“Factors associated with mediastinal lymph node positivity in proximal gastric tumor patients undergoing curative surgery”

Abstract 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 surgical resection and Transcrural lymphadenectomy for proximal gastric tumors between January 2012 and January 2020. The patients were divided into Group1 (negative) and Group2 (positive) according to the positivity of mediastinal lymph nodes. These groups were compared for clinical variables. The diagnostic value of composite immunonutritional and inflammatory indices in predicting lymph node positivity was examined. Results There were 88 patients in our study. Group1 included 54 and Group2 included 34 patients.Among the laboratory parameters, only 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 in Group2 The tumor size (25.3 vs. 33 mm, p:0.0001), was higher in Group2. Tumors were more advanced in Group2 (p<0.001). Among the composite indices, only the neutrophil-to-lymphocyte ratio 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. Conlusion 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. Knowing the relationship between clinicopathological characteristics and mediastinal lymph node positivity in proximal gastric tumors can be useful in determining the surgical strategy for EGJ tumors.