Abstract
BackgroundThe status of lymph nodes in early gastric cancer is critical to make further clinical treatment decision, but the prediction of lymph node metastasis remains difficult before operation. This study aimed to develop a nomogram that contained preoperative factors to predict lymph node metastasis in early gastric cancer patients.MethodsThis study analyzed the clinicopathologic features of 823 early gastric cancer patients who underwent gastrectomy retrospectively, among which 596 patients were recruited in the training cohort and 227 patients in the independent validation cohort. Significant risk factors in univariate analysis were further identified to be independent variables in multivariable logistic regression analysis, which were then incorporated in and presented with a nomogram. And internal and external validation curves were plotted to evaluate the discrimination of the nomogram.ResultsTotally, six independent predictors, including the tumor size, macroscopic features, histology differentiation, P53, carbohydrate antigen 19-9, and computed tomography-reported lymph node status, were enrolled in the nomogram. Both the internal validation in the training cohort and the external validation in the validation cohort showed the nomogram had good discriminations, with a C-index of 0.82 (95%CI, 0.78 to 0.86) and 0.77 (95%CI, 0.60 to 0.94) respectively.ConclusionsOur study developed a new nomogram which contained the most common and significant preoperative risk factors for lymph node metastasis in patients with early gastric cancer. The nomogram can identify early gastric cancer patients with the high probability of lymph node metastasis and help clinicians make more appropriate decisions in clinical practice.
Highlights
The status of lymph nodes in early gastric cancer is critical to make further clinical treatment decision, but the prediction of lymph node metastasis remains difficult before operation
With the development of endoscopic therapy, most early gastric cancer (EGC) can be effectively treated by minimum invasive endoscopic treatments, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which can better preserve gastric function
A meta-analysis showed that the tumor recurrence after ESD is higher than surgical resection [7], whose reasons are related to metachronous new primary tumors, non-curative ESD, synchronous multiple primary tumors [8], and occult lymph node metastasis (LNM) before the operation [9]
Summary
The status of lymph nodes in early gastric cancer is critical to make further clinical treatment decision, but the prediction of lymph node metastasis remains difficult before operation. This study aimed to develop a nomogram that contained preoperative factors to predict lymph node metastasis in early gastric cancer patients. A meta-analysis showed that the tumor recurrence after ESD is higher than surgical resection [7], whose reasons are related to metachronous new primary tumors, non-curative ESD, synchronous multiple primary tumors [8], and occult lymph node metastasis (LNM) before the operation [9]. Endoscopic treatment should be suggested under the circumstance that the possibility of LNM is exceedingly low, and both the lesion size and site of the EGC are suitable for whole resection [10]. Patients with cT1N0 GC should be recommended to undergo a D1 or a D1+ lymphadenectomy, and a D2 lymphadenectomy is suggested for patients with cT1N+ tumors, according to the Japanese Gastric Cancer Treatment Guideline [11]
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