Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2025; 17(2): 98803
Published online Feb 15, 2025. doi: 10.4251/wjgo.v17.i2.98803
Metastatic lymph node distribution and pathology correlations in upper and lower gastric cancer patients: A multicenter retrospective study
Xian-Bei Yuan, Gang Sun, Jun Niu, Lei Dong, Yi Sui, Yong-Zhu Lv
Xian-Bei Yuan, Gang Sun, Department of General Surgery, No. 967 Hospital of the People's Liberation Army Joint Logistics Support Force, Dalian 116000, Liaoning Province, China
Jun Niu, Department of Trauma Surgery, The No. 967 Hospital of People's Liberation Army Joint Logistics Support Force, Dalian 116000, Liaoning Province, China
Lei Dong, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
Yi Sui, Department of General Surgery, The Fifth People's Hospital of Shenyang, Shenyang 110000, Liaoning Province, China
Yong-Zhu Lv, Department of General Surgery, The Fifth People's Hospital of Dalian, Dalian 116000, Liaoning Province, China
Co-corresponding authors: Gang Sun and Jun Niu.
Author contributions: Yuan XB contributed to the manuscript writing, data collection and analysis; Sun G and Niu J were involved in the conceptualization and supervision of this study; Sui Y, Dong L, Lv YZ and Sui provided multicenter data support. All authors have read and approved the final version to be published.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of The No. 967 Hospital of PLA Joint Logistics Support Force, the leading unit for this project.
Informed consent statement: The analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest related to this article.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Sun, MD, PhD, Associate Chief Physician, Associate Professor, Department of General Surgery, The No. 967 Hospital of PLA Joint Logistics Support Force, No. 89 Maolin Street, Dalian 116000, Liaoning Province, China. neomoon@yeah.net
Received: July 6, 2024
Revised: October 17, 2024
Accepted: October 25, 2024
Published online: February 15, 2025
Processing time: 196 Days and 5.8 Hours
Abstract
BACKGROUND

Gastric cancer (GC) poses a significant threat to public health. However, the clinicopathological features and tumor biological behaviors vary among the GC patients, leading to individual variations in lymph node metastasis. Consequently, the stratification of lymph node dissection according to the specific type, particularly upper GC, has emerged as a prominent area of research.

AIM

To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.

METHODS

Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum test. Logistic regression models were used to identify risk factors for GC lymph node metastasis, while Cox regression models were used to analyze risk factors affecting patient prognosis. The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.

RESULTS

Significant differences were observed between the two GC populations regarding tumor diameter, histological grade, pT stage, pN stage, tumor-node-metastasis (pTNM) stage, vascular invasion, and adjuvant chemotherapy usage (all P < 0.05). Lymph node metastasis rates were highest for Siewert type II patients in groups Nos. 1, 3, 2 and 7; for Siewert type III patients in groups Nos. 3, 1, 2 and 7; and for other/unclassified patients in groups Nos. 1, 3, 7, 2. In the lower GC samples, the sequences were Nos. 3, 6, 7, 4. Pathological type, pT stage, pTNM stage, and positive vascular invasion were independent risk factors for development of lymph node metastasis. Age, pathological type, pT stage, pN stage, pTNM stage, vascular invasion, and absence of adjuvant chemotherapy were identified as independent prognostic factors.

CONCLUSION

Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.

Keywords: Upper gastric cancer; Lower gastric cancer; Metastatic lymph nodes; Prognosis; Retrospective study

Core Tip: Upper gastric cancer (GC) has a significantly greater degree of malignancy than lower GC. In upper GC, the rate of lymph node metastasis was greater in groups Nos. 1, 2, 3 and 7 among the different subtypes. In lower GC, the rate of lymph node metastasis was greater in groups Nos. 3–8. Pathological type, histological grade, pT stage, tumor-node-metastasis (pTNM) stage, and vascular invasion independently influenced the occurrence of lymph node metastasis. Age, pathological type, pT stage, pN stage, pTNM stage, vascular invasion, and absence of adjuvant chemotherapy independently influenced prognosis.