Study Of The Clinicopathological Features Of Early Gastric Cancer And Factors For Lymph Node Metastasis

ObjectiveTo provide evidence-based medicine basis for individualized and accurate diagnosis and treatment,we performed a retrospectively analysis in patients with early gastric cancer(EGC)and treated by surgery to describe the clinicopathological characteristics of EGC,analyze the predictive factors for lymph node metastasis(LNM),and discuss the prognosis of EGC cases.Methods257 EGC cases accepted D2 radical operation in the First Affiliated Hospital of Soochow University from January 2013 to December 2015 were retrospectively analyzed.The clinicopathological characteristics of EGC were described and compared between early proximal gastric carcinoma and distal gastric carcinoma,such as gender,age,smoking history,Helicobacter pylori(Hp)infection,body mass index(BMI),tumor size,location,histological differentiation,depth of invasion,lymphovascular involvement,perineural involvement and lymph node metastasis.Chi-square test or Fisher exact test were used to evaluate the relationship between clinicopathological characteristics and LNM,while logistic regression was applied to determine independent factors of LNM.Survival information was got by telephone follow-up.ResultsIn the 257 EGC cases,the male to female ratio was 2.52:1,and the age ranged from 33 to 84 with 63 being the median.The age(P=0.011)?Hp infection rate(P=0.010)?histological differentiation(P<0.001)and LNM(P=0.015)varied between early proximal gastric cancer and distal gastric cancer.Proximal gastric cancer showed older age,lower Hp infection rate,less poor differentiation and fewer LNM.LNM was observed in 15.6%(45/257)of EGC patients in general.The incidence of LNM was 5.1%(6/118)in mucosal cancers and 26.6%(37/139)in submucosal cancers.Smoking index,tumor size,tumor location,histological differentiation,depth of invasion,perineural involvement and lymphovascular involvement were showed positive correlation with LNM in univariate analysis.Multivariate analysis indicated that smoking index <400(P=0.027),growing in distal stomach(P=0.027),poor differentiation(P=0.026),invading to SM2(P=0.043),with lymphovascular involvement(P=0.001)were independent risk factors of LNM.In this study,duration of follow-up ranged from 13 to 48 months,the median follow-up was 28 months.1-year and 3-year survival rate of EGC patients after surgery were 98.2% and 96.1%.ConcusionProximal gastric cancer showed older age,lower Hp infection rate,less poor differentiation and fewer LNM.Smoking index,tumor size,tumor location,histological differentiation,depth of invasion,perineural involvement and lymphovascular involvement were showed positive correlation with LNM in total early gastric cancer.Smoking index,location,histological differentiation,depth of invasion and lymphovascular involvement were independent factor of LNM.1-year and 3-year survival rate of EGC patients after surgery were 98.2% and 96.1%.