Analysis of clinicopathology and risk of lymph nodes metastasis in 315 patients with early gastric cancer according to World Health Organization criteria

Abstract

Objective To investigate the clinicopathologic features of Chinese patients with early gastric cancer (EGC) according to the World Health Organization(WHO) diagnostic criteria, and to explore the risk factors of lymph node metastasis (LNM) in EGC. Methods From 2002 to 2017, at the Second Affiliated Hospital of Nantong University, and from 2014 to 2017, at the People′s Hospital of Qidong City, the People′s Hospital of Haimen City and the People′s Hospital of Rugao City, 315 EGC patients with complete clinicopathological data were enrolled. The clinicopathologic features were analyzed including gender, age, tumor location, tumor size, macroscopic type, histological type (WHO), differentiation degree, depth of tumor invasion, Lauren subtype, infiltration pattern, ulceration, lymphoid follicles, lymphovascular invasion and perineural invasion. Chi-square test and Fisher′s exact test were performed for univariate analysis and the logistic regression was used for multivariate analysis. Results The ratio of EGC was 10.0% (315/3 140) of patients with gastric cancer and received surgery during the same period. Among the 315 EGC, the ratio of well-differentiated tubular adenocarcinoma was 11.7% (37/315), which was lower than 24.8%(2 752/11 104) in Japan and 19.9%(41/206) in South Korea, and the differences were statistically significant (χ2=28.208, P<0.01; χ2=6.510, P=0.011), however there was no statistically significant difference when compared with Western countries (11.9%, 8/67; χ2=0.002, P=0.964). Among the 276 patients who underwent radical gastrectomy, 49(17.8%) patients had with LNM. The results of univariate analysis showed that tumor size, macroscopic type, differentiation degree, depth of invasion, infiltration pattern, ulceration and lymphovascular invasion were related with LNM (χ2=9.327, 6.038, 6.381, 34.983, 19.309, 52.297 and 5.058; all P<0.05). The results of multivariate analysis revealed that lymphovascular invasion and ulceration were the independent risk factors of LNM (odd ratio (OR)=7.028 and 2.566, both P<0.05). Conclusions There is obvious difference in pathological diagnostic standard of well-differentiated tubular adenocarcinoma between China, Japan and South Korea, which may influence the therapeutic strategy of EGC. Lymphovascular invasion and ulceration are independent risk factors of LNM in EGC. Key words: Early gastric cancer; Histpatholology; Lymph node metastasis; Clinicopathology