Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection

Objectives: Selected patients with early gastric cancer (GC) are treated endoscopically. Lymph node metastasis (LNM) in the T1 stage may also be detected during surgical resection for early GC. The aim of this study was to determine factors associated with LNM and the effect on survival.
Methods: A total of 63 patients with tumor invasion stage T1a or T1b who were operated on for early GC between 2010 and 2018 were included in the study. Parameters were investigated retrospectively to identify predictive factors for LNM and overall survival. Significance was defined with a 2-sided p-value of <0.05.
Results: Among the 63 patients, 21 (33.3%) had LNM. Lymphovascular invasion (LVI) (p=0.02) and a high-grade tumor (p=0.02) were significantly associated with LNM. The overall survival rate was 73.0%. The number of patients with LNM was greater among the deceased patients compared with the censored group (p=0.03). The median follow-up time of the entire group was 28 months (range: 12-55 months) while it was 23 months (range: 7-39 months) in the deceased group and 33.5 months (15.5-60 months) in the censored group (p=0.06). The mean survival was 62.36 months in patients with LNM and 71.99 months in those without LNM (p=0.09). The cut-off value determined for the neutrophil-to-lymphocyte ratio (NLR) was 2.33 and it was an effective value in survival analysis (p<0.05).
Conclusion: Surgical treatment should be considered for early GC patients with high-grade tumors and cases demonstrating LVI. The overall survival was shorter in patients with a high NLR value and LNM.

Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection

Amaç: Mide kanseri kansere baðlý ölümler arasýnda ikinci sýrada yer almaktadýr. Günümüzde seçilmiþ erken evre mide kanseri tedavisinde endoskopik rezeksiyon uygulanmaktadýr. Biz de kliniðimizde mide kanseri nedeniyle rezeksiyon ve lenf nodu diseksiyonu uygulanan erken evre mide kanseri hastalarýnda lenf nodu metastazýna (LNM) ve genel saðkalýmý etkileyen faktörleri belirlemeyi amaçladýk.
Yöntem: 2010-2018 yýllarý arasýnda mide kanseri nedeniyle opere edilen ve tümör invazyonu T1a ve T1b olan hastalar çalýþmaya dahil edildi. Postoperatif patoloji sonucunda LNM olan ve olmayan olarak iki gruba ayrýldý. LNM’ý ve saðkalýma etki edebilecek, demografik ve labaratuvar parametreleri istatiksel olarak karþýlaþtýrýldý. P<0.05 deðeri anlamlý olarak kabul edildi.
Bulgular: Çalýþmaya dahil edilen 63 hastanýn 21’inde (%33,3) LNM saptandý. Lenfovasküler invazyonu ( LVI) saptanan ve saptanmayan hastalarda LNM pozitifliði sýrasýyla % 61.5 -% 26.0 (p = 0.02) olarak bulundu. Yüksek dereceli tümörlü olan ya da olmayan hastalarda LNM sýrasýyla % 46.9 ve % 19.4 (p = 0.02) olarak bulundu. Tüm grubun medyan takip süresi 28 (12-55) ay olurken mortalite olan grupta 23 (7 – 39) ay ve saðkalan grupta 33.5 (15.5 – 60) ay olarak bulundu (p=0,06). Genel saðkalým oraný% 73.0 olarak saptandý. Mortalite geliþen hastalarda LNM daha yüksekti (p = 0,03). Ortalama saðkalým süresi LNM olanlar ve olmayanlarda sýrasýyla 62.36 ve 71.99 aydý (p = 0.09). Nötrofil-lenfosit oranýnýn (NLR) cut-off deðeri 2.33 olarak bulundu ve saðkalým üzerine etkili olduðu görüldü (p <0.05).
Sonuç: Sonuç olarak, özellikle LVI ve yüksek dereceli erken evre mide kanseri tespit edilen tümörlerin tedavisinde endoskopik rezeksiyondan çok cerrahi rezeksiyon düþünülmelidir. NLR deðerleri ve LNM deðerleri yüksek olan hastalarda genel saðkalým daha kýsadýr.