Abstract
Purpose To investigate the relationship between lymph node micrometastasis (LNMM) and clinicopathological factors and to evaluate the prognostic effects of LNMM in pN0 gastric cancer (GC) patients. Methods One hundred and seventy-two GC patients who received radical gastrectomy with D2 lymph node dissection were enrolled in the present study. 1371 negative lymph nodes from level 2 station confirmed by pathology were examined. The LNMM was diagnosed by telomeric repeat amplification protocol/enzyme-linked immunosorbent assay (TRAP-ELISA). The relationship between clinicopathological factors and LNMM was investigated by multivariate analysis. Survival analysis was performed to evaluate the effects of LNMM on prognosis. Results LNMM was detected in 423 lymph nodes from 72 patients. The results showed that invasion depth (OR = 3.755, P = 0.004), TNM staging (OR = 3.152, P = 0.002), lymphatic invasion (OR = 2.178, P = 0.009), and tumor differentiation (OR = 1.266, P = 0.013) were independent risk factors associated with LNMM. Survival analysis showed that patients with LNMM had significantly worse 5-year survival compared with those without LNMM (42% vs. 76.4%, P < 0.05). Multivariate analysis demonstrated that LNMM, tumor size, Lauren type, invasion depth, and lymphatic invasion (P < 0.05) were independently factors associated with 5-year survival. Conclusions The findings showed that tumor invasion depth, TNM staging, lymphatic invasion, and tumor differentiation were independent risk factors associated with LNMM occurrence. Moreover, LNMM is a clinically negative prognostic factor in pN0 GC patients.
Highlights
Gastric cancer (GC) is the fifth most frequently diagnosed cancer and the third leading cause of cancer death worldwide, which is responsible for over 1,000,000 new cases and an estimated 783,000 deaths in 2018 [1]
Multivariate analysis showed that tumor differentiation (OR = 1:266, 95% CI 4.274-37.037, P = 0:013), lymphatic infiltration (OR = 2:178, 95% CI 1.635-6.327, P = 0:009), the depth of tumor invasion (OR = 3:755, 95% CI 1.716-8.218, P = 0:004), and TNM staging (OR = 3:152, 95% CI 1.547-7.589, P = 0:002) were independent risk factors associated with lymph node micrometastasis (LNMM) (Table 2)
No-censored Yes-censored sis showed that the depth of invasion, TNM staging, lymphatic infiltration, and tumor differentiation were independent risk factors associated with LNMM
Summary
Gastric cancer (GC) is the fifth most frequently diagnosed cancer and the third leading cause of cancer death worldwide, which is responsible for over 1,000,000 new cases and an estimated 783,000 deaths in 2018 [1]. Lymph node metastasis is currently considered to be one of the most significant prognostic factors in GC patients. Despite curative resection of primary tumor and lymphadenectomy, some patients with histologically node-negative GC still die of local or distant tumor recurrence [4,5,6]. Previous studies suggest that lymph node micrometastasis (LNMM) may be one of the key causative factor for GC recurrence [7]. Prior studies have attempted to clarify the relationship between LNMM and clinicopathological features and to explore the prognostic value of LNMM in GC patients [5, 9, 10], the clinical significance of MM remains controversial currently
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