）和未分化组织学类型（OR，2.952；P<0.001）、T1b 期（OR，2.041；P<0.001）、溃疡（OR，1.758；P=0.027）和血管淋巴管侵犯（OR，5.722；P<0.001）是 EGC 患者发生 LNM 的独立危险因素。使用适当的预测因子构建了列线图，以便术前预测 EGC 患者发生 LNM 的风险。
本研究确定了 EGC 患者与 LNM 相关的临床病理因素，并建立了预测模型，从而促进了各种治疗方式在 EGC 患者管理中的整合。
