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Predictive Factors of Lymph Nodes Invasion and Factors Associated with Advanced Lymph Nodes Invasion in Gastric Cancer: Retrospective Study of 145 Cases

Houyem Mansouri, Ines Zemni*, Ines Ben Safta, Mohamed Ali Ayadi, Tarek Ben Dhiab, Riadh Chargui, Khaled Rahal

Introduction: The detection of risk factors for lymph node extension in gastric cancers is crucial to standardize the indications of endoscopic treatment in early tumors, to rationalize the extension of lymphadenectomy and to adapt adjuvant and neoadjuvant therapies in locally advanced tumor. This study aimed to identify the clinical, biological, and histological predictive factors of lymph node involvement in gastric cancer.

Patients and Methods: Clinical and histological data of 145 patients treated for gastric adenocarcinoma have been enrolled. Univariate and multivariate analyzes of risk factors for lymph node involvement were performed.

Results: Lymph node invasion was found in 82.1% of cases. Among our patients, 32.4% were staged at pN3, 28.3% at pN2, and 21.4% at pN1. In univariate analysis, lymph node metastasis was significantly associated with the presence of Lymphovascular Invasion (LVI) (p=0.04), Perineural Invasion (PNI) (p=0.006), the degree of differentiation (p=0.04), the depth parietal invasion (p=0.019) and a high levels of Carcinoembryonic Antigen (CEA) (p=0.027). In multivariate analysis, the depth of parietal invasion (HR: 4.97, 95% CI:1.46-16.88, p=0.01), the presence of LVI (HR:0.053, 95% CI:0.004-0.70, p=0.026), PNI (HR:41.24, 95% CI: 2.86-59.36,p=0.006), and the CEA level (HR:5.40, 95% CI:1.21-22.58, p=0.021) were the independent predictive factors of lymph node metastasis.

Conclusion: The high level of tumor markers, the depth of parietal infiltration, the presence of LVI, and PNI are the main risk factors of lymph node metastases in gastric cancer.