title: Inverse association between visceral obesity and lymph node metastasis in gastric cancer.
abstract: BACKGROUND
  The relationship between fat distribution and lymph node metastasis has not been well studied. The goal of this study was to determine the impact of visceral obesity on lymph node metastasis in gastric cancer.
  
  
  METHODS
  Metastatic lymph node ratio (MLR) was defined as the number of involved nodes by tumor divided by the total number of resected lymph nodes. Visceral (VFA) and subcutaneous fat areas (SFA) were determined by measuring abdominal fat volume distribution via CT scan, and visceral obesity was defined as a VFA to total fat area ratio (V/T) >0.29.
  
  
  RESULTS
  With lymph node metastasis as a dependent variable, the following factors were significant in multivariate analysis among 495 patients: pathologic T stage (P < 0.001), lympho-vascular invasion (P < 0.001), and V/T (hazard ratio (HR) = 0.455, 95 % confidence interval (CI) = 0.263-0.786, P = 0.005). Similarly, when MLR was the dependent variable in multivariate analysis, MLR was significantly associated with lympho-vascular invasion (HR = 2.222, 95 % CI = 1.149-4.296, P = 0.018), and V/T (HR = 0.247, 95 % CI = 0.133-0.458, P < 0.001).
  
  
  CONCLUSIONS
  Visceral obesity defined by higher visceral to total fat area ratio was significantly associated with decreased MLR.
authors.affiliation: Department of Internal Medicine Institute of Gastroenterology, College of Medicine, Hallym University, Gyeonggi-do, South Korea.
authors.forename: Se Woo
authors.initials: SW
authors.lastname: Park
authors.forename: Hang Lak
authors.initials: HL
authors.lastname: Lee
authors.forename: Yong Won
authors.initials: YW
authors.lastname: Ju
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Jun
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Lee
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoon
authors.forename: Ho Soon
authors.initials: HS
authors.lastname: Choi
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Hahm
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary* / Q000601:surgery; D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D056128:Obesity, Abdominal / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D050151:Subcutaneous Fat