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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 7/2019

01-07-2019 | Original Article

Risk Factors Associated with Lymph Node Metastasis for Early Gastric Cancer Patients Who Underwent Non-curative Endoscopic Resection: a Systematic Review and Meta-analysis

Authors: Bochao Zhao, Jingting Zhang, Jiale Zhang, Rui Luo, Zhenning Wang, Huimian Xu, Baojun Huang

Published in: Journal of Gastrointestinal Surgery | Issue 7/2019

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

Lymphatic invasion, vascular invasion, deeper submucosal invasion (SM2), and positive vertical margin should be strongly considered in selecting the candidates for additional surgery treatment.
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Metadata
Title
Risk Factors Associated with Lymph Node Metastasis for Early Gastric Cancer Patients Who Underwent Non-curative Endoscopic Resection: a Systematic Review and Meta-analysis
Authors
Bochao Zhao
Jingting Zhang
Jiale Zhang
Rui Luo
Zhenning Wang
Huimian Xu
Baojun Huang
Publication date
01-07-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 7/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3924-5

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