Risk factors of lymph node metastasis in elderly patients with undifferentiated early gastric cancer

Yizhen ZHANG; Xi WU; Weixun ZHOU; Long ZOU; Tao GUO; Dongsheng WU; Aiming YANG

ABSTRACT

Objective:

To investigate the clinicopathological characteristics and the risk factors of lymph node metastasis(LNM) of undifferentiated early gastric cancers(EGCs) in elderly patients.

Methods:

The elderly patients(≥65 years old) who underwent radical gastrectomy with lymph node dissection and were diagnosed as having EGCs in Peking Union Medical College Hospital from January 2010 to August 2019 were included. The clinicopathological characteristics of undifferentiated EGCs(namely signet ring cell EGCs and poorly differentiated EGCs) were compared with those of differentiated EGCs, and the risk factors for LNM of undifferentiated EGCs in the elderly patients were analyzed with logistic regression.

Results:

Data of 165 elderly EGCs patients were reviewed, including 82 undifferentiated EGCs (11 signet ring cell and 71 poorly differentiated) and 83 differentiated EGCs. The overall LNM incidence was 9.1% (15/165) in elderly EGCs patients, 4.8% (4/83) and 13.4% (11/82) in differentiated and undifferentiated EGCs, respectively. Of all undifferentiated EGCs, the LNM incidence in poorly differentiated EGCs was 15.5%(11/71), and none of 11 signet ring cell EGCs had LNM. Depth of tumor invasion( P=0.019), tumor size( P=0.006), combination of ulceration( P=0.006), depressed gross type( P=0.003) were found to be associated with LNM in elderly undifferentiated EGCs patients under univariate analysis. Multivariate analysis revealed that submucosal invasion( OR=11.98, 95% CI 1.17-122.84, P=0.037) and tumor size >2 cm ( OR=11.95, 95% CI 1.88-76.07, P=0.009) were independent risk factors for LNM in elderly undifferentiated EGCs patients. All elderly undifferentiated EGCs patients who met the criteria for expanded indications had no LNM.

Conclusion:

Submucosal invasion and tumor size >2 cm are independent risk factors for LNM in elderly undifferentiated EGCs patients. The elderly EGCs patients who met the criteria for expanded indications are suitable for endoscopic submucosal dissection.