Comprehensive analysis of risk factors associated with submucosal invasion in patients with early-stage gastric cancer

Table 1 Baseline characteristics of patients with early-stage differentiated gastric cancer

Characteristic	n (%)
Total patients	268
Gender
Male	199 (72.3)
Female	69 (25.7)
Age (years)
mean ± SD	61.5 ± 9.8
Age range	30-83
Age ≥ 60 years	192 (71.6)
Lifestyle factors
History of alcohol consumption	143 (53.4)
History of smoking	152 (56.7)
Family history of gastric cancer	37 (13.8)
Clinical assessments
Anemia	12 (4.5)
Positive fecal occult blood test	60 (22.4)
Elevated CEA	19 (7.1)
Imaging findings
CT showing gastric wall thickening	111 (41.4)
CT showing lymph node enlargement	34 (12.7)
Endoscopic characteristics
Lesion location
Upper third of the stomach	87 (32.5)
Middle third of the stomach	41 (15.3)
Lower third of the stomach	140 (52.2)
Gross morphology
Elevated type	144 (53.7)
Flat type	51 (19.0)
Depressed type	73 (27.2)

CEA: Carcinoembryonic antigen; CT: Computed tomography; WLE: White-light endoscopy; LCI: Linked color imaging; OR: Odds ratio; CI: Confidence interval.

Table 2 Univariate analysis of clinical and endoscopic characteristics between patients with submucosal and mucosal gastric cancer, n (%)

Characteristic	Submucosal invasion (n = 71)	Mucosal invasion (n = 197)	χ² (t, Z) value	P value	OR (95%CI)	P value
Demographics and medical history
Male	61 (85.9)	138 (70.1)	χ² = 1.509	0.122	1.90 (0.70-5.75)	0.228
Age ≥ 60 years	52 (73.2)	140 (71.1)	χ² = 0.251	0.615	0.85 (0.31-2.75)	0.634
Age (years)	62.9 ± 10.5	64.3 ± 10.2	t = 1.132	0.272	0.94 (0.91-1.23)	0.352
Alcohol history	43 (60.6)	100 (50.8)	χ² = 4.738	< 0.05	2.25 (1.25-5.94)	< 0.05
Smoking history	45 (63.4)	107 (54.3)	χ² = 4.342	< 0.05	2.56 (1.15-6.44)	< 0.05
Family history of gastric cancer	10 (14.1)	27 (13.7)	χ² = 0.314	0.532	0.63 (0.33-1.97)	0.517
Clinical and imaging findings
Anemia	4 (5.6)	8 (4.1)	χ² = 0.342	0.643	2.55 (0.45-11.82)	0.275
Positive fecal occult blood test	16 (22.5)	44 (22.3)	χ² = 0.692	0.548	0.58 (0.28-1.23)	0.462
Elevated CEA	4 (5.6)	15 (7.6)	χ² = 0.012	0.913	1.39 (0.63-6.34)	0.649
CT showing gastric wall thickening	42 (59.2)	69 (35.0)	χ² = 6.784	< 0.05	3.10 (1.40-7.25)	0.026
CT showing lymph node enlargement	16 (22.5)	18 (9.1)	χ² = 2.954	0.107	3.21 (0.85-8.96)	0.109
Endoscopic characteristics
Tumor location: Upper third	51 (71.8)	36 (18.3)	χ² = 28.231	< 0.01	18.25 (6.41-56.16)	< 0.001
Middle third	10 (14.1)	31 (15.7)
Lower third of the stomach	10 (14.1)	130 (66.0)
Gross type: Elevated type	17 (23.9)	127 (47.4)	χ² = 18.400	< 0.001	5.50 (2.19-14.32)	< 0.01
Flat type	14 (19.7)	37 (18.8)
Depressed type	40 (56.3)	33 (16.8)
Lesion diameter ≥ 20 mm	16 (22.5)	44 (22.3)	χ² = 3.741	0.052	2.46 (0.96-5.82)	0.072
Lesion diameter (mm)	20 (12, 32)	15 (13, 21)	Z = 1.742	0.071	1.13 (0.97-1.15)	0.089
Spontaneous bleeding	6 (8.5)	21 (10.7)	χ² = 0.274	0.795	1.53 (0.54-4.69)	0.579
Central depression	9 (12.7)	33 (16.8)	χ² = 0.894	0.324	1.67 (0.64-4.86)	0.371
Gastric wall rigidity	8 (11.3)	12 (6.1)	χ² = 0.505	0.493	2.63 (0.89-30.25)	0.517
Marginal elevation	26 (36.6)	28 (14.2)	χ² = 10.646	0.002	4.10 (1.58-9.65)	0.006
Fold changes	12 (16.9)	16 (8.1)	χ² = 3.774	0.081	11.83 (3.25-35.61)	0.018
Presence of ulcer	12 (16.9)	48 (24.3)	χ² = 2.773	0.103	1.75 (0.78-4.03)	0.254
Surface roughness	44 (62.0)	126 (64.0)	χ² = 1.222	0.243	1.58 (0.70-4.15)	0.302
WLE color difference ≥ 12.6	30 (42.3)	82 (41.6)	χ² = 9.500	< 0.01	5.00 (1.66-12.77)	< 0.01
WLE color difference	18.1 (12.6, 20.3)	13.2 (9.8, 22.1)	Z = 3.630	< 0.01	1.40 (1.14-1.58)	< 0.01
LCI color difference ≥ 18.1	51 (71.8)	95 (48.2)	χ² = 11.731	< 0.01	4.27 (1.82-10.11)	< 0.01
LCI color difference	26.8 (19.1, 34.2)	18.6 (14.1, 23.1)	Z = 3.226	< 0.01	1.13 (0.96-1.06)	< 0.01

CEA: Carcinoembryonic antigen; CT: Computed tomography; WLE: White-light endoscopy; LCI: Linked color imaging; OR: Odds ratio; CI: Confidence interval.

Table 3 Multivariate logistic regression analysis of predictors for submucosal invasion in gastric cancer

Characteristic	β value	Standard error	Wald χ² value	P value	OR (95%CI)
Tumor located in upper 2/3 of stomach	1.622	0.403	18.542	< 0.001	5.268 (2.434-10.984)
Depressed type	1.846	0.689	7.625	0.006	5.841 (1.745-21.243)
Marginal elevation	1.398	0.624	4.662	0.027	4.132 (1.235-15.869)
LCI color difference ≥ 18.1	1.489	0.672	5.427	0.021	4.479 (1.274-14.856)

LCI: Linked color imaging; OR: Odds ratio; CI: Confidence interval.

Table 4 Receiver operating characteristic analysis of predictive indicators for submucosal invasion

Indicator	AUC (95%CI)	Youden index maximum cutoff	Selected cutoff	Sensitivity at cutoff	Specificity at cutoff
Lesion diameter	0.630 (0.462-0.712)	26.80	21.1	0.593	0.582
WLE color difference	0.799 (0.642-0.842)	14.2	13.1	0.823	0.484
LCI color difference	0.760 (0.571-0.791)	19.9	17.3	0.788	0.448

AUC: Area under the curve; CI: Confidence interval; WLE: White-light endoscopy; LCI: Linked color imaging.