Objective: To investigate the relationship between clinicopathologic features and lymph node metastasis in early gastric cancer (EGC) and the influence of lymph node metastasis on prognosis of EGC patients.
Methods: The clinical data of 186 EGC patients who underwent surgical treatment from October 2010 to December 2018 in Anqing Hospital Affiliated to Anhui Medical University were retrospectively analyzed.
Results: Of the 186 EGC patients, regional lymph node metastases occurred in 17 cases (9.1%). Univariate analysis showed that the lymph node metastasis rate in patients with submucosal invasion (T1b) was higher than that in patients with intramucosal cancer (T1a) (15.1% vs. 4.2%, χ2=5.177, P=0.023), in patients with the maximal lesion diameter >2 cm was higher than in patients with the maximal lesion diameter ≤2 cm (14.3% vs. 5.5%, χ2=4.190, P=0.041), in patients with vascular invasion was higher than that in patients without vascular invasion (50.0% vs. 6.8%, χ2=21.247, P=0.000), and in patients with total lymph node dissection ≥15 was higher than that in patients with lymph node dissection <15 (12.5% vs. 0, χ2=6.879, P=0.009); no significant relationships were noted between lymph node metastasis and the variables that included sex, age, tumor site, gross type of tumor, degree of differentiation, and surgical method (all P>0.05). Multivariate analysis showed that vascular infiltration was an independent risk factor for EGC lymph node metastasis (RR=6.886, 95% CI=1.399–33.898, P=0.018). Complete follow-up data were available in 173 patients (93.0%), and the follow-up time ranged from 2 to 95 months. The 3- and 5-year survival rates in the whole group were 96.1% and 92.4%, which were 97.1% and 95.5% in patients without lymph node metastasis and 87.5% and 65.6% in patients with lymph node metastasis, respectively. Although the survival in the former was better than that in the latter, the difference did not reach a statistical significance (χ2=2.478, P=0.115).
Conclusion: EGC patients with submucosal invasion, maximal lesion diameter >2 cm or vascular infiltration have a higher risk of regional lymph node metastasis, so standardized lymph node dissection should be performed for accurate determination of postoperative pathological stage and decision of subsequent treatment. The influence of lymph node metastasis on the prognosis of EGC patients needs clarification by further long-term follow-up studies.