Clinical Study And Meta-analysis Of Risk Factors For Lymph Nodes Metastasis In Early Gastric Cancer

Aim:To investigate the risk factors for lymph node metastasis in early gastric cancer(EGC).Understanding the lymph node metastasis of EGC will provide a basis for individualized treatment in patients.Methods:(1)221 patients with early gastric cancer who underwent sUrgical treatment at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2016 to October 2018 were retrospectively analyzed.The clinicopathological parameters included gender,age,lesion size,differentiation type,macroscopic type,depth of the invasion,ulceration and lymphovascular invasion(LVI).Univariate analysis was performed by ?2 tests or Fisher's exact probability method.Multivariate analysis was analyzed by the binary logistic regression model.(2)A systematic search was conducted using the PubMed,Embase and Cochrane Library electronic databases.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale.Review Manager software version 5.3 was used for the meta-analysis.Egger's and Begg's tests were used to assess the publication bias.Results:(1)23.5%(52/221)of EGC had lymph node metastasis.Gender,lesion size,macroscopic type,depth of the invasion,ulceration,and LVI(P<0.05)were risk factors by univariate analysis.By multivariate analysis,female sex,submucosa invasion,and LVI were found to be significant independent risk factors for lymph node metastasis.(2)Twenty-one studies with 11549 patients were ultimately included in the meta-analysis.16.3%(1886/11549)of EGC had lymph node metastasis.Female gender,age<60 years,tumor size?20mm,tumor location at the lower third of the stomach,depressed type,undifferentiated EGC,submucosa invasion,LVI,and ulcer were demonstrated to be associated with lymph node metastasis in EGC.Conclusions:The retrospective analysis suggests female gender,depth of the invasion and LVI were closely associated with lymph node metastasis in EGC.The meta-analysis shows:In China,young women,tumor size?20mm,tumor location at the lower third of the stomach,submucosa invasion,depressed type,undifferentiated EGC,LVI,and ulcer were risk factors for lymph node metastasis in EGC.Further larger prospective studies are needed to confirm this conclusion.