Analysis of risk factors on vascular invasion in patients with early gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the risk factors of vascular invasion in patients with early gastric cancer (EGC), and to investigate the influence of vascular invasion on the prognosis of EGC patients.</p><p><b>METHODS</b>From January 2014 to December 2015, 449 EGC patients underwent curative gastrectomy at the First Affiliated Hospital of Anhui Medical University, of whom 27 cases (6.0%) developed vascular invasion. Clinicopathological and follow-up data of EGC cases were analyzed retrospectively. The association between clinicopathological features and vascular invasion was analyzed by using the Chi-square test or Fisher exact test, and the independent risk factors influencing vascular invasion were identified with logistic regression. The influence of vascular invasion on overall survival was investigated with Kaplan-Meier curve. This study was approved by Ethics Committee of The First Affiliated Hospital of Anhui Medical University (No. 2018-03-12).</p><p><b>RESULTS</b>Of 449 EGC patients, 325 were males and 124 were females (ratio 2.6:1.0) with the mean age of (60.8±10.5) (27 to 87) years; 228 were diagnosed as T1a stage and 221 were diagnosed as T1b. Univariate analysis showed that incidence of vascular invasion in EGC patients with ulceration or scar was 8.4%(18/225), which was higher than 3.8%(9/234) in those without ulceration, and the difference was statistically significant (χ²=4.061, P=0.044). The incidence of vascular invasion in patients with low differentiated tumor was 8.8% (20/226), which was significantly higher than 3.1%(7/223) in those with middle-high differentiated tumor(χ²= 8.363, P=0.012). The incidence of vascular invasion in patients staging T1b was 10.9% (24/221), which was significantly higher than 1.3% (3/228) in those staging T1a (P=0.000); The incidence of vascular invasion in patients with lymph node metastasis was 27.3% (15/55), which was significantly higher than 3.0%(12/394) in those without lymph node metastasis (χ²=50.122, P=0.000). However, there were no significant associations of vascular invasion with gender, age, surgical type, multiple tumor, tumor deposit, tumor location and tumor size (all P > 0.05). Multivariate analysis showed that T1b stage (RR=4.653, 95%CI:1.293-16.747, P=0.019) and lymph node metastasis(RR=7.302, 95%CI: 3.063-17.408, P=0.000) were independent risk factors for vascular invasion in EGC patients. Among 449 EGC patients, 444 received complete follow-up(98.9%), including 26 cases with vascular invasion and 418 cases without vascular invasion. The overall survival in vascular invasion group was significantly lower than that in non-vascular invasion group (χ²=60.463, P=0.000). Besides, 198 EGC patients gained follow-up for 3 years, and the 3-year survival rates of 11 vascular invasion cases and 187 non-vascular invasion cases were 54.5% and 96.8% respectively.</p><p><b>CONCLUSIONS</b>The risk of vascular invasion is higher in EGC patients with lymph node metastasis and tumor infiltrating the submucosa. The prognosis of EGC patients with vascular invasion is poor.</p>

Stratifying risk and establishing predictive risk-scoring model for lymph-node metastasis in early gastric cancer / 中华普通外科杂志

Objective To explore the independent risk factors of lymph-node metastasis (LNM) in patients with early gastric cancer (EGC),and establish a risk-prediction model based on LNM.Method 962 early gastric cancer patients undergoing curative radical gastrectomy in the First Hospital of Anhui Medical University from July 2011 to April 2016 were enrolled in this study.The relationships between different clinicopathologic characteristics and LNM were analyzed by Chi-square test or Fisher exact probability,and the independent risk factors were determined using Logistic regression analysis.Moreover,LNM risk was stratified and a risk-predicting model was established on the basis of the identified independent risk factors for LNM.Further,the risk-predicting model was validated using 962 EGC cases.The discriminatory accuracy of risk-predicting model was measured by area under ROC curve (ROC-AUC).Results Mucosal differentiated cancer ≤2 cm,irrespective of the existence of an ulcer,had low LNM rates (LNMR ＜ 3.0％).Univariate and multivariate analysis revealed that female EGC patients with submucosal,undifferentiated,vessel invasion and tumor size ＞ 2 cm were independent risk factors of LNM for EGC patients,and relative risks were 1.893,3.173,1.956,1.922 and 9.027 respectively (P ＜ 0.05).ROCAUC of risk-predicting model was 0.768 (P ＜ 0.01),which showed high diagnostic accuracy and sensitivity.Conclusion Female EGC patients with submucosal undifferentiated carcinomas measuring ＞ 2 cm with vessel invasion have higher risk of LNM.