Sex-specific differences in risk factors of lymph node metastasis in patients with early gastric cancer

Accurate prediction of lymph node status is of crucial importance in the appropriate treatment planning for patients with early gastric cancer (EGC). Some studies have examined factors predicting lymph node metastasis (LNM) in EGC; however, these studies did not consider sex-specific differences. This study aimed to investigate sex-specific differences in predictive risk factors of LNM in EGC based on surgical specimens. Patients who underwent surgical treatment for EGC between January 2003 and February 2016 were retrospectively evaluated. Patients who underwent previous gastric surgery or treatment for gastric neoplasms were excluded. Finally, 1076 patients treated for EGC were included in the analysis. We analyzed risk factors of LNM by dividing patients into male and female groups. Of 1076 patients (mean age 59.6 years), 69% were men. The overall LNM rate was 9.4%. The LNM rate was lower in men (7.8%) than in women (12.9%). Multivariate analysis showed that elevated type (odds ratio [OR], 2.084; 95% confidence interval [CI]: 1.053–4.125; P = 0.035), submucosal invasion (OR, 2.162; 95% CI: 1.018–4.595; P = 0.045), undifferentiated type (OR, 2.044; 95% CI: 1.107–3.772; P = 0.022), and lymphovascular invasion (LVI) (OR, 7.210; 95% CI: 3.835–13.554; P<0.001) were independent predictive risk factors of LNM in EGC in men. However, only submucosal invasion (OR, 8.772; 95% CI: 2.823–27.259; P<0.001) and LVI (OR, 8.877; 95% CI: 3.861–20.410; P<0.001) were independent predictive risk factors of LNM in EGC in women. Submucosal invasion and LVI were risk factors of LNM in both men and women. However, elevated and undifferentiated types were risk factors in men but not in women. Clinicians should consider these sex-specific differences with regard to individualized management.