Difficulty of predicting the presence of lymph node metastases in patients with clinical early stage gastric cancer: a case control study

Nakagawa, Masatoshi; Choi, Yoon Young; An, Ji Yeong; Lee, Hyuk-Joon; Seo, Sang Hyuk; Shin, Hyun Beak; Bang, Hyun Joo; Li, Shuangxi; Kim, Wook; Cheong, Jae‐Ho; Hyung, Woo Jin; Noh, Sung Hoon

doi:10.1186/s12885-015-1940-3

Cited by 23 publications

(22 citation statements)

References 38 publications

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“…Lager tumor size, depressed type, and poor differentiation were proved to be independent risk factors in the present study which coincides with previous studies [19][20][21]. Lager tumor size, depressed type, and poor differentiation indicated worse biological behavior, which might also indicate higher probability of LNM.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 92%

“…However, since the cost of PET-CT was expensive, it was not a regular examination for patients. Thus, CT is still the most reliable tool in current practice [19]. In our study, CT was proved to be an independent predictor of LNM in EGC.…”

Section: Discussionsupporting

confidence: 55%

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

et al. 2020

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“…72 In AGC with LNM, large or clustered LNs are usually found around the primary lesion [34]. 73 However, EGC with few LNM usually has very small metastatic LNs and is less typical in MDCT imaging than in AGC [35]. 74 Microscopic metastases found in the LNs of patients with EGC are often classed as negative because the diameters do not meet the criteria for LNM, which makes accurate N staging more di cult in EGC than in AGC [12].…”

Section: Discussionmentioning

confidence: 99%

“…Search strategy: Two authors searched systematically from the PubMed, Cochrane library and Web of science databases for all relevant articles published from January 01, 2002 to April 01, 2020, that about MDCT for preoperative N staging of GC in Eastern Asia. 35 The following keywords were used in the search article: "(stomach neoplasm) OR (gastric neoplasm) OR (stomach cancers) OR (gastric cancer) OR (cancer, gastric) OR (gastric cancers) OR (stomach cancer)" and "(lymph node metastasis) OR (lymph node involvement) OR (lymph node staging) OR (lymphatic metastasis) OR (nodal involvement) OR (lymph node status) OR (N staging)" and "(computed tomography) OR (multidetector computed tomography) OR (CT) OR (MDCT)". 36 No language restrictions, and also manually checked whether the reference list of the related studies met the inclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Multidetector Computed Tomography for N Staging of Gastric Cancer in Eastern Asia: A Meta-analysis and Systematic Review

Gao

Zhang³

2020

Preprint

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Abstract Background:Eastern Asia is a region with a high incidence of gastric cancer (GC), and the detection rate of early gastric cancer (EGC) has been rising in recent decades.2With the development of endoscopic submucosal dissection (ESD) and the scope of its indications gradually expanded,the treatment for EGC is becoming a hot topic, which involves accurate preoperative evaluation.3The purpose of this study was to assess overall accuracy of multidetector computed tomography (MDCT) in N staging of GC in Eastern Asia.4Methods: A comprehensive search was conducted to collect all relevant published studies about MDCT in assessing N staging of GC in Eastern Asia, within the PubMed, Cochrane library and Web of science databases from January 01, 2002 to April 01, 2020.5 The raw data from the included studies calculated the pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for evaluating the performance of MDCT.6 The studies were grouped according to different criteria to assess the effect of possible factors on the sensitivity of MDCT.7Results: fourteen studies (5119 patients) were included in this analysis.8 In Eastern Asia, MDCT had a pooled accuracy of 67% (95% confidence interval [CI] 0.62-0.72, I = 90.1%) for N staging. By subgroup analysis, reference diameter of lymph node metastasis (LNM) and degree of tumor invasion (DTI) were correlated with the sensitivity of N staging.9 And the pooled sensitivity for N+ of EGC was relatively low.10Conclusions: In Eastern Asia, as the influence of reference diameter of LNM and DTI, the sensitivity of MDCT in N staging of GC was insufficient.11 This may lead to incorrect preoperative staging, so that patients with GC may be over treated or inadequate lymph node (LN)dissection.12 The hierarchical assessment strategy may significantly improve the sensitivity for N+ of EGC to make appropriate methods of treatment.13

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“…Consequently, the development of methods to accurately predict the presence of lymph node metastases is a current research focus, and this issue must be addressed in order to actively propagate minimally invasive surgery for gastric cancer. Numerous prior studies have tried to predict lymph node metastases preoperatively using various clinical variables (14)(15)(16). However, the methods reported in these studies are not yet sufficiently accurate for translation into clinical use.…”

mentioning

confidence: 99%

Difficulty of predicting the presence of lymph node metastases in patients with clinical early stage gastric cancer: a case control study

Cited by 23 publications

References 38 publications

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

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

Accuracy of Multidetector Computed Tomography for N Staging of Gastric Cancer in Eastern Asia: A Meta-analysis and Systematic Review

The era of laparoscopic surgery for gastric cancer: what is the present territory and what will be next?

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