| ObjGCtive To investigate the histopathological features and risk factors of submucosal invasionin distal or proximal early gastric cancer (EGC). Methods The retrospective cohort includes EGC patients who underwent surgery or endoscopic submucosal dissection (ESD) at our hospital from March 2020 to May 2024, matched 1:1 according to tumor location, with 69 patients in the proximal group and 69 patients in the distal group. The main outcome was submucosal infiltration, and a column chart prediction model was constructed; The secondary outcome was the difference in histopathological features between proximal and distal tissues. Results The proportion of GC patients with diffuse, submucosal invasionand surgical operation in proximal group was significantly higher than that in distal group (P<0.05). Compared with the mucosa invasion group, the tumor diameter and proximal location, the proportion of patients with sunken, undifferentiated, diffuse and vascular invasion were significantly increased in the submucosa invasion group (P<0.05). LASSO regression screening and multivariate Logistic regression model analysis showed that proximal location, tumor diameter ≥20mm and vascular invasion were independent risk factors for submucosal invasion (P<0.05). The results showed that the risk factors for submucosal invasion in EGC patients were vascular invasion, proximal GC, tumor diameter ≥20mm, and sunken GC. ROC curve analysis showed that the AUC of submucosal invasionpredicted by the nomogram model was 0.77 (95%CI: 0.70-0.85), and the Hosmer-Lemeshow goodness of fit test showed that the model was well fitted (χ2=4.862, P=0.433). According to clinical decision curve analysis, when the high risk threshold was 0.05 ～ 0.9, the nematic model predicted that the submucosal invasionhad a good net clinical benefit. Conclusion Compared with distal EGC, patients with proximal EGC have a higher proportion of diffuse and submucosal infiltration. Proximal location, concave type, tumor diameter and vascular invasion were risk factors for EGC submucosal invasion. Therefore, proximal EGC requires careful treatment decisions due to its higher risk of submucosal invasion. |
