Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1628-1635
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1628
Impact of lymph node micrometastasis on gastric carcinoma prognosis: A meta-analysis
Yong-Ji Zeng, Chun-Dong Zhang, Dong-Qiu Dai
Yong-Ji Zeng, Chun-Dong Zhang, Dong-Qiu Dai, Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
Author contributions: Zeng YJ and Dai DQ conceived the study; Zeng YJ and Zhang CD collected the data and performed data analysis; Zeng YJ, Zhang CD and Dai DQ designed the study and participated in writing the paper; Zeng YJ and Dai DQ submitted the final manuscript; all authors read and approved the final manuscript.
Supported by Grants from Liaoning Province Science and Technology Plan Project, No. 2013225021.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong-Qiu Dai, MD, Professor, Chief Physician, Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Chongshan Eastern Road, Huanggu District, Shenyang 110032, Liaoning Province, China. daidq63@163.com
Telephone: +86-24-62043110 Fax: +86-24-62043110
Received: May 3, 2014
Peer-review started: May 4, 2014
First decision: June 18, 2014
Revised: July 24, 2014
Accepted: November 11, 2014
Article in press: November 11, 2014
Published online: February 7, 2015
Processing time: 281 Days and 20.1 Hours
Abstract

AIM: To investigate the prognostic significance of lymph node micrometastasis (LNMM) in patients with gastric carcinoma.

METHODS: Two reviewers independently searched electronic databases including PubMed, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Controlled Studies Register, and the China National Knowledge Infrastructure electronic database between January 1996 and January 2014. Strict literature retrieval and data extraction were performed to extract relevant data. Data analysis was conducted using RevMan 5.2.4 software, and relative risks (RRs) for patient death in five years and recurrence were calculated. A fixed- or random-effects model was selected to pool and a forest plot was used to display RRs.

RESULTS: Twelve cohort studies containing a total of 1684 patients were identified. LNMM positivity was worse than LNMM negativity with regards to the number of patients who died in five years. The effects of LNMM positivity in patients with gastric cancer of different T-stages remain unclear. LNMM in patients with gastric carcinoma was also associated with a higher recurrence rate. With regards to the number of patients who died in five years, Asian patients were worse than European and Australian patients.

CONCLUSION: We recommend that LNMM should not be used as a gold standard for prognosis evaluation in patients with gastric cancer in clinical settings until more high quality trials are available.

Keywords: Gastric carcinoma; Survival; Lymph node micrometastasis; Meta-analysis

Core tip: This is the first meta-analysis describing the effect of lymph node micrometastasis (LNMM) on gastric carcinoma prognosis worldwide. LNMM positivity was associated with a worse prognosis compared with LNMM negativity. The effects of LNMM positivity in patients with gastric cancer of different T-stages remain unclear. LNMM in patients with gastric carcinoma was also associated with a higher recurrence rate. With regards to the number of patients who died in five years, Asian patients were worse than European and Australian patients.