Correlation Between Lymph Node Metastasis And Clinico-pathological Parameters In Early Gastric Cancer And Prognosis Analysis Of Lymph Node Metastasis In Early Gastric Cancer Cases

Part1Lymph node metastasis in early gastric cancer and clinical-pathological parametersBackground and Aim:According to the definition put forward by Japanese gastric cancer institute in1962, early gastric cancer (EGC) refers to the limitation of cancer cells to the lining of the stomach mucosa or submucosa, regardless of the presence of lymph node metastasis of gastric cancer. Prognosis of EGC was better than active stage of gastric cancer and the presence of lymph node metastasis (LNM) is one of the most important factors that affect prognosis of EGC. However, the preoperative examinations are often difficult to accurately evaluate LNM status in EGC patients. To analyze the predictive factors for LNM in EGC patients, we performed a retrospectively analysis in473EGC patients in our hospital.MethodsClinical and pathological data of473EGC patients who had operation in our hospital from2006to2009were retrospectively analyzed. In order to evaluate risk factors of LNM in EGC patients, we included13clinical and pathological status. Chi-square test was applied to evaluate the relationship between clinical and pathological features and LNM status, while logistic regression was used to determine independent risk factors of LNM. P value less than0.05was defined as statistical significance. All reported P values were two-sided.ResultsLNM was observed in16.3%of EGC patients. Chi-square tests showed that the major factors for LNM in EGC patients were gender, tumor size, tumor gross type, tumor differential degree, infiltration depth, and lymphatic vessel emboli. Logistic regression revealed that the gender, tumor size of EGC were significantly related with LNM.ConclusionsLNM of EGC is related with patients’gender, tumor size, infiltration depth and differential degree. Part2Prognostic factors in early gastric cancerBackground and AimEarly gastric cancer (EGC) has better therapeutic effect than active and advanced stage gastric cancer with a5year survival rate of more than90%. It is well known that EGC patients without lymph node metastasis (LNM) has better5-year survival than those with LNM. However, long term survival status of EGC patients after surgery is closely related to patients’clinical and pathological features other than LNM status. Thus, it is essential to discuss the relationship between the clinical pathological features and prognosis of EGC cases.Methods473EGC cases submitted for surgical resection from2006to2009were included for survival analysis.55cases were lost to follow-up and418cases were included ultimately with a median follow-up of60months. We eliminated62cases in2009to calculate5-year survival rate as the follow-up time of these cases had not reached5years. We further investigated the predictive value of LNM of356cases within subgroups. Comparison between cases with LNM and without LNM for overall survival was planned using Kaplan-Meier method and the Kaplan-Meier curves were rendered for5-year survival and3-year survival respectively.ResultsAmong356EGC cases from2006to2008,5-year survival rate of patients with LNM was significantly lower than that of patients without LNM.(86.6%vs.93.3%; P=0.0069). Similarly,3-year survival rate among418cases was significantly lower in patients with LNM (87.8%vs.97.3%; P=0.025).The prognostic significance of LNM was retained in6subgroups. Univariate analysis showed that the prognosis of EGC was related to age、with or without ulcer and status of lymph node metastasis. Multivariate analysis showed that age、with or without ulcer and the status of lymph node metastasis can seperatly be the only independent prognostic factor.ConclusionsThe status of lymph node metastasis is the key indicator of the prognosis of EGC. Age, with or without ulcer are the independent risk factors to the status of LNM in early gastric cancer.