Abstract
BACKGROUND: Limited evidence and contradictory results exist regarding lymph node metastasis (LNM) and prognosis in early gastric cardia cancer (EGCC) and early gastric non-cardia cancer (EGNCC). This study aims to compare the clinicopathological features, LNM patterns, and survival outcomes between EGCC and EGNCC using a large population-based dataset. METHODS: This study utilized data from the Surveillance, Epidemiology, and End Results (SEER) population and employed multivariate analysis, Kaplan-Meier method, propensity score matching (PSM), and nomogram analysis to achieve comprehensive insights. RESULTS: EGCC tended to be younger in age, intestinal type, smaller tumor size, and well-differentiated type (P<0.05). No positive association was found between LNM and tumor location after adjusting for other risk factors [odds ratio (OR): 0.87; 95% confidence interval (CI): 0.60-1.25; P=0.44]. Moreover, patients with EGNCC showed a better prognosis compared with EGCC patients [5-year disease-specific survival (DSS): 87.3% vs. 80.3%, P<0.001 for log-rank test]. Patients with early gastric cancer (EGC) were further divided by invasion depth. When EGC patients were limited to the mucosa, EGCC patients had a similar overall survival (OS) to EGNCC patients (P=0.26). As the depth of infiltration reached the submucosa, EGCC had a significantly worse DSS compared to EGNCC (5-year DSS: 73.9% vs. 85.7%, P<0.001 for log-rank test). PSM further proved that our analysis was credible and reliable. CONCLUSIONS: The risk of LNM in EGCC is comparable to that in EGNCC. However, EGCC exhibits poorer survival outcomes compared to EGNCC. This discovery underscores the importance of enhanced monitoring and individualized treatment approaches for patients with EGCC to improve their prognosis and survival.