Study On Associated Risk Factors Of Lymph Node Metastasis And Postoperative Long-term Survival Outcomes In Early Gastric Cancer T1a

Background As one of the most common malignant tumors in the world,gastric cancer(GC)is the predominant leading cause of cancer-related death.With the continuous development of endoscopic techniques,pathological biopsy techniques and surgical treatment level,the detection rate and cure rate of early gastric cancer(EGC)have been significantly improved and good prognosis has been achieved.For the treatment of early gastric cancer,there are two surgical procedures in recent years,including radical gastrectomy and endoscopic submucosal dissection(ESD).Early gastric cancer T1 a has been recognized as the main indication for endoscopic submucosal dissection.But for patients with early gastric cancer T1 a who have lymph node metastasis,surgical treatment should be performed on the basis of ESD.Therefore,the presence of lymph node metastasis plays a decisive role in the choice of treatment modalities for patients with early gastric cancer T1 a,it also emphasizes the importance of preoperative assessment of lymph node metastasis.Methods In this study,we retrospectively analyzed the clinicopathological datas of 466 patients with early gastric cancer T1 a who underwent surgery in the First Affiliated Hospital of Nanjing Medical University.And then we investigated the relationship between clinicopathological factors and lymph node metastasis by using univariate analysis(adopting Chi-square test or Fisher's exact test),multivariable analysis(adopting binary logistic regression)and hierarchical analysis.According to the follow-up outcomes,the relationship between clinicopathological factors and postoperative recurrence was analyzed by using univariate analysis,Log-rank test and COX regression analysis in 255 patients with early gastric cancer T1 a.Results Univariate analysis showed that age,gender,tumor location and histological type were significantly associated with lymph node metastasis(P < 0.05).Multivariable analysis revealed that age(P=0.029),gender(P=0.020)and histological type(P=0.045)were the independent influencing factors of lymph node metastasis.Hierarchical analysis indicated that lymph node metastasis more easily occurred in female patients with early gastric cancer T1 a who were less than 65 years old and poor differentiation,while the incidence of lymph node metastasis was lower in patients who were more than or equal to 65 years old.In 255 patients with follow-up outcomes,tumor recurrence occurred in 21 patients,among which 17 patients died.The 3-year and 5-year overall survival(OS)were 99.5% and 91.6%,respectively.The 3-year and 5-year relapse-free survival(RFS)were 99.1% and 86.1%,respectively.Univariate analysis and Log-rank test showed that age,histological type and ulcer were significantly associated with postoperative recurrence(P < 0.05).COX regression analysis revealed that age(P=0.005),histological type(P=0.037)and ulcer(P=0.023)were the independent risk factors of postoperative recurrence.Conclusion Age,gender and histological type were the independent risk factors of lymph node metastasis in patients with early gastric cancer T1 a.And age,histological type and ulcer might be the independent risk factors of postoperative recurrence in early gastric cancer T1 a patients.