Metastatic lymph node distribution and pathology correlations in upper and lower gastric cancer patients: A multicenter retrospective study

doi:10.4251/wjgo.v17.i2.98803

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Feb 15, 2025 (publication date) through Feb 21, 2025

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World Journal of Gastrointestinal Oncology

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Retrospective Study

World J Gastrointest Oncol. Feb 15, 2025; 17(2): 98803
Published online Feb 15, 2025. doi: 10.4251/wjgo.v17.i2.98803

Table 1 Comparative analysis of clinicopathological factors in upper vs lower gastric cancer, n (%)

Variables	Upper GC	Lower GC	χ²	P value
Gender			2.582	0.108
Male	554 (67.8)	635 (64.2)
Female	263 (32.2)	354 (35.8)
Age (year)			0.485	0.486
< 60	277 (33.9)	320 (32.4)
≥ 60	540 (66.1)	669 (67.6)
Tumor diameter (cm)			61.410	< 0.001^a
< 4	453 (55.4)	723 (73.1)
≥ 4	364 (44.6)	266 (26.9)
Pathological type			1.941	0.379
Adenocarcinoma	654 (80.0)	813 (82.2)
Signet-ring cell carcinoma	139 (17.0)	155 (15.7)
Other	24 (2.9)	21 (2.1)
Histological grade				0.018^a
G₁	42 (5.1)	82 (8.3)
G₂	234 (28.6)	295 (29.8)
G₃	541 (66.2)	612 (61.9)
pT stage				< 0.001^a
T₁	163 (20.0)	269 (27.3)
T₂	127 (15.5)	131 (13.2)
T₃	267 (32.7)	473 (47.8)
T₄	260 (31.8)	116 (11.7)
pN stage				< 0.001^a
N₀	340 (41.6)	429 (43.4)
N₁	124 (15.2)	303 (30.6)
N₂	135 (16.5)	152 (15.4)
N₃	218 (26.7)	105 (10.6)
pTNM stage				< 0.001^a
I	354 (43.3)	455 (46.0)
II	50 (6.1)	115 (11.6)
III	413 (50.6)	419 (42.4)
Vascular invasion			4.642	0.031^a
Positive	527 (64.5)	589 (59.6)
Negative	290 (35.5)	400 (40.4)
Surgery type			3.370	0.066
PG	656 (80.3)	827 (83.6)
TG	161 (19.7)	162 (16.4)
Chemotherapy			58.041	< 0.001^a
Yes	448 (19.7)	713 (72.1)
No	369 (45.2)	276 (27.9)

^aP < 0.05.

GC: Gastric cancer; PG: Partial gastrectomy; TG: Total gastrectomy; TNM: Tumor-node-metastasis.

Table 2 Lymph node metastasis distribution patterns in upper vs lower gastric cancer groups

Groups	Upper gastric cancer (n = 817)			Lower gastric cancer (n = 989)
	Siewert type II (n = 219)	Siewert type III (n = 253)	Other/unclassified (n = 345)	Lower gastric cancer (n = 989)
	Cases/ratio	Cases/ratio	Cases/ratio	Cases/ratio
1	93 (42.47)	98 (38.73)	145 (42.03)	52 (5.26)
2	65 (29.68)	77 (30.43)	98 (28.41)	25 (2.53)
3	82 (37.44)	104 (41.11)	135 (39.13)	410 (41.46)
4	32 (14.61)	35 (13.83)	53 (15.36)	229 (23.15)
5	28 (12.78)	32 (12.65)	41 (11.88)	208 (21.03)
6	16 (7.31)	13 (5.14)	18 (5.22)	387 (39.13)
7	61 (27.85)	71 (28.06)	101 (29.28)	253 (25.58)
8	23 (10.50)	32 (12.65)	35 (10.14)	195 (19.72)
9	20 (9.13)	19 (7.51)	39 (11.30)	72 (7.28)
10	11 (5.02)	15 (5.93)	19 (5.51)	12 (1.21)
11	25 (11.42)	31 (12.25)	37 (10.72)	22 (2.22)
12	2 (0.91)	4 (1.58)	3 (0.87)	32 (3.24)
13	0	1 (0.40)	1 (0.29)	9 (0.91)
14	0	0	1 (0.29)	7 (0.71)
15	0	0	0	8 (0.81)
16	0	0	0	2 (0.20)
17	0	0	0	0
18	0	0	0	0
19	0	0	0	0
20	0	0	0	0
110	16 (7.31)	0	8 (2.32)	0
111	12 (5.48)	0	9 (2.61)	0
112	0	0	0	0

Table 3 Analysis of risk factors for lymph node metastasis using logistic regression models

Variables	Univariate analysis			Multivariable analysis
Variables	OR	95%CI	P value	OR	95%CI			P value
Gender
Male	1.000
Female	1.096	0.534–2.250	0.102
Age (year)
< 60	1.000
≥ 60	0.432	0.121-1.542	0.196
Tumor diameter (cm)
< 4	1.000
≥ 4	1.316	0.544-3.121	0.531
Tumor location
Lower	1.000
Upper	1.075	0.891-1.296	0.451
Pathological type
Other	1.000			1.000
Adenocarcinoma	1.754	0.962-3.197	0.067	3.193		0.983-10.375			0.053
Signet-ring cell carcinoma	2.655	1.401-5.029	0.003^a	4.846		1.431-16.419			0.011^a
Histological grade
G₁	1.000			1.000
G₂	2.443	1.578-3.782	< 0.001^a	3.695		1.622-8.419			0.002^a
G₃	5.603	3.680-8.530	< 0.001^a	6.369		2.834-14.314			< 0.001^a
pT stage
T₁	1.000			1.000
T₂	3.893	2.694-5.471	< 0.001^a	2.298			1.538-3.434		< 0.001^a
T₃	14.211	10.501-19.230	< 0.001^a	3.475			2.340-5.162		< 0.001^a
T₄	23.882	16.531-34.502	< 0.001^a	5.987			3.992-8.978		< 0.001^a
pTNM stage
I	1.000			1.000
II	5.988	3.993-8.977	< 0.001^a	1.465			1.087-2.132		0.004^a
III	113.033	72.436-176.382	< 0.001^a	4.833			1.596-18.423		< 0.001^a
Vascular invasion
Negative	1.000			1.000
Positive	9.144	7.347-11.380	< 0.001^a	2.845			1.467-5.517		0.016^a

^aP < 0.05.

OR: Odds ratio; PG: Partial gastrectomy; TG: Total gastrectomy; TNM: Tumor-node-metastasis.

Table 4 Cox regression models analysis of prognostic risk factors in gastric cancer

Variables	Univariate analysis			Multivariable analysis
Variables	HR	95%CI	P value	HR	95%CI	P value
Gender
Male	1.000
Female	1.106	0.976–1.254	0.114
Age (year)
< 60	1.000			1.000
≥ 60	1.419	1.246-1.617	< 0.001^a	1.594	1.395-1.821	< 0.001^a
Tumor diameter (cm)
< 4	1.000
≥ 4	1.142	0.747-1.746	0.534
Tumor location
Upper	1.000			1.000
Lower	1.302	1.158-1.464	< 0.001^a	1.049	0.921-1.195	0.473
Pathological type
Other	1.000			1.000
Adenocarcinoma	1.400	0.933-2.100	0.094	1.566	1.039-2.362	0.032^a
Signet-ring cell carcinoma	1.490	0.974-2.280	0.066	1.586	1.027-2.450	0.037^a
Histological grade
G₁	1.000			1.000
G₂	1.457	1.096-1.938	0.010^a	1.087	0.814-1.453	0.571
G₃	1.943	1.481-2.549	< 0.001^a	1.201	0.905-1.593	0.204
pT stage
T₁	1.000			1.000
T₂	1.577	1.257-1.979	< 0.001^a	1.205	0.946-1.534	0.130
T₃	2.566	2.153-3.059	< 0.001^a	1.411	1.128-1.766	0.003^a
T₄	3.864	3.194-4.676	< 0.001^a	1.801	1.395-2.326	< 0.001^a
pN stage
N₀	1.000			1.000
N₁	1.715	1.464-2.009	< 0.001^a	1.328	1.083-1.628	0.006^a
N₂	2.441	2.059-2.893	< 0.001^a	1.645	1.282-2.111	< 0.001^a
N₃	3.505	2.989-4.110	< 0.001^a	2.148	1.666-2.768	< 0.001^a
pTNM stage
I	1.000			1.000
II	1.383	1.102-1.735	0.005^a	1.223	0.958-1.563	0.107
III	2.651	2.331-3.015	< 0.001^a	1.812	1.395-2.354	< 0.001^a
Surgery type
PG	1.000
TG	1.147	0.987-1.333	0.124
Vascular invasion
Negative	1.000			1.000
Positive	2.440	2.136-2.787	< 0.001^a	1.813	1.512-2.218	< 0.001^a
Chemotherapy
Yes	1.000			1.000
NO	1.433	1.271-1.616	< 0.001^a	1.670	1.460-1.910	< 0.001^a

^aP < 0.05.

HR: Hazard ratio; PG: Partial gastrectomy; TG: Total gastrectomy; TNM: Tumor-node-metastasis.

Citation: Yuan XB, Sun G, Niu J, Dong L, Sui Y, Lv YZ. Metastatic lymph node distribution and pathology correlations in upper and lower gastric cancer patients: A multicenter retrospective study. World J Gastrointest Oncol 2025; 17(2): 98803
URL: https://www.wjgnet.com/1948-5204/full/v17/i2/98803.htm
DOI: https://dx.doi.org/10.4251/wjgo.v17.i2.98803