A nomogram for predicting the likelihood of lymph node metastasis in early gastric patients.

Zhixue Zheng,Yiqiang Liu,Xiaojiang Wu,Yinan Zhang,Ziyu Li,Lianhai Zhang,Zhaode Bu,Jiafu Ji

doi:10.1186/s12885-016-2132-5

Zhixue Zheng, Yiqiang Liu + Show 6 more

Open Access

https://doi.org/10.1186/s12885-016-2132-5

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Abstract

BackgroundEarly gastric cancer is defined as a lesion confined to the mucosa or submucosa, regardless of the size or lymph node metastasis. Treatment methods include endoscopic mucosal resection or endoscopic submucosal dissection, wedge resection, laparoscopically assisted gastrectomy and open gastrectomy. Lymph node metastasis is strong related with survival and recurrence. Therefore, the likelihood of lymph node metastasis is one of the most important factors when determining the most appropriate treatment.MethodsWe retrospectively analyzed 597 patients who underwent D2 gastrectomy for early gastric cancer. The relationship between lymph node metastasis and clinicopathological features was analyzed. Using multivariate logistic regression analyses, we created a nomogram to predict the lymph node metastasis probability for early gastric cancer. Receiver operating characteristic analyses was performed to assess the predictive value of the model.ResultsIn the present study, 58 (9.7 %) early gastric cancer patients were histologically shown to have lymph node metastasis. The multivariate logistic regression analysis demonstrated that the age at diagnosis, differentiation status, the presence of ulcers, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in early gastric cancer. Additionally, the tumor macroscopic type, size and histology type significantly correlated with these important independent factors. We constructed a predictive nomogram with these factors for lymph node metastasis in early gastric cancer patients, and the discrimination was good with the AUC of 0.860 (95 % CI: 0.809–0.912).ConclusionsWe developed an effective nomogram to predict the incidence of lymph node metastasis for early gastric cancer patients.

Highlights

Gastric cancer is defined as a lesion confined to the mucosa or submucosa, regardless of the size or lymph node metastasis
The correlations between lymph node metastasis and the clinicopathological features of Early gastric cancer (EGC) patients There were totally 597 patients involved in this study at Peking University Cancer Hospital, including 416 men and 181 women. 355 tumors were confined in the mucosal layer while 262 tumors invaded the submucosal layer
Lymph node metastasis was associated with age, macroscopic type, size, histology, differentiation, ulcer, lymphovascular invasion and depth of invasion

Summary

Introduction

Gastric cancer is defined as a lesion confined to the mucosa or submucosa, regardless of the size or lymph node metastasis. The likelihood of lymph node metastasis is one of the most important factors when determining the most appropriate treatment. Gastric cancer (EGC) is defined as a lesion confined to the mucosa or submucosa, regardless of the size or the presence of regional lymph node metastasis [4,5,6,7]. Treatment options for EGC include endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), wedge resection, The likelihood of lymph node metastasis is one of the most important factors to consider when determining. Based on a large-scale case series, expanded indications for endoscopic resection have been proposed because those tumors meeting the expanded criteria had no risk of lymph node metastasis [16]. In the era of endoscopic resection, the accurate prediction of the risk of lymph node metastasis in EGC is crucial to select patients suitable for this procedure

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