Purpose: This study investigated the risk factors associated with mediastinal lymph node metastases due to proximal gastric cancer.
Methods: The study included patients who had curative surgical resection and transcural lymphadenectomy for proximal gastric tumors between January 2012 and January 2020. The patients were divided into Group 1 (negative) and Group 2 (positive) according to the positivity of mediastinal lymph nodes. These groups were compared for demographic and clinical data, histopathological characteristics, and operative variables. The diagnostic value of composite immunonutritional and inflammatory indices in predicting lymph node positivity was examined.
Results: A total of 88 patients were included in our study and divided into Group 1 (n=54) and Group 2 (n=34). There was no difference between the groups in terms of age (59.4 vs. 57.1, P=0.381). Among the laboratory parameters, only C-reactive protein (CRP) was higher in Group 2 (4.58 vs. 10.7, P=0.044). The rate of postoperative respiratory complications (5.6% vs. 29.4%, P=0.002) was higher and the length of hospital stay was longer in Group 2 (9 vs. 12 days, P<0.001). The tumor size (25.3 mm vs. 33 mm, P=0.0001), the total number of lymph nodes, and the number of metastatic lymph nodes were higher in Group 2. The pT stage (P=0.008) and the pN stage (P<0.001) were more advanced in Group 2. Tumors were more advanced in Group 2 (P<0.001). Among the composite indices, only the neutrophil-to-lymphocyte ratio (NLR) had a diagnostic value, with a sensitivity of 67.65% and a specificity of 55.56% at a cut-off point of > 2.19. According to the multivariate analysis, a tumor size of > 3 cm, a CRP value of > 7, and tumor localization were independent risk factors.
Discussion: Our study found that mediastinal lymph node positivity was associated with elevated CRP and that these patients had more advanced tumors and poor histopathological characteristics. Mediastinal lymph node positivity was also associated with increased postoperative respiratory complications. We established the diagnostic value of the NLR in predicting lymph node positivity. It is helpful to establish the relationship between clinicopathological characteristics and mediastinal lymph node positivity in proximal gastric tumors since it can be useful in determining the surgical strategy for esophagogastric junction tumors.
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