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Lymph node involvement in gastric adenocarcinoma

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Abstract

Background

Endoscopic management of early gastric cancer is limited by the risk of lymph node metastasis. We aimed to examine the incidence and predictors of nodal metastasis in early gastric adenocarcinoma in a large national US cohort.

Methods

Cases were abstracted from the National Cancer Database from 2004 to 2016. The incidence and predictors of lymph node involvement for patients with Tis, T1a, and T1b tumors were examined.

Results

A total of 202,216 cases of gastric adenocarcinoma were identified in the NCDB. Cases with unknown patient or tumor characteristics, presence of other cancers, and prior neoadjuvant chemotherapy or radiotherapy were excluded. 1839 cases of Tis, T1a, and T1b tumors were identified. Lymph node metastases were present in 18.1% of patients. Lymphovascular invasion (LVI), high-grade histology, stage T1b, and larger size (> 3 cm) were independently associated with an increased risk of nodal metastasis on multivariate analysis (P < 0.05). The presence of LVI was the strongest predictor of nodal metastasis with an OR (95% CI) of 5.7 (4.3–7.6), P < 0.001. No lymph node metastasis was found in any Tis tumors. Small T1a low-grade tumors with no LVI had a low risk of nodal metastasis (0.6% < 2 cm and 0.9% < 3 cm).

Conclusion

In this large national cohort, size, lymphovascular invasion, higher grade histology, and T stage were independently associated with lymph node metastasis. For patients with low-grade tumors, < 3 cm, without lymphovascular invasion, the risk of nodal involvement was very low, suggesting that this Western cohort could be considered for endoscopic resection.

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References

  1. World Health Organization (2019) Cancer Fact Sheet. Available at https://www.who.int/en/news-room/factsheets/detail/cancer. Accessed 25 Apr 2020

  2. Ajani J, D'Amico T (2020) National Comprehensive Cancer Network Gastric Cancer Guidelines. National Comprehensive Cancer Network. Available from https://www.nccn.org/patients/guidelines/content/PDF/stomachpatient.pdf. Accessed 26 Apr 2020

  3. Wang S, Zhang Z, Liu M, Li S, Jiang C (2015) Endoscopic resection compared with gastrectomy to treat early gastric cancer: a systematic review and meta-analysis. PLoS One 10:e0144774

    Article  Google Scholar 

  4. Japanese Gastric Cancer A (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Article  Google Scholar 

  5. Hanada Y, Choi AY, Hwang JH, Draganov PV, Khanna L, Sethi A, Bartel MJ, Goel N, Abe S, De Latour RA, Park K, Melis M, Newman E, Hatzaras I, Reddy SS, Farma JM, Liu X, Schlachterman A, Kresak J, Trapp G, Ansari N, Schrope B, Lee JY, Dhall D, Lo S, Jamil LH, Burch M, Gaddam S, Gong Y, Del Portillo A, Tomizawa Y, Truong CD, Brewer Gutierrez OI, Montgomery E, Johnston FM, Duncan M, Canto M, Ahuja N, Lennon AM, Ngamruengphong S (2019) Low frequency of lymph node metastases in patients in the United States with early-stage gastric cancers that fulfill Japanese endoscopic resection criteria. Clin Gastroenterol Hepatol 17:1763–1769

    Article  Google Scholar 

  6. Pokala SK, Zhang C, Chen Z, Gamboa AM, Cristofaro SL, Keilin SA, Cai Q, Willingham FF (2018) Lymph node metastasis in early gastric adenocarcinoma in the United States of America. Endoscopy 50:479–486

    Article  Google Scholar 

  7. Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17:3077–3079

    Article  Google Scholar 

  8. El-Omar EM, Rabkin CS, Gammon MD, Vaughan TL, Risch HA, Schoenberg JB, Stanford JL, Mayne ST, Goedert J, Blot WJ, Fraumeni JF Jr, Chow WH (2003) Increased risk of noncardia gastric cancer associated with proinflammatory cytokine gene polymorphisms. Gastroenterology 124:1193–1201

    Article  CAS  Google Scholar 

  9. Feith M, Stein HJ, Siewert JR (2006) Adenocarcinoma of the esophagogastric junction: surgical therapy based on 1602 consecutive resected patients. Surg Oncol Clin N Am 15:751–764

    Article  Google Scholar 

  10. Rusch VW (2004) Are cancers of the esophagus, gastroesophageal junction, and cardia one disease, two, or several? Semin Oncol 31:444–449

    Article  Google Scholar 

  11. Pyo JH, Lee H, Min BH, Lee JH, Choi MG, Lee JH, Sohn TS, Bae JM, Kim KM, Ahn JH, Carriere KC, Kim JJ, Kim S (2016) Long-term outcome of endoscopic resection vs. surgery for early gastric cancer: a non-inferiority-matched cohort study. Am J Gastroenterol 111:240–249

    Article  Google Scholar 

  12. Meng FS, Zhang ZH, Wang YM, Lu L, Zhu JZ, Ji F (2016) Comparison of endoscopic resection and gastrectomy for the treatment of early gastric cancer: a meta-analysis. Surg Endosc 30:3673–3683

    Article  Google Scholar 

  13. Chen CY, Hsu JS, Wu DC, Kang WY, Hsieh JS, Jaw TS, Wu MT, Liu GC (2007) Gastric cancer: preoperative local staging with 3D multi-detector row CT–correlation with surgical and histopathologic results. Radiology 242:472–482

    Article  Google Scholar 

  14. Kim HJ, Kim AY, Oh ST, Kim JS, Kim KW, Kim PN, Lee MG, Ha HK (2005) Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology 236:879–885

    Article  Google Scholar 

  15. Mocellin S, Pasquali S (2015) Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009944.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  16. Choi KK, Bae JM, Kim SM, Sohn TS, Noh JH, Lee JH, Choi MG, Kim S (2016) The risk of lymph node metastases in 3951 surgically resected mucosal gastric cancers: implications for endoscopic resection. Gastrointest Endosc 83:896–901

    Article  Google Scholar 

  17. Willingham FF, Garud SS, Davis SS, Lewis MM, Maithel SK, Kooby DA (2012) Human hybrid endoscopic and laparoscopic management of mass lesions of the foregut (with video). Gastrointest Endosc 75:905–912

    Article  Google Scholar 

  18. Li ZY, Zhang QW, Teng LM, Zhang CH, Huang Y (2019) Comparable rates of lymph node metastasis and survival between diffuse type and intestinal type early gastric cancer patients: a large population-based study. Gastrointest Endosc 90:84–95

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Rosemary Nustas, Ahmed A. Messallam, Steven Keilin, Saurabh Chawla, Vaishali Patel, Qiang Cai & Field F. Willingham

  2. Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Theresa Gillespie

  3. Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Emory University Hospital, 1365 Clifton Road, NE, Building B—Suite 1200, Atlanta, GA, 30322, USA

    Field F. Willingham

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  1. Rosemary Nustas
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  2. Ahmed A. Messallam
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  5. Saurabh Chawla
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  6. Vaishali Patel
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  8. Field F. Willingham
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Correspondence to Field F. Willingham.

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Disclosures

Dr. Field F. Willingham serves as primary investigator for clinical research trials of the following companies: Boston Scientific, Cook, Cancer Prevention Pharmaceuticals, RedPath Technologies, Xlumena, and Oncolys. Drs. Rosemary Nustas, Ahmed A. Messallam, Theresa Gillespie, Steven Keilin, Saurabh Chawla, Vaishali Patel, and Qiang Cai have no conflicts of interest or financial ties to disclose.

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Nustas, R., Messallam, A.A., Gillespie, T. et al. Lymph node involvement in gastric adenocarcinoma. Surg Endosc 36, 3876–3883 (2022). https://doi.org/10.1007/s00464-021-08704-7

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  • DOI: https://doi.org/10.1007/s00464-021-08704-7

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