Background: The management of early gastric cancer (EGC) has witnessed a rise in the utilization of endoscopic submucosal dissection (ESD) as a treatment modality, although prognostic markers are needed to guide management strategies. This study investigates the prognostic implications of lymphovascular invasion (LVI) in ESD-eligible EGC patients, specifically its implications for subsequent radical surgery. Material and methods: A retrospective, multicenter study from two primary hospitals analyzed clinicopathological data from 1369 EGC patients eligible for ESD, who underwent gastrectomy at Shanghai Cancer Center and Huashan Hospital between 2009 and 2018. We evaluated the relationship between LVI and lymph node metastasis (LNM), as well as the influence of LVI on recurrence-free survival (RFS) and overall survival (OS). Results: We found a strong association between LVI and LNM (p< 0.001). Advanced machine learning approaches, including Random Forest, Gradient Boosting Machine, and eXtreme Gradient Boosting, confirmed the pivotal role of LVI in forecasting LNM from both centers. Multivariate analysis identified LVI as an independent negative prognostic factor for both RFS and OS, with hazard ratios of 4.5 (95% CI: 2.4–8.5,p< 0.001) and 4.4 (95% CI: 2.1–8.9,p< 0.001), respectively. Conclusions: LVI is crucial for risk stratification in ESD-eligible EGC patients, underscoring the necessity for radical gastrectomy. Future research should explore the potential incorporation of LVI status into existing TNM staging systems and novel therapeutic strategies.
背景：早期胃癌（EGC）的治疗中，内镜黏膜下剥离术（ESD）作为一种治疗方式的应用日益增多，但仍需预后标志物来指导治疗策略。本研究探讨了符合ESD条件的EGC患者中淋巴血管侵犯（LVI）的预后意义，特别是其对后续根治性手术的影响。材料与方法：一项来自两家主要医院的多中心回顾性研究分析了2009年至2018年间在上海癌症中心和华山医院接受胃切除术的1369例符合ESD条件的EGC患者的临床病理数据。我们评估了LVI与淋巴结转移（LNM）之间的关系，以及LVI对无复发生存期（RFS）和总生存期（OS）的影响。结果：我们发现LVI与LNM之间存在显著关联（p<0.001）。先进的机器学习方法，包括随机森林、梯度提升机和极限梯度提升，证实了LVI在预测两个中心LNM中的关键作用。多变量分析确定LVI是RFS和OS的独立负面预后因素，风险比分别为4.5（95% CI: 2.4–8.5, p<0.001）和4.4（95% CI: 2.1–8.9, p<0.001）。结论：LVI对于符合ESD条件的EGC患者的风险分层至关重要，强调了根治性胃切除术的必要性。未来的研究应探索将LVI状态纳入现有TNM分期系统和新型治疗策略的潜力。
肿瘤(癌症)患者之家