Evidence map›Paper›PMID 42310645›Full record

SynthesisWorld journal of surgical oncology2026

Endoscopic resection or radical gastrectomy? Risk factors for lymph node metastasis in early gastric cancer: a systematic review and meta-analysis.

Yike Zhang, Haozhe Wang, Tianhang Luo

Abstract readSystematic ReviewMeta-AnalysisReview
In one paragraph

Synthesis in World journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Yike Zhang *College of Basic Medical Sciences, Naval Medical University, Shanghai, China.
Haozhe Wang *College of Basic Medical Sciences, Naval Medical University, Shanghai, China.
Tianhang LuoDepartment of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China. luotianhang78@126.com.

Funding

Multi-center clinical research project of Changhai Hospital 2024LYB02
6 · The paper itself

Abstract

backgroundThe management of EGC hinges on accurate LNM risk assessment, guiding the critical choice between endoscopic resection (ER) and radical gastrectomy. This study provides a comprehensive evidence synthesis to optimize treatment selection.

methodsThis systematic review and meta-analysis (PROSPERO CRD420251152013) was conducted in accordance with PRISMA guidelines. A comprehensive literature search of PubMed, Web of Science, Scopus, and Embase was performed for studies published up to September 5, 2025. Study quality and risk of bias were assessed using the ROBINS-I tool, and the certainty of evidence for each association was evaluated with the GRADE framework. Statistical heterogeneity was investigated, and the sources were explored through meta-regression where appropriate.

resultsOne hundred one studies were included. Meta-analysis identified predictors: LVI (OR = 9.04, with LVI negative as reference, 95% CI: 7.18-11.37), mucosal invasion (T1a) (OR = 0.20, with T1b as reference, 95% CI: 0.19-0.22), tumor size ≤ 2 cm (OR = 0.39, with > 2 cm as reference, 95% CI: 0.36-0.43), differentiated histology (OR = 0.45, with undifferentiated type as reference, 95% CI: 0.40-0.50), PNI (OR = 3.41, with PNI negative as reference, 95% CI: 2.46-4.71), ulceration (OR = 1.68, with ulceration negative as reference, 95% CI: 1.37-2.05), age ≤ 60 years (OR = 1.13, with > 60 years old as reference, 95% CI: 1.06-1.21), male (OR = 0.69, with females as reference, 95% CI: 0.65-0.72), middle location (OR = 0.96, with other parts as reference, 95% CI: 0.90-1.02), CEA > 0.5 ng/mL (OR = 1.35, with CEA ≤ 0.5ng/mL as reference, 95% CI: 1.04-1.75), CA199 > 37 U/mL (OR = 4.02, with CA199 ≤ 37 U/mL as reference, 95% CI: 1.46-11.11), CA125 (OR = 1.17, with CA125 ≤ 35 U/mL as reference, 95% CI: 0.48-2.81), CA724 (OR = 1.33, with CA724 ≤ 7 U/mL as reference, 95% CI: 0.84-2.11). All reported pooled ORs represent unadjusted estimates derived from univariate data.

conclusionThis meta-analysis provides a comprehensive evidence base for risk stratification in EGC. By distinguishing patients suitable for ER from those requiring radical operation, our findings serve as a critical guide for optimizing clinical practice and resolving the therapeutic dilemma between endoscopy and radical surgery.

Indexed as

GastrectomyGastroscopyLymphatic MetastasisLymph NodesStomach NeoplasmsHumansPrognosisRisk FactorsEarly gastric cancerEndoscopic resectionLymph node metastasisMeta-analysisRisk factor

Identifiers

PMID42310645
PMCPMC13520326

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.