J Cancer 2019; 10(18):4389-4396. doi:10.7150/jca.30260

Research Paper

Higher Risk of Lymph Node Metastasis in Young Patients with Early Gastric Cancer

Zu-Kai Wang1,2#, Jian-Xian Lin1,2,3,4#, Ping Li1,2,3,4, Jian-Wei Xie1,2, Jia-Bin Wang1,2, Jun Lu1,2, Qi-Yue Chen1,2, Long-Long Cao1,2, Mi Lin1,2, Ru-Hong Tu1,2, Chang-Ming Huang1,2,3,4✉, Chao-Hui Zheng1,2,3,4 ✉

1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China
#Zu-Kai Wang and Jian-Xian Lin contributed equally to this work and should be considered co-first authors

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Citation:
Wang ZK, Lin JX, Li P, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Huang CM, Zheng CH. Higher Risk of Lymph Node Metastasis in Young Patients with Early Gastric Cancer. J Cancer 2019; 10(18):4389-4396. doi:10.7150/jca.30260. Available from http://www.jcancer.org/v10p4389.htm

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Abstract

Objective: Whether age affects lymph node metastasis (LNM) in patients with gastric cancer (GC) is currently inconclusive. This study investigates the effect of age on LNM in patients with GC.

Methods: From January 1988 to December 2013, 22,808 GC patients underwent gastrectomy at the Surveillance, Epidemiology, and End Results database were included. The relationship between age and LNM was analyzed.

Results: The median number of examined lymph nodes (ELNs) was 12 (interquartile range [IQR], 7-20) among the 22,808 patients with GC, and the median numbers of ELNs were 10 (IQR, 5-18), 12 (IQR, 6-19), 13 (IQR, 7-21) and 13 (IQR, 7-21) in patients with T1 to T4 disease, respectively. A total of 13,780 (60.4%) patients presented with LNM. The LNM rates were 69.6%, 66.1%, 64.7%, 61.8%, 57.8% and 55.6% for patients in the 20-39, 40-49, 50-59, 60-69, 70-79 and ≥ 80 age groups, respectively (P < 0.001). The LNM rates and the number of positive lymph nodes were correlated with age among patients whose diseases were of the same T stage (all P < 0.01). Multivariate analysis showed that age was an independent predictor for LNM in patients with early gastric cancer (EGC) (P < 0.05), and linear regression analysis showed that the LNM rate was higher in young patients with EGC (P < 0.05).

Conclusions: Age is an independent predictor for LNM in EGC. Moreover, LNM is more common in young patients with EGC than in other age groups, which indicates that limited lymph node dissection may not be appropriate for young patients with EGC.

Keywords: lymph node metastasis, early gastric cancer, young, limited lymph node dissection