Meta-analysis Of The Relationship Between Extra Capsular Lymph Node Involvement And Clinicopathology In Gastric Cancer

Objective:In the 8th edition of the UICC Guidelines for Gastric Cancer,it is recommended to include extra capsular lymph node involvement（EC-LNI）as a disease registry variable.However,there are few studies on the clinicopathology and Prognosis assessment of EC-LNI in gastric cancer,and the number of included cases is small.In this study,Meta analysis was used to study the relationship between extrinsic lymph node invasion and clinicopathologic Parameters of gastric cancer,evaluate the influence on Prognosis,and Preliminarily speculate the significance of EC-LNI in clinical staging of gastric cancer.Method:The search strategy was formulated to search the literature on the impact of extralateral lymph node invasion on the Prognosis of gastric cancer in China’s National Knowledge Infrastructure Database（CNKI）,Wan fang Database,VIP database and Pub Med database.According to the exclusion and inclusion criteria formulated in this Paper,relevant literature and trial data from randomized controlled clinical studies were screened.Meta analysis method and related software were used to Process the data,and a conclusion was finally drawn through comparative study.The indicators included in the comparison were:Patient’s gender,tumor T stage,tumor N stage,TNM stage,tumor location,maximum tumor diameter,tumor differentiation degree,Lauren’s classification,the Presence of vascular cancer thrombus and nerve invasion.By using Rev Man5.4 software to analyze the data in literature and related studies,a total of 10 literatures and related studies,a total of 8356Patients were included in this meta-analysis.Results:Among the 8356 Patients with gastric cancer,2074 were Positive for exter nal lymph node invasion,and the Positive rate of EC-LNI was 24.82%.The res ults of meta-analysis showed that the Positive rate of EC-LNI was related to T stage（T₁stage:OR=0.08,95%CI:[0.06,0.12],P<0.00001;T₂:OR=0.28,95%CI:[0.23,0.36],P<0.00001;T₃:OR=1.81,95%CI:[1.55,2.12],P<0.00001;T₄:OR=3.75,95%CI:[3.17,4.44],P<0.00001）.The positive rate of EC-LNI was correlated wit h N stage（N₁stage:OR=0.50,95%CI:[0.43,0.59],P<0.00001;N₂stage:OR=1.23,95%CI:[1.06,1.43],P=0.007;N₃:OR=4.78,95%CI:[4.10,5.59],P<0.00001）.The Positive rate of EC-LNI was correlated with TNM stage（stageⅠ:OR=0.08,95%CI:[0.04,0.13],P<0.00001;StageⅡ:OR=0.32,95%CI:[0.25,0.40],P<0.00001;Sta geⅢ:OR=4.25,95%CI:[3.51,5.15],P<0.00001;StageⅣ:OR=4.13,95%CI:[2.54,6.74],P<0.00001）.The positive rate of EC-LNI was not correlated with tumor l ocation（Lower:OR=0.80,95%CI:[0.57,1.12],P=0.19;Middle:OR=1.01,95%CI:[0.69,1.47],P=0.98;Upper:OR=1.08,95%CI:[0.83,1.41],P=0.57）.The positive r ate of EC-LNI was correlated with the maximum tumor diameter（when the ma ximum tumor diameter was<5cm,OR=0.48,95%CI:[0.35,0.65],P<0.00001;W hen the maximum tumor diameter was≥5cm,OR=2.10,95%CI:[1.54,2.87],P<0.00001）.The positive rate of EC-LNI was correlated with the degree of tumor differentiation（OR=0.56,95%CI:[0.47,0.66],P<0.00001;When the tumor was undifferentiated,OR=1.79,95%CI:[1.51,2.12],P<0.00001）.The Positive rate o f EC-LNI was related to Lauren Intestinal types（OR=1.65,95%CI:[1.33,2.06],P<0.00001;Diffuse:OR=0.68,95%CI:[0.55,0.85],P=0.0005;Mixed:OR=0.68,95%CI:[0.50,0.92],P=0.01）.The positive rate of EC-LNI was associated with t he presence or absence of vascular thrombosis（OR=1.72,95%CI:[1.46,2.02],P<0.00001）.The positive rate of EC-LNI was correlated with the presence of nerve invasion（OR=1.86,95%CI:[1.24,2.77],P=0.002）.Conclusion:EC-LNI was associated with T stage,N stage,TNM stage,maximum tumor diameter,tumor differentiation degree,Lauren type,vascular thrombus and nerve invasion.It can Provide guidance for the clinical work of gastric cancer Patients such as accurate staging after surgery and follow-up treatment after surgery.To make a more effective and reliable assessment of the survival time of patients with gastric cancer.