Development and validation of a nomogram for preoperative prediction of lymph node metastasis in early gastric cancer

Abstract

Background: 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. Methods: This 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. Results: Totally, 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. Conclusions: Our 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.

Nomograms Involving HER2 for Predicting Lymph Node Metastasis in Early Gastric Cancer

“…The incidence of lymph node metastasis in our study was 17.33%, which is similar to previous studies (Pereira et al, 2018;Yin et al, 2020;Mei et al, 2021). Although our study confirmed that lymphovascular invasion and perineural invasion were risk factors for lymph node metastasis in patients with EGC, clinicians could not obtain evidence of lymphovascular invasion and perineural invasion in the period of preoperative evaluation; thus, it was not included in the multivariate model.…”

Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

“…However, few molecular markers have proven useful in diagnosing lymph node metastasis in actual clinical specimens. These include VEGF-C (43,44), EGFR (99), E-cadherin (100, 101), CD44v6 (102), and p53 (103,104). Unfortunately, these are still in the research stage and have not yet been used in clinical practice.…”

A novel prognostic model based on epithelial-mesenchymal transition-related genes predicts patient survival in gastric cancer

“…For example, miR-489 overexpression can inhibit the survival, invasion, and migration of gastric cancer cells, and circulating lncRNAs play an important role in the early diagnosis of GC [ 34 , 35 ]. Furthermore, the clinical results of gastric cancer can be predicted by constructing nomogram [ 36 ].…”