Risk Factors Associated with Lymph Node Metastasis for Early Gastric Cancer Patients Who Underwent Non-curative Endoscopic Resection: a Systematic Review and Meta-analysis
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Recently, increased evidence indicated that additional surgery should be performed in highly selected patients with non-curative endoscopic resection. In this study, we performed a systematic review and meta-analysis to evaluate the risk factors associated with lymph node metastasis for the patients with non-curative endoscopic resection of early gastric cancer.
The related studies were identified by searching PubMed and Embase databases. According to the status of lymph node metastasis, all patients were classified into node-negative group and node-positive group. The relevant clinicopathologic factors were extracted, and the pooled odds ratio (OR) and 95% confidence interval (CIs) were assessed using a fixed effects model or random effects model.
A total of nine relevant studies involving 1720 early gastric cancer patients who underwent additional surgery following the non-curative endoscopic resection were included in this meta-analysis. The results indicated that deeper submucosal invasion (SM2) (OR 3.44, 95% CI 1.94–6.10, P < 0.001; I2 = 0%), positive vertical margin (OR 2.35, 95% CI 1.57–3.53, P < 0.001; I2 = 0%), lymphatic invasion (OR 11.06, 95% CI 5.47–22.36, P < 0.001; I2 = 0%), and vascular invasion (OR 2.79, 95% CI 1.68–4.64, P < 0.001; I2 = 0%) were significantly associated with lymph node metastasis for these patients. However, horizontal margin, tumor size, differentiation type, and ulceration were not identified as risk factors associated with lymph node metastasis.
Lymphatic invasion, vascular invasion, deeper submucosal invasion (SM2), and positive vertical margin should be strongly considered in selecting the candidates for additional surgery treatment.
KeywordsEarly gastric cancer Endoscopic submucosal dissection (ESD) Non-curative endoscopic resection Lymph node metastasis Additional surgery
Study conception and design: Bochao Zhao and Baojun Huang; collection and acquisition of data: Bochao Zhao, Jiale Zhang, and Rui Luo; analysis and interpretation of data: Bochao Zhao, Jingting Zhang, and Jiale Zhang; drafting of manuscript: Bochao Zhao and Jingting Zhang; critical revision: Zhenning Wang, Huimian Xu, and Baojun Huang.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
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