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Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection [SETB]
SETB. 2019; 53(4): 371-378 | DOI: 10.14744/SEMB.2019.30643

Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection

Emine Ozlem Gur1, Serkan Karaisli1, Erdinc Kamer1, Haldun Kar1, Ahmet Naci Emecen2, Nese Ekinci3, Osman Nuri Dilek1, Mehmet Haciyanli1
1Department of General Surgery, Katip Celebi University Faculty of Medicine, Ataturk Training and Research Hospital, Izmir, Turkey
2Department of Public Health, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
3Department of Pathology, Katip Celebi University Faculty of Medicine, Ataturk Training and Research Hospital, Izmir, Turkey

Objectives: Selected patients with early gastric cancer (GC) are treated endoscopically. Lymph node metastasis (LNM) in the T1 stage may also be detected during surgical resection for early GC. The aim of this study was to determine factors associated with LNM and the effect on survival.
Methods: A total of 63 patients with tumor invasion stage T1a or T1b who were operated on for early GC between 2010 and 2018 were included in the study. Parameters were investigated retrospectively to identify predictive factors for LNM and overall survival. Significance was defined with a 2-sided p-value of <0.05.
Results: Among the 63 patients, 21 (33.3%) had LNM. Lymphovascular invasion (LVI) (p=0.02) and a high-grade tumor (p=0.02) were significantly associated with LNM. The overall survival rate was 73.0%. The number of patients with LNM was greater among the deceased patients compared with the censored group (p=0.03). The median follow-up time of the entire group was 28 months (range: 12-55 months) while it was 23 months (range: 7-39 months) in the deceased group and 33.5 months (15.5-60 months) in the censored group (p=0.06). The mean survival was 62.36 months in patients with LNM and 71.99 months in those without LNM (p=0.09). The cut-off value determined for the neutrophil-to-lymphocyte ratio (NLR) was 2.33 and it was an effective value in survival analysis (p<0.05).
Conclusion: Surgical treatment should be considered for early GC patients with high-grade tumors and cases demonstrating LVI. The overall survival was shorter in patients with a high NLR value and LNM.

Keywords: Early gastric cancer, gastric cancer; lymph node metastasis.

Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection

Emine Ozlem Gur1, Serkan Karaisli1, Erdinc Kamer1, Haldun Kar1, Ahmet Naci Emecen2, Nese Ekinci3, Osman Nuri Dilek1, Mehmet Haciyanli1
1Department of General Surgery, Katip Celebi University Faculty of Medicine, Ataturk Training and Research Hospital, Izmir, Turkey
2Department of Public Health, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
3Department of Pathology, Katip Celebi University Faculty of Medicine, Ataturk Training and Research Hospital, Izmir, Turkey

Amaç: Mide kanseri kansere bağlı ölümler arasında ikinci sırada yer almaktadır. Günümüzde seçilmiş erken evre mide kanseri tedavisinde endoskopik rezeksiyon uygulanmaktadır. Biz de kliniğimizde mide kanseri nedeniyle rezeksiyon ve lenf nodu diseksiyonu uygulanan erken evre mide kanseri hastalarında lenf nodu metastazına (LNM) ve genel sağkalımı etkileyen faktörleri belirlemeyi amaçladık.
Yöntem: 2010-2018 yılları arasında mide kanseri nedeniyle opere edilen ve tümör invazyonu T1a ve T1b olan hastalar çalışmaya dahil edildi. Postoperatif patoloji sonucunda LNM olan ve olmayan olarak iki gruba ayrıldı. LNM’ı ve sağkalıma etki edebilecek, demografik ve labaratuvar parametreleri istatiksel olarak karşılaştırıldı. P<0.05 değeri anlamlı olarak kabul edildi.
Bulgular: Çalışmaya dahil edilen 63 hastanın 21’inde (%33,3) LNM saptandı. Lenfovasküler invazyonu ( LVI) saptanan ve saptanmayan hastalarda LNM pozitifliği sırasıyla % 61.5 -% 26.0 (p = 0.02) olarak bulundu. Yüksek dereceli tümörlü olan ya da olmayan hastalarda LNM sırasıyla % 46.9 ve % 19.4 (p = 0.02) olarak bulundu. Tüm grubun medyan takip süresi 28 (12-55) ay olurken mortalite olan grupta 23 (7 – 39) ay ve sağkalan grupta 33.5 (15.5 – 60) ay olarak bulundu (p=0,06). Genel sağkalım oranı% 73.0 olarak saptandı. Mortalite gelişen hastalarda LNM daha yüksekti (p = 0,03). Ortalama sağkalım süresi LNM olanlar ve olmayanlarda sırasıyla 62.36 ve 71.99 aydı (p = 0.09). Nötrofil-lenfosit oranının (NLR) cut-off değeri 2.33 olarak bulundu ve sağkalım üzerine etkili olduğu görüldü (p <0.05).
Sonuç: Sonuç olarak, özellikle LVI ve yüksek dereceli erken evre mide kanseri tespit edilen tümörlerin tedavisinde endoskopik rezeksiyondan çok cerrahi rezeksiyon düşünülmelidir. NLR değerleri ve LNM değerleri yüksek olan hastalarda genel sağkalım daha kısadır.

Anahtar Kelimeler: mide kanseri, erken mide kanseri, lenf nodu metastazı

Emine Ozlem Gur, Serkan Karaisli, Erdinc Kamer, Haldun Kar, Ahmet Naci Emecen, Nese Ekinci, Osman Nuri Dilek, Mehmet Haciyanli. Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection. SETB. 2019; 53(4): 371-378

Corresponding Author: Emine Ozlem Gur
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