Analysis Of Risk Factors For Lymph Node Metastasis In 153 Patients With Early Gastric Cancer And A New Preliminary Evaluation Of The Risk Score System For Lymph Node Metastasis Of Early Gastric Cancer

【Background and purpose】Early gastric cancer（EGC）has a good prognosis compared with advanced gastric cancer.In addition,how to treat early gastric cancer is no longer a single operation.With the improvement of the level of diagnosis and treatment,such as endoscopic treatment,laparoscopic radical gastrectomy,and double-mirror combined therapy,it has gradually moved toward individualized treatment.Lymph node metastasis（LMN）and undifferentiation type are important preoperative assessment and prognostic factors for EGC.In addition,LNM and degree of differentiation are also important in the selection of therapeutic interventions in EGC patients.This study was to investigate the correlation between EGC lymph node metastasis（LNM）and differentiation degree and the preoperative and postoperative clinical data in patients undergoing radical gastrectomy,and to propose a new EGC lymph node metastasis risk score.The preliminary discussion of the system is to prepare the corresponding optimal treatment plan for different EGC patients before surgery.【Information and Methods】This study included 153 patients with EGC who underwent surgical treatment of the Department of Gastrointestinal Surgery,the First Affiliated Hospital of Fujian Medical University from January2013 to October 2018,and retrospectively analyzed the patients before and after surgery.And other clinical data.According to the degree of lymph node metastasis and differentiation,they were divided into two groups.There were 30 patients in the LNM group,123 patients in the LNM group,86 patients in the differentiation group,and 67 patients in the undifferentiated group.Preoperative and postoperative clinical data were counted using"examples".SPSS 22.0 statistical software was used for data analysis and analysis.The relationship between preoperative and postoperative data and lymph node metastasis and differentiation degree was analyzed by chi-square test.The chi-square test P<0.05 index was used to use two-class logistic regression model.The independent risk factors of EGC lymph node metastasis,degree of differentiation and preoperative and postoperative data were analyzed,and P<0.05 was considered statistically significant.【Result】Of the 153 subjects,30 cases had EGC with LNM and 123 cases had no LNM.The lymph node metastasis rate accounted for 19.06%of the total study.Single-factor analysis using chi-square test found that:1.The main complaints of digestive tract symptoms in EGC cases were not statistically significant with LNM.2,gender,tumor size,infiltration of gastric wall depth,tumor location,vascular infarction,presence or absence of ulceration,degree of lesion differentiation and EGC associated with LNM（c²=5.202,9.460,24.438,5.193,10.414,15.846,4.580,4.580,P<0.05,Table 2）.Age,BMI,gastric history,HP,tumor number,and tumor morphological classification were not associated with EGC lymph node metastasis（c²=1.199,1.762,1.88,1.290,0.366,4.583,P>0.05,Table 2）.3,gender,age,lymph node metastasis,depth of gastric wall infiltration and EGC differentiation(c²⁼8.763,12.955,19.877,6.042,P<0.05,Table 4),but the number of tumors,tumor size,tumor location,BMI,history of stomach,HP,presence or absence of ulceration,vascular infarction,and morphological classification of the lesion were not related to the degree of EGC differentiation.（c²=0.651,0.103,2.361,4.022,0.909,0.000,2.585,0.584,0.825,P>0.05,Table 4）Multivariate analysis was performed using logistic regression model.Multivariate analysis was performed on preoperative and postoperative data with statistically significant differences in single factor analysis in the previous study.Data analysis showed that:1.Female,tumor maximum diameter>2 cm,early distal gastric cancer Tumor undifferentiated,tumor infiltrated into the submucosa,vascular thrombus infiltration and EGC associated with LNM correlation analysis showed that the OR values were 2.925,3.912,3.228,5.470,22.678,3.368,P<0.05.2,female,<60 years old,tumor infiltration to the submucosa,LMN and EGC differentiation analysis showed that the OR values were 3.162,3.816,2.657,4.581,P<0.05.According to this scoring system,for patients who only found early gastric cancer but failed to detect lymph node metastasis by endoscopic ultrasonography or CT,if the preoperative patient score is greater than or equal to 8 points,the risk of lymph node metastasis is higher,the proportion is 56.4%,patients have no obvious surgical contraindications,and feasible surgical intervention.For patients with preoperative scores of less than 8 points,the risk of lymph node metastasis is relatively low,about 7.01%,feasible endoscopic treatment.【Conclusion】1.The clinical symptoms of EGC mainly manifested as gastrointestinal symptoms,the rest were mostly physical examination findings（18.3%）,and there was no statistically significant difference with LNM.2.EGC with LNM independent risk factors:female,tumor maximum diameter>2 cm,vascular thrombus infiltration,undifferentiated lesions,tumor infiltration to the submucosa,early distal gastric cancer.3.Independent risk factors for EGC differentiation:female,<60 years old,tumor infiltration to the submucosa,LNM.4.Early gastric cancer patients with a preoperative score of 8 points,suitable for radical gastrectomy,and≦7 points,can be considered for endoscopic treatment.