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Gastric Cancer

, Volume 22, Issue 1, pp 223–230 | Cite as

Risk factors for lymph node metastasis in non-sentinel node basins in early gastric cancer: sentinel node concept

  • Masashi Takeuchi
  • Hiroya TakeuchiEmail author
  • Hirofumi Kawakubo
  • Ayako Shimada
  • Tadaki Nakahara
  • Shuhei Mayanagi
  • Masahiro Niihara
  • Kazumasa Fukuda
  • Rieko Nakamura
  • Koichi Suda
  • Norihito Wada
  • Yuko Kitagawa
Original Article

Abstract

Background

Sentinel node (SN) concept is being applied to early gastric cancer. However, when SNs are positive for metastasis, it is unclear how often LNs in other LN basins show metastasis. We aimed to investigate LN metastasis possibility in LN basins without SNs (non-SN basins). We determined risk factors for metastasis in non-SN basins and identified a prediction model for non-SN basin metastasis using classification and regression tree (CART) analysis.

Methods

We enrolled 550 patients who were diagnosed with cT1N0M0 or cT2N0M0 gastric cancer with a single lesion and underwent SN mapping. We adopted a dual-tracer method using a radioactive colloid and blue dye to detect SNs.

Results

Of all, 45 (8.2%) patients had SN metastasis; we divided them into two groups: LN metastasis positive and LN metastasis negative in non-SN basins. Univariate analysis showed that the groups differed significantly regarding lymphatic invasion (p = 0.007), number of identified SNs (p = 0.032), and macrometastasis in SN basins (p = 0.005). The CART decision tree for predicting LN metastasis in non-SN basins had area under the curve value of 0.86. Moreover, there were significantly differences in cancer-specific survival (CSS) between the two groups (p = 0.028).

Conclusions

Macrometastasis in SN basins, lymphatic invasion, and number of identified SNs ≥ 5 are risk factors for LN metastasis in non-SN basins among gastric cancer patients. We identified a prediction model with CART analysis; patients with macrometastasis in SN basins and lymphatic invasion were considered to be at the highest risk for LN metastasis.

Keywords

Stomach neoplasms Gastrectomy Sentinel lymph node biopsy 

Notes

Acknowledgements

The authors thank Kumiko Motooka, who is a staff member at the Department of Surgery in the Keio University School of Medicine, for her help in the preparation of this manuscript.

Compliance with ethical standards

Ethical standards

All procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interest

Yuko Kitagawa has received grants from Daiichi Sankyo Co., Ltd.

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Masashi Takeuchi
    • 1
  • Hiroya Takeuchi
    • 1
    • 2
    Email author
  • Hirofumi Kawakubo
    • 1
  • Ayako Shimada
    • 1
  • Tadaki Nakahara
    • 3
  • Shuhei Mayanagi
    • 1
  • Masahiro Niihara
    • 4
  • Kazumasa Fukuda
    • 1
  • Rieko Nakamura
    • 1
  • Koichi Suda
    • 1
  • Norihito Wada
    • 1
  • Yuko Kitagawa
    • 1
  1. 1.Department of SurgeryKeio University School of MedicineTokyoJapan
  2. 2.Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
  3. 3.Department of RadiologyKeio University School of MedicineTokyoJapan
  4. 4.Division of Esophageal SurgeryShizuoka Cancer Center HospitalShizuokaJapan

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