Risk of Lymph Node Metastasis in T1b Gastric Cancer: An International Comprehensive Analysis from the Global Gastric Group (G3) Alliance

Elvira L. Vos, Masaya Nakauchi, Mithat Gönen, Jason A. Castellanos, Alberto Biondi, Daniel G. Coit, Johan L. Dikken, Domenico D'Ugo, Henk Hartgrink, Ping Li, Makoto Nishimura, Mark Schattner, Kyo Young Song, Laura H. Tang, Ichiro Uyama, Santosha Vardhana, Rob H.A. Verhoeven, Bas P.L. Wijnhoven, Vivian E. Strong*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


Objective: We sought to define criteria associated with low lymph node metastasis risk in patients with submucosal (pT1b) gastric cancer from 3 Western and 3 Eastern countries. Summary Background Data: Accurate prediction of lymph node metastasis risk is essential when determining the need for gastrectomy with lymph node dissection following endoscopic resection. Under present guidelines, endoscopic resection is considered definitive treatment if submucosal invasion is only superficial, but this is not routinely assessed. Methods: Lymph node metastasis rates were determined for patient groups defined according to tumor pathological characteristics. Clinicopathological predictors of lymph node metastasis were determined by multivariable logistic regression and used to develop a nomogram in a randomly selected subset that was validated in the remainder. Overall survival was compared between Eastern and Western countries. Results: Lymph node metastasis was found in 701 of 3166 (22.1%) Eastern and 153 of 560 (27.3%) Western patients. Independent predictors of lymph node metastasis were female sex, tumor size, distal stomach location, lymphovascular invasion, and moderate or poor differentiation. Patients fulfilling the National Comprehensive Cancer Network guideline criteria, excluding the requirement that invasion not extend beyond the superficial submucosa, had a lymph node metastasis rate of 8.9% (53/594). Excluding moderately differentiated tumors lowered the rate to 3.4% (10/296). The nomogram's area under the curve was 0.690. Regardless of lymph node status, overall survival was better in Eastern patients. Conclusions: The lymph node metastasis rate was lowest in patients with well differentiated tumors that were 3 cm and lacked lymphovascular invasion. These criteria may be useful in decisions regarding endoscopic resection as definitive treatment for pT1b gastric cancer.

Original languageEnglish
Pages (from-to)e339-e345
JournalAnnals of Surgery
Issue number2
Publication statusPublished - 1 Feb 2023

Bibliographical note

Funding: This study was supported in part by an NCI Cancer Center Support Grant (P30 CA008748) to the institution for core resources.

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.


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