Abstract
Predicting lymph node metastasis (LNM) accurately is of great importance to formulate optimal treatment strategies preoperatively for patients with early gastric cancer (EGC). This study aimed to explore risk factors that predict the presence of LNM in EGC. A total of 697 patients underwent gastrectomy enrolled in this study, were divided into training and validation set, and the relationship between LNM and other clinicopathologic features, preoperative serum combined tumor markers (CEA, CA19-9, CA125) were evaluated. Risk factors for LNM were identified using logistic regression analysis, and a nomogram was created by R program to predict the possibility of LNM in training set, while receiver operating characteristic (ROC) analysis was applied to assess the predictive value of the nomogram model in validation set. Consequently, LNM was significantly associated with tumor size, macroscopic type, differentiation type, ulcerative findings, lymphovascular invasion, depth of invasion and combined tumor marker. In multivariate logistic regression analysis, factors including of tumor size, differentiation type, ulcerative findings, lymphovascular invasion, depth of invasion and combined tumor marker were demonstrated to be independent risk factors for LNM. Moreover, a predictive nomogram with these independent factors for LNM in EGC patients was constructed, and ROC curve demonstrated a good discrimination ability with the AUC of 0.847 (95% CI: 0.789-0.923), which was significantly larger than those produced in previous studies. Therefore, including of these tumor markers which could be convenient and feasible to obtain from the serum preoperatively, the nomogram could effectively predict the incidence of LNM for EGC patients.
Highlights
Risk factors for lymph node metastasis (LNM) were identified using logistic regression analysis, and a nomogram was created by R program to predict the possibility of LNM in training set, while receiver operating characteristic (ROC) analysis was applied to assess the predictive value of the nomogram model in validation set
This study evaluating a number of early gastric cancer (EGC) patients revealed detailed data on LNM risk factors and developed a nomogram to predict the risk value for LNM in EGC patients
A majority of studies showed that patients with poorly differentiation type and ulcerative findings had higher rates of LNM,[22, 27,28,29,30] having a poor prognosis, while some authors insisted that differentiation type and ulcerative findings were not significant associated with LNM, [15, 16, 31] being not prognostic factors for EGC patients
Summary
The incidence of early gastric cancer (EGC), defined as adenocarcinoma limited to the mucosa or submucosa of the stomach, irrespective of lymph node metastasis (LNM), has been increasing worldwide.[1,2,3] Apart from gastrectomy with lymphadenectomy, endoscopic surgical techniques including of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have gained increasing popularity and have been widely regarded as an alternate treatment for some EGC patients [4, 5], from which patients can avoid a potentially morbid surgical procedure and preserve stomach function as well as maintain high postoperative quality of life.[6,7,8,9] endoscopic resection with curative intent should only be considered with the absence of regional www.impactjournals.com/oncotarget lymph node metastases, as regional lymph nodes are untreated in this procedure.[10, 11] identifying the risk factors for LNM is of crucial importance to determine the optimal treatment for EGC patients. Previous studies suggested that some clinicopathologic features, such as differentiated type, depth of invasion, tumor size and the presence of ulceration [12,13,14,15], and biological markers including of P53, ki, Her-2 and E-cad [16, 17], were the independent risk factors for LNM, even if unanimous agreement has not been reached. There were few studies evaluating the correlation between the preoperative serum tumor markers (CEA, CA125, CA19-9) and LNM in EGC [18, 19], and nomogram has been applied to quantify risk factors of LNM in several carcinomas other than EGC [20, 21]. There is no predictive nomogram analyzing the clinicopathologic features and preoperative serum tumor markers for the risk of LNM in EGC. The aim of this study was to identify risk factors for LNM and to construct a nomogram based on these factors for EGC patients to guide treatment
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