Risk factors for lymph node metastasis and prognostic analysis of early gastric cancer

doi:10.3877/cma.j.issn.1674-3946.2026.04.010

Abstract

Abstract:

Objective

To explore the risk factors for lymph node metastasis and the prognosis of patients with early gastric cancer.

Methods

The clinical data of 243 patients with early gastric cancer who underwent radical gastrectomy from January 2015 to January 2020 were retrospectively analyzed. Risk factors for lymph node metastasis were identified. All patients were followed up for 3-year overall survival, and Kaplan-Meier survival curves were plotted to evaluate the impact of lymph node metastasis on prognosis. Binary Logistic regression was used to analyze qualitative outcome data. Survival curves were generated with the Kaplan-Meier method. Nomograms and receiver operating characteristic (ROC) curves were established using R software.

Results

Among the 243 patients with early gastric cancer, the overall lymph node metastasis rate was 20.2% (49/243). The metastasis rate was 7.3% (8/109) in T1a stage and 30.6% (41/134) in T1b stage. Univariate analysis showed that poor tumor differentiation, submucosal invasion, tumor diameter > 2 cm and tumor ulceration were correlated with lymph node metastasis. Multivariate analysis revealed that poor tumor differentiation, submucosal invasion and tumor diameter > 2 cm were independent risk factors for lymph node metastasis. The 3-year overall survival rate was 96.2%. There was a statistically significant difference in 3-year overall survival (OS) between patients with and without lymph node metastasis (LNM) (P<0.05). A nomogram was constructed based on the independent risk factors to preliminarily predict the risk of lymph node metastasis.

Conclusion

Poor tumor differentiation, submucosal invasion and tumor diameter > 2 cm are independent risk factors for lymph node metastasis in early gastric cancer. The nomogram can be used to roughly assess the risk of lymph node metastasis. Lymph node metastasis significantly worsens the prognosis of patients with early gastric cancer.

Key words: Stomach Neoplasms, Early Phase, Lymph Node Metastasis, Risk Factors, Nomotu, Prognosis

Bin Zhang, Min Wang, Peng Zheng, Li Feng, Xin Li, Gaoping Zhao. Risk factors for lymph node metastasis and prognostic analysis of early gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(04): 337-342.

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References 40

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临床病理特征	例数（n=243）	淋巴结转移阳性（n=49）	淋巴结转移阴性（n=194）	P值
年龄
<45岁	27(11.1)	7(14.3)	20(10.3)	0.540
45~65岁	143(58.9)	23(46.9)	120(61.9)
>65岁	73(30.0)	19(38.8)	54(27.8)
性别
男	153(63.0)	27(55.1)	126(64.9)	0.203
女	90(37.0)	22(44.9)	68(35.1)	0.203
CEA（ng/ml）
正常	238(97.9)	48(98.0)	190(97.9)	0.993
升高	5(2.1)	1(2.0)	4(2.1)	0.993
CA199（IU/ml）
正常	237(97.5)	48(98.0)	189(97.4)	0.829
升高	6(2.5)	1(2.0)	5(2.6)	0.829
CA125（IU/ml）
正常	239(98.4)	48(98.0)	191(98.5)	0.808
升高	4(1.6)	1(2.0)	3(1.5)	0.808
CA724（μg/L）
正常	228(93.8)	44(89.8)	184(94.8)	0.193
升高	15(6.2)	5(10.2)	10(5.2)	0.193
肿瘤位置
胃上1/3	16(6.6)	3(6.1)	13(6.7)	0.796
胃中1/3	47(19.3)	9(18.4)	38(19.6)
胃下1/3	180(74.1)	37(75.5)	143(73.7)
Paris分型
Ⅰ型	26(10.7)	6(12.2)	20(10.3)	0.100
Ⅱ型	90(37.0)	11(22.5)	79(40.7)
Ⅲ型	127(52.3)	32(65.3)	95(49.0)
肿瘤分化程度
低分化	131(53.9)	35(71.4)	96(49.5)	0.002
中分化	54(22.2)	10(20.4)	44(22.7)
高分化	58(23.9)	4(8.2)	54(27.8)
浸润深度
T_1a	109(44.9)	8(16.3)	101(52.1)	0.000
T_1b	134(55.1)	41(83.7)	93(47.9)	0.000
肿瘤最大径
≤2 cm	138(56.8)	19(38.8)	119(61.3)	0.004
>2 cm	105(43.2)	30(61.2)	75(38.7)	0.004
溃疡形成
有	131(53.9)	33(67.3)	98(50.5)	0.034
无	112(46.1)	16(32.7)	96(49.5)	0.034
脉管癌栓
有	5(2.1)	2(4.1)	3(1.5)	0.265
无	238(97.9)	47(95.9)	191(98.5)	0.265
神经侵犯
有	1(0.4)	1(2.0)	0	0.295
无	242(99.6)	48(98.0)	194(100)	0.295

临床病理特征	例数（n=243）	淋巴结转移阳性（n=49）	淋巴结转移阴性（n=194）	P值
年龄
<45岁	27(11.1)	7(14.3)	20(10.3)	0.540
45~65岁	143(58.9)	23(46.9)	120(61.9)
>65岁	73(30.0)	19(38.8)	54(27.8)
性别
男	153(63.0)	27(55.1)	126(64.9)	0.203
女	90(37.0)	22(44.9)	68(35.1)	0.203
CEA（ng/ml）
正常	238(97.9)	48(98.0)	190(97.9)	0.993
升高	5(2.1)	1(2.0)	4(2.1)	0.993
CA199（IU/ml）
正常	237(97.5)	48(98.0)	189(97.4)	0.829
升高	6(2.5)	1(2.0)	5(2.6)	0.829
CA125（IU/ml）
正常	239(98.4)	48(98.0)	191(98.5)	0.808
升高	4(1.6)	1(2.0)	3(1.5)	0.808
CA724（μg/L）
正常	228(93.8)	44(89.8)	184(94.8)	0.193
升高	15(6.2)	5(10.2)	10(5.2)	0.193
肿瘤位置
胃上1/3	16(6.6)	3(6.1)	13(6.7)	0.796
胃中1/3	47(19.3)	9(18.4)	38(19.6)
胃下1/3	180(74.1)	37(75.5)	143(73.7)
Paris分型
Ⅰ型	26(10.7)	6(12.2)	20(10.3)	0.100
Ⅱ型	90(37.0)	11(22.5)	79(40.7)
Ⅲ型	127(52.3)	32(65.3)	95(49.0)
肿瘤分化程度
低分化	131(53.9)	35(71.4)	96(49.5)	0.002
中分化	54(22.2)	10(20.4)	44(22.7)
高分化	58(23.9)	4(8.2)	54(27.8)
浸润深度
T_1a	109(44.9)	8(16.3)	101(52.1)	0.000
T_1b	134(55.1)	41(83.7)	93(47.9)	0.000
肿瘤最大径
≤2 cm	138(56.8)	19(38.8)	119(61.3)	0.004
>2 cm	105(43.2)	30(61.2)	75(38.7)	0.004
溃疡形成
有	131(53.9)	33(67.3)	98(50.5)	0.034
无	112(46.1)	16(32.7)	96(49.5)	0.034
脉管癌栓
有	5(2.1)	2(4.1)	3(1.5)	0.265
无	238(97.9)	47(95.9)	191(98.5)	0.265
神经侵犯
有	1(0.4)	1(2.0)	0	0.295
无	242(99.6)	48(98.0)	194(100)	0.295

变量	标准误	Wald值	OR值	P值	95%置信区间
分化程度差	0.581	4.957	0.274	0.026	0.088~0.857
肿瘤最大径>2 cm	0.349	5.328	2.237	0.021	1.129~4.433
黏膜下侵犯	0.433	12.704	4.684	0.000	2.004~10.951
伴有溃疡病变	0.375	1.178	1.502	0.278	0.721~3.130
常量	0.464	33.384	0.068	0.000	-

变量	标准误	Wald值	OR值	P值	95%置信区间
分化程度差	0.581	4.957	0.274	0.026	0.088~0.857
肿瘤最大径>2 cm	0.349	5.328	2.237	0.021	1.129~4.433
黏膜下侵犯	0.433	12.704	4.684	0.000	2.004~10.951
伴有溃疡病变	0.375	1.178	1.502	0.278	0.721~3.130
常量	0.464	33.384	0.068	0.000	-

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