Abstract
Background: Preoperative accurate prediction of lymph node status is especially important for the formulation of treatment plans for patients with gastric cancer (GC). The purpose of this study was to establish decision rules and a risk assessment model for lymph node metastasis (LNM) in GC using preoperative indicators.Methods: The clinical data of 554 patients who underwent gastrectomy with D2 lymphadenectomy were collected. A 1:1 propensity score matching (PSM) system was used, and the clinical data of the matched 466 patients were further analyzed. The important risk factors for LNM were extracted by the random forest algorithm, and decision rules and nomogram models for LNM were constructed with a classification tree and the “rms” package of R software, respectively.Results: Tumor size (OR: 2.058; P = 0.000), computed tomography (CT) findings (OR: 1.969; P = 0.001), grade (OR: 0.479; P = 0.000), hemoglobin (Hb) (OR: 1.211; P = 0.005), CEA (OR: 1.111; P = 0.017), and CA19-9 (OR: 1.040; P = 0.033) were independent risk factors for LNM in GC. Tumor size did rank first in the ranking of important factors for LNM in GC and was the first-level segmentation of the two initial branches of the classification tree. The accuracy, sensitivity, specificity, and positive predictive value of the decision rules in diagnosing preoperative LNM in GC were 75.6, 85.7, 73.9, 73.5, and 79.3%, respectively. The accuracy, sensitivity, and specificity of the risk assessment model in predicting preoperative LNM in GC were 79.3, 80.3, and 79.4%, respectively.Conclusion: Tumor size was the most important factor for evaluating LNM in GC. This decision rules and nomogram model constructed to take into account tumor size, CT findings, grade, hemoglobin, CEA, and CA19-9 effectively predicted the incidence of LNM in preoperative GC.
Highlights
METHODSGastric cancer (GC) is a common malignant tumor of the digestive system with the third highest fatality rate in the world [1]
An accurate preoperative diagnosis of Lymph node metastasis (LNM) is of great significance for the formulation of treatment plans and the evaluation of prognosis of patients with gastric cancer (GC)
We found that low Hb levels were a high-risk predictor of LNM in GC
Summary
METHODSGastric cancer (GC) is a common malignant tumor of the digestive system with the third highest fatality rate in the world [1]. The Japanese gastric cancer treatment guidelines 2018 (5th edition) proposed that neoadjuvant chemotherapy (NAC) should be required for GC patients who have extensive and large-volume LNM [10]. Tsuburaya et al [11] showed that NAC followed by radical gastrectomy could improve the survival rate of patients with AGC with a large number of metastatic lymph nodes along the major perigastric vessels and/or aorta. The benefits of NAC have been confirmed in some randomized controlled trials, and most oncologists recommend that NAC should be given to patients with AGC, especially those with LNM, to reduce preoperative TNM staging, thereby improving the rate of radical resection [13, 14]. Preoperative accurate prediction of lymph node status is especially important for the formulation of treatment plans for patients with gastric cancer (GC). The purpose of this study was to establish decision rules and a risk assessment model for lymph node metastasis (LNM) in GC using preoperative indicators
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