Analysis of risk factors associated with lymph node metastasis after conversion therapy (combined with immunotherapy) for locally unresectable gastric cancer

doi:10.3877/cma.j.issn.1674-3946.2025.06.009

Abstract

Abstract:

Objective

To investigate the risk factors associated with lymph node metastasis after conversion therapy (combined with immunotherapy) for locally unresectable gastric cancer.

Methods

A total of 218 patients with locally unresectable gastric cancer who underwent radical resection after conversion therapy with the SOX regimen (combined with PD-1 monoclonal antibody immunotherapy) from January 2019 to November 2024 were included. Clinical data of the patients were collected through the medical record system. Univariate analysis and Logistic regression model were used to analyze the risk factors for lymph node metastasis.

Results

Univariate analysis showed that tumor size, depth of invasion, presence or absence of perineural invasion, presence or absence of vascular invasion, and Lauren classification were associated with lymph node metastasis (P<0.05). Multivariate analysis revealed that vascular invasion (OR=7.475, 95%CI: 2.839-19.680, P<0.001), depth of invasion (OR=2.656, 95%CI: 1.713-4.119, P<0.001), and Lauren classification (OR=1.814, 95%CI: 1.062-3.098, P=0.029) were independent risk factors for lymph node metastasis in gastric cancer patients. Among 86 patients with T_0-2 stage, perineural invasion (OR=22.776, 95%CI: 1.658-312.782, P=0.019) and vascular invasion (OR=10.078, 95%CI: 1.791-56.700, P=0.009) were independent risk factors for lymph node metastasis. Among 132 patients with T_3-4 stage, vascular invasion (OR=8.258, 95%CI: 2.404-28.364, P<0.001) and Lauren classification (OR=3.179, 95%CI: 1.310-7.713, P=0.011) were independent risk factors for lymph node metastasis.

Conclusion

Vascular invasion, depth of invasion, and Lauren classification are independent risk factors for lymph node metastasis after conversion therapy (combined with immunotherapy) for locally unresectable gastric cancer. Among them, perineural invasion and vascular invasion are independent risk factors for patients with T_0-2 stage, while vascular invasion and Lauren classification are independent risk factors for patients with T_3-4 stage. For these patients, radical lymph node dissection should be performed as much as possible to improve prognosis.

Key words: Stomach Neoplasms, Lymphatic Metastasis, Risk Factors, Neoadjuvant Immunochemotherapy

Long Qian, Daming Cai, Xingzhou Wang, Shichao Ai, Qiongyuan Hu, Feng Sun, Peng Song, Feng Wang, Meng Wang, Xiaofeng Lu, Huanhuan Zhu, Xiaofei Shen, Wenxian Guan. Analysis of risk factors associated with lymph node metastasis after conversion therapy (combined with immunotherapy) for locally unresectable gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(06): 624-627.

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References 17

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因素	淋巴结阳性组（n=100）	淋巴结阴性组（n=118）	χ²值	P值
性别			0.134	0.714
男	80（80.0）	92（78.0）
女	20（20.0）	26（22.0）
年龄			4.023	0.058
≤60岁	39（39.0）	31（26.3）
>60岁	61（61.0）	87（73.7）
肿瘤大小			11.893	0.001
≤20mm	10（10.0）	34（28.8）
>20mm	90（90.0）	84（71.2）
肿瘤部位			3.086	0.214
上	44（44.0）	66（55.9）
中	24（24.0）	22（18.6）
下	32（32.0）	30（25.4）
浸润深度			69.668	<0.001
T₀	2（2.0）	21（17.8）
T₁	5（5.0）	39（33.1）
T₂	13（13.0）	26（22.0）
T₃	54（54.0）	28（23.7）
T₄	26（26.0）	4（3.4）
神经侵犯			45.861	<0.001
无	43（43.0）	102（86.4）
有	57（57.0）	16（13.6）
脉管侵犯			66.036	<0.001
无	44（44.0）	111（94.1）
有	56（56.0）	7（5.9）
Lauren分型			23.148	<0.001
肠型	51（51.0）	93（78.8）
弥漫型	24（24.0）	19（16.1）
混合型	25（25.0）	6（5.1）
治疗方式			4.472	0.034
免疫+化疗	52（52.0）	78（66.1）
单纯化疗	48（48.0）	40（33.9）

因素	淋巴结阳性组（n=100）	淋巴结阴性组（n=118）	χ²值	P值
性别			0.134	0.714
男	80（80.0）	92（78.0）
女	20（20.0）	26（22.0）
年龄			4.023	0.058
≤60岁	39（39.0）	31（26.3）
>60岁	61（61.0）	87（73.7）
肿瘤大小			11.893	0.001
≤20mm	10（10.0）	34（28.8）
>20mm	90（90.0）	84（71.2）
肿瘤部位			3.086	0.214
上	44（44.0）	66（55.9）
中	24（24.0）	22（18.6）
下	32（32.0）	30（25.4）
浸润深度			69.668	<0.001
T₀	2（2.0）	21（17.8）
T₁	5（5.0）	39（33.1）
T₂	13（13.0）	26（22.0）
T₃	54（54.0）	28（23.7）
T₄	26（26.0）	4（3.4）
神经侵犯			45.861	<0.001
无	43（43.0）	102（86.4）
有	57（57.0）	16（13.6）
脉管侵犯			66.036	<0.001
无	44（44.0）	111（94.1）
有	56（56.0）	7（5.9）
Lauren分型			23.148	<0.001
肠型	51（51.0）	93（78.8）
弥漫型	24（24.0）	19（16.1）
混合型	25（25.0）	6（5.1）
治疗方式			4.472	0.034
免疫+化疗	52（52.0）	78（66.1）
单纯化疗	48（48.0）	40（33.9）

因素	OR值	95%CI	P值
神经侵犯	1.358	0.556-3.319	0.502
脉管侵犯	7.475	2.839-19.680	<0.001
肿瘤大小	1.237	0.458-3.340	0.675
浸润深度	2.656	1.713-4.119	<0.001
Lauren分型	1.814	1.062-3.098	0.029
治疗方式	0.752	0.346-1.631	0.470

因素	OR值	95%CI	P值
神经侵犯	1.358	0.556-3.319	0.502
脉管侵犯	7.475	2.839-19.680	<0.001
肿瘤大小	1.237	0.458-3.340	0.675
浸润深度	2.656	1.713-4.119	<0.001
Lauren分型	1.814	1.062-3.098	0.029
治疗方式	0.752	0.346-1.631	0.470

因素	OR值	95%CI	P值
神经侵犯	22.776	1.658-312.782	0.019
脉管侵犯	10.078	1.791-56.700	0.009
肿瘤大小	1.916	0.514-7.144	0.333
Lauren分型	0.808	0.296-2.212	0.679
治疗方式	0.449	0.087-2.328	0.340

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