A nomogram to predict lymph node metastasis in patients with early gastric cancer.

Chun Guang Guo,Qian Liu,Zhi Xiang Zhou,Gui Qi Wang,Dong Bing Zhao,Ping Zhao,Jian Qiang Cai

doi:10.18632/oncotarget.14660

Abstract

BackgroundLymph node status is crucial to determining treatment for early gastric cancer (EGC). We aim to establish a nomogram to predict the possibility of lymph node metastasis (LNM) in EGC patients.MethodsMedical records of 952 EGC patients with curative resection, from 2002 to 2014, were retrospectively retrieved. Univariate and multivariate analysis were performed to examine risk factors associated with LNM. A nomogram for predicting LNM was established and internally validated.ResultsFive variables significantly associated with LNM were included in our model, these are sex (Odd ratio [OR] = 1.961, 95% confidence index [CI], 1.334 to 2.883; P = 0.001), depth of tumor (OR = 2.875, 95% CI, 1.872 to 4.414; P = 0.000), tumor size (OR = 1.986, 95% CI, 1.265 to 3.118; P = 0.003), histology type (OR = 2.926, 95% CI, 1.854 to 4.617; P = 0.000) and lymphovascular invasion (OR = 4.967, 95% CI, 2.996 to 8.235; P = 0.000). The discrimination of the prediction model was 0.786.ConclusionsA nomogram for predicting lymph node metastasis in patients with early gastric cancer was successfully established, which was superior to the absolute endoscopic submucosal dissection (ESD) indication in terms of the clinical performance.

Highlights

Gastric cancer (EGC) has been increasing though overall incidence of gastric cancer declined around the world [1, 2]
Five variables significantly associated with lymph node metastasis (LNM) were included in our model, these are sex (Odd ratio [OR] = 1.961, 95% confidence index [confidence interval (CI)], 1.334 to 2.883; P = 0.001), depth of tumor (OR = 2.875, 95% CI, 1.872 to 4.414; P = 0.000), tumor size (OR = 1.986, 95% CI, 1.265 to 3.118; P = 0.003), histology type (OR = 2.926, 95% CI, 1.854 to 4.617; P = 0.000) and lymphovascular invasion (OR = 4.967, 95% CI, 2.996 to 8.235; P = 0.000)
A nomogram for predicting lymph node metastasis in patients with early gastric cancer was successfully established, which was superior to the absolute endoscopic submucosal dissection (ESD) indication in terms of the clinical performance

Summary

Introduction

Gastric cancer (EGC) has been increasing though overall incidence of gastric cancer declined around the world [1, 2]. As many as about 80% of patients exhibited no lymph node metastasis (LNM), most patients underwent excessive surgery and suffered from morbidity [5]. Considering the risk of lymph nodal metastasis, only patients with differentiated mucosal adenocarcinoma, absence of lymphovascular invasion (LVI) and 20 mm or less in size are eligible for ESD (absolute indication) [3]. Given the excessively strict indication, various strategies were proposed to expand the ESD criteria for patients with negligible risk of LNM [10, 11]. Lymph node status is crucial to determining treatment for early gastric cancer (EGC). We aim to establish a nomogram to predict the possibility of lymph node metastasis (LNM) in EGC patients

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Methods

Results

Conclusion