Lymph node metastasis patterns and prognosis of early gastric cancer

Abstract Background Currently, numerous studies focus on the analysis of risk factors for lymph node metastasis in early gastric cancer, but few studies analyze the drainage patterns of metastatic lymph nodes. Methods Data was retrospectively analyzed from a database of gastric cancer resections from 2014–2018. The cohort included 786 pT1 patients with complete data. Outcomes evaluated were lymph node metastasis frequencies, survival analyses, and risk factors impacting prognosis. Results The overall lymph node metastasis rate was 23.7%. The 5-year overall survival rate (54.8% vs 95.7%; P < 0.001) and disease-free survival rate (48.4% vs 95.7%; P  2 cm (P = 0.007, < 0.001), poor differentiation (P = 0.007, < 0.001), T1b stage (all P < 0.001), lymph node metastasis (all P < 0.001), and vascular invasion (all P = 0.002, 0.016) as independent negative prognostic factors affecting 5-year OS and DFS in patients with early gastric cancer. Postoperative chemotherapy (P < 0.001, 0.019)was an independent positive prognostic factor. Conclusion This real-world observational study demonstrates that lymph node metastasis in early gastric cancer is widely and disorderly not depending on the location. Therefore, systematic lymph node dissection is necessary to cure early gastric cancer. Meanwhile its prognosis is closely related to lymph node metastasis.