Abstract
Aim Gastrectomy with lymph node dissection is standard treatment in gastric cancer. This study aimed to explore whether preoperative investigation finds could predict lymph node metastatic scope in gastric carcinoma so that the optimal surgical procedure could be selected. Materials and Methods Radical gastrectomy patients (n = 378) were separated into two groups according to the lymph node metastatic scope. Univariate and multivariate analyses of preoperative examination results were performed to identify the predictors of metastatic scope. ROC curves were constructed, and the area under the curve (AUC) was calculated to estimate diagnostic values. Results Serum CEA (OR: 3.73; 95% CI: 1.84–7.56; P ≤ 0.001), tumor size (OR: 2.07; 95% CI: 1.08–3.98; P = 0.03), and CT examination results (OR: 17.81; 95% CI: 9.18–34.55; P ≤ 0.001) were identified as independent predictors. The AUC proved that they possessed significant diagnostic value. When CT examination was negative, the combination of serum CEA and tumor size showed high specificity (95.3%; 164/172), negative predictive value (92.7%; 164/177), and accuracy (89.0%; 170/191). Conclusions Preoperative serum CEA, tumor size, and CT examination are independent predictors of lymph node metastatic scope and can be used for selecting the appropriate lymphadenectomy pattern in gastric cancer patients.
Highlights
The mortality of gastric cancer is declining as a result of the tremendous advances in therapeutic methods, it is still the second most common cause of cancer-related death in China and the world [1,2,3]
On multivariate analysis (Table 3), serum CEA (OR: 3.73; 95% CI: 1.84–7.56; P ≤ 0 001), tumor size (OR: 2.07; 95% CI: 1.08–3.98; P = 0 03), and computed tomography (CT) examination (OR: 17.81; 95% CI: 9.18–34.55; P ≤ 0 001) were found to be independent predictors of the scope of lymph node metastasis
We found that tumor size > 5 cm was an independent predictor of lymph node metastatic scope, while for lymphocyte count, it was found to be a significant predictor of lymph node metastatic scope in univariate analysis but not in multivariate analysis
Summary
The mortality of gastric cancer is declining as a result of the tremendous advances in therapeutic methods, it is still the second most common cause of cancer-related death in China and the world [1,2,3]. Recurrence and metastasis are the major threats to gastric cancer patients [4, 5]. Of all the metastatic patterns, lymphatic metastasis is most common It is an independent prognostic factor [6, 7], and special attention must be paid to lymphatic metastasis in gastric cancer patients. Gastrectomy with lymph node dissection remains the first choice and standard treatment for the majority of gastric cancer patients. According to the Japanese Gastric Cancer Treatment Guidelines 2010 [8], only early gastric cancer (EGC) with differentiated histologic type or no lymph node metastasis is suitable for D1 and D1+ lymphadenectomy. Other EGC and advanced gastric cancer patients require D2 lymphadenectomy. Every patient has unique clinicopathological features, and the therapeutic approach should be personalized to avoid the problem of over- and underdissection of lymph nodes
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