title: The clinical significance and risk factors of solitary lymph node metastasis in gastric cancer.
abstract: OBJECTIVE
  To assess the clinical significance and risk factors of solitary lymph node metastasis (SLM) in gastric carcinoma and establish a more accurate method to evaluate the possibility of lymph node metastasis (LM).
  
  
  METHODS
  A total of 385 patients with gastric carcinoma who underwent D2 lymphadenectomy at the Cancer Center of Sun Yat-Sen University were included in this research. Then we used a group of data from Sun Yat-sen University Gastrointestinal Hospital (SYSUGIH) to validate the accuracy of our developed method. The χ2 test, Kaplan-Meier analysis, log-rank test, COX model, and discriminate analysis were used to analyze the data with SPSS13.0.
  
  
  RESULTS
  We found that the LM number and pathological T staging were independent prognostic risk factors. CEA grading, LN status by CT, and T staging by CT were independent risk factors for LM in gastric carcinoma. In addition, we developed the equation Y = -5.0 + X1 + 1.8X3 + 0.7X4 (X1 = CEA grading, X3 = LN status by CT, X4 = T staging by CT) to evaluate the situation of LM. The data from SYSUGIH shows this equation has a better accuracy compared with CT.
  
  
  CONCLUSIONS
  SLM is an independent risk factor in gastric cancer. And there was no survival difference between the skip metastasis group and the other SLM group (P = 0.659). It is inappropriate for the patient with SLM doing a standard D2 lymphadenectomy, due to the fact that LM rarely occurs in the splenic artery, splenic hilum. The risk factors for LM include CEA grading, LN status by CT, and T staging by CT. And we can use Y = -5.0 + X1 + 1.8X3 + 0.7X4 (X1, CEA grading, X3 = LN status by CT, X4 = T staging by CT, the critical value is 0.3) to estimate the possibility of LM, which has a better accuracy compared with CT.
authors: The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.
authors: Min
authors: M
authors: Ma
authors: The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastroenterology Surgery, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors: Shi
authors: S
authors: Chen
authors: The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.
authors: Bao-yan
authors: BY
authors: Zhu
authors: The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.
authors: Bai-Wei
authors: BW
authors: Zhao
authors: Department of Gastroenterology Surgery, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors: Hua-She
authors: HS
authors: Wang
authors: Department of Gastroenterology Surgery, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors: Jun
authors: J
authors: Xiang
authors: Department of Gastroenterology Surgery, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors: Xiao-Bin
authors: XB
authors: Wu
authors: Department of Gastroenterology Surgery, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors: Yi-Jia
authors: YJ
authors: Lin
authors: The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.
authors: Zhi-Wei
authors: ZW
authors: Zhou
authors: Department of Gastroenterology Surgery, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors: Jun-Sheng
authors: JS
authors: Peng
authors: The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.
authors: Ying-Bo
authors: YB
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
references: Anticancer Res. 2005 Mar-Apr;25(2B):1349-52
references: 15865090
references: PLoS One. 2013;8(11):e78846
references: 24223855
references: ANZ J Surg. 2005 Aug;75(8):645-9
references: 16076325
references: Cancer Metastasis Rev. 2006 Jun;25(2):269-77
references: 16770539
references: World J Gastroenterol. 2007 Sep 21;13(35):4776-80
references: 17729400
references: CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
references: 18287387
references: J Surg Oncol. 2009 Jan 1;99(1):20-7
references: 18937292
references: Ann Surg Oncol. 2009 Mar;16(3):603-8
references: 19127361
references: World J Surg. 2009 Jun;33(6):1235-9
references: 19288280
references: Gastric Cancer. 2009;12(3):148-52
references: 19890694
references: Eur J Surg Oncol. 2011 Jan;37(1):55-9
references: 21115231
references: BMC Cancer. 2011;11:18
references: 21241483
references: Cancer Treat Rev. 2000 Aug;26(4):243-55
references: 10913380
references: Gut. 2001 Feb;48(2):225-9
references: 11156645
references: J Surg Oncol. 2002 Mar;79(3):188-93
references: 11870670
references: Br J Surg. 2003 May;90(5):563-6
references: 12734863
references: World J Surg. 1999 Feb;23(2):187-92; discussion 192-3
references: 9880430
references: Surgery. 1999 Feb;125(2):148-54
references: 10026747
references: Eur J Surg Oncol. 2005 May;31(4):393-400
references: 15837046
references: Scand J Surg. 2011;100(3):174-80
references: 22108745
references: Chin J Cancer. 2013 Mar;32(3):106-12
references: 23452393
references: Chin J Cancer. 2013 Sep;32(9):512-9
references: 23149312
references: J Clin Oncol. 2013 Oct 10;31(29):3704-10
references: 24019550
references: J Surg Oncol. 2005 Jun 1;90(3):147-51; discussion 151-2
references: 15895450