A Nomogram for Predicting Extraperigastric Lymph Node Metastasis in Patients With Early Gastric Cancer

Abstract

Background There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM). Materials and Methods Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation. Results Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement. Conclusions A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.

Early Gastric Cancers in Central Norway 2001 to 2016—A Population-Based Study

“…In our relatively small cohort containing only eight N+ patients, these sub-analyses did not reach statistical significance. Patients with N+ had a tumor invasion depth of M, SM1, or SM2 at frequencies similar to previous reports [ 46 , 47 ]. The eCura risk score has recently been proposed to identify patients who after ESD of EGC should be considered for subsequent formal surgical resection.…”

Risk Factors for Lymph Node Metastasis in a Western Series of Patients with Distal Early Gastric Cancer

“…EGC has a generally excellent prognosis, with the 5-year survival rate exceeding 90% after curative resection [2,3,5,10,16,19,29,[31][32][33][34][35][36]. This scenario can be changed by LNMs, because node-positive patients show a significant decline in survival expectancy [3,16].…”

“…In the present study, T1b cancer was associated with a higher number of LNMs than in mucosal invasion, despite the fact that no LNM from station 7 to 12 was observed in our patients. D1+ lymphadenectomy has been recommended in Eastern countries for EGC where alternative treatment is considered unlikely to be effective [5,25,34].…”

“…The removal of at least 16 LNs would allow the N stage to be precisely defined. A lymphadenectomy of at least 16 LNs would not lead to an increase in postoperative mortality [6,13,25,30,34,42]. The number of retrieved LNs serves as prognostic factor for gastric cancer, despite the fact that the optimal number of retrieved LNs remains controversial.…”