Clinicopathologic factors predict lymph node metastasis in gastric cancer

Last Updated: 2018-03-02

By Reuters Staff

NEW YORK (Reuters Health) - T stage, lymphovascular invasion and other factors predict the likelihood of lymph node metastasis in patients with T1 gastric cancer, researchers report.

For patients with early gastric cancer who are considering endoscopic resection as a therapeutic option, the possibility of lymph node metastasis remains an important prognostic factor, the investigators note in Surgery, online February 2. A high risk of lymph node involvement should obviate the need for endoscopic resection, as it does not include lymph node dissection.

Dr. George A. Poultsides from Stanford Cancer Institute, in Stanford, California, and colleagues from seven academic centers participating in the U.S. Gastric Cancer Collaborative sought to identify predictors of lymph node metastasis in patients with T1 gastric cancer and to develop a clinicopathologic risk score that can be used preoperatively to determine the risk of lymph node metastasis.

Of the 176 patients with T1 tumors, 38 (21.6%) had lymph node metastasis on pathology after curative gastrectomy.

Factors independently associated with lymph node involvement on multivariate analysis included poor differentiation, tumor size >2 cm, tumor invading the muscularis mucosa (T1b), and the presence of lymphovascular invasion (LVI).

The researchers developed a clinicopathologic score by assigning three points each for poor differentiation, T1b tumors and LVI - and two points for tumor size >2 cm.

A score greater than 3 points was 100% sensitive in detecting lymph node metastasis, whereas no lymph node involvement was present among patients with scores of 0 or 2 points (no patients had 1 point).

Incrementally greater scores correlated with a greater incidence of lymph node metastasis, so that 77% of patients with the maximum score of 11 points showed evidence of lymph node involvement.

"Although operative resection remains the gold standard for early gastric cancer, there may be a role for endoscopic resection in high-risk patients with a low score to obviate the morbidity associated with gastrectomy," the researchers note. "In contrast, if 2 or more of the aforementioned factors are present, the risk of lymph node metastasis appears to be high, and endoscopic resection alone does not appear to be an appropriate treatment strategy oncologically."

"Further study is needed to validate our findings in Western patients with early gastric cancer," they add.

Dr. Poultsides did not respond to a request for comment.

SOURCE: http://bit.ly/2FhrzkU

Surgery 2018.