Risk factors of lymph node metastasis or lymphovascular invasion for early gastric cancer: a practical and effective predictive model based on international multicenter data

Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative f...

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Published in:	BMC cancer Vol. 19; no. 1; pp. 1048 - 9
Main Authors:	Lin, Jian-Xian, Wang, Zu-Kai, Wang, Wei, Desiderio, Jacopo, Xie, Jian-Wei, Wang, Jia-Bin, Lu, Jun, Chen, Qi-Yue, Cao, Long-Long, Lin, Mi, Tu, Ru-Hong, Zheng, Chao-Hui, Li, Ping, Parisi, Amilcare, Zhou, Zhi-Wei, Huang, Chang-Ming
Format:	Journal Article
Language:	English
Published:	London BioMed Central 06.11.2019 BioMed Central Ltd BMC
Subjects:	Aged Biomedical and Life Sciences Biomedicine Cancer cancer imaging Cancer metastasis Cancer Research Early Detection of Cancer - methods Early gastric cancer Female Gastrectomy - methods Gastric Mucosa - pathology Gastric Mucosa - surgery Health Promotion and Disease Prevention Humans interventional therapeutics Lymph Node Excision - methods Lymph node metastasis Lymphatic Metastasis Lymphovascular invasion Male Medical research Medicine/Public Health Middle Aged Multivariate Analysis Neoplasm Invasiveness Oncology Predictive model Prognosis Recursive partitioning analysis Regression analysis Research Article Risk Factors Stomach cancer Stomach Neoplasms - diagnosis Stomach Neoplasms - surgery Surgery Surgical Oncology Survival Analysis Tumors Lymph node metastasis Recursive partitioning analysis Early gastric cancer Lymphovascular invasion Predictive model
ISSN:	1471-2407, 1471-2407
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Abstract	Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. Methods EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center ( n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial ( n = 172) were selected as the validation set. Results In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference ( P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659–0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively ( P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662–0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. Conclusions The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested.
AbstractList	Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. Methods EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set. Results In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. Conclusions The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested. Keywords: Lymph node metastasis, Lymphovascular invasion, Early gastric cancer, Predictive model, Recursive partitioning analysis Abstract Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. Methods EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set. Results In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659–0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662–0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. Conclusions The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested. Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set. In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested. Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set. In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested. Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors. Methods EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center ( n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial ( n = 172) were selected as the validation set. Results In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference ( P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659–0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively ( P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662–0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set. Conclusions The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested. Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors.BACKGROUNDMost lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by postoperative pathology. In this study, we aimed to develop a model for predicting the risk of LNM/LVI in EGC using preoperative factors.EGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set.METHODSEGC patients who underwent radical gastrectomy at Fujian Medical University Union Hospital and Sun Yat-sen University Cancer Center (n = 1460) were selected as the training set. The risk factors of LNM/LVI were investigated. Data from the International study group on Minimally Invasive surgery for GASTRIc Cancer trial (n = 172) were selected as the validation set.In the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set.RESULTSIn the training set, the incidence of LNM/LVI was 21.6%. The 5-year cancer-specific survival rates of patients with and without LNM/LVI were 92.4 and 95.0%, respectively, with significant difference (P = 0.030). Multivariable logistic regression analysis showed that the four independent risk factors for LNM/LVI were female, tumor larger than 20 mm, submucosal invasion and undifferentiated tumor histological type (all P < 0.05); the area under the curve (AUC) was 0.694 (95% confidence interval [CI]: 0.659-0.730). Patients were divided into low-risk, intermediate-risk, high-risk and extremely high-risk groups by recursive partitioning analysis; the incidences of LNM/LVI were 5.4, 12.6, 24.2 and 37.8%, respectively (P < 0.001). The AUC of the validation set was 0.796 (95%CI, 0.662-0.851) and the predictive performance of the LNM/LVI risk in the validation set was consistent with that in the training set.The risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested.CONCLUSIONSThe risk of LNM/LVI in differentiated mucosal EGC is low, which indicated that endoscopic resection is a treatment option. The risk of LNM/LVI in undifferentiated mucosal EGC and submucosa EGC are high and gastrectomy with lymph node dissection is suggested.
ArticleNumber	1048
Audience	Academic
Author	Wang, Wei Zheng, Chao-Hui Zhou, Zhi-Wei Li, Ping Lin, Mi Wang, Zu-Kai Chen, Qi-Yue Parisi, Amilcare Huang, Chang-Ming Wang, Jia-Bin Tu, Ru-Hong Desiderio, Jacopo Lin, Jian-Xian Lu, Jun Xie, Jian-Wei Cao, Long-Long
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Keywords	Lymph node metastasis Recursive partitioning analysis Early gastric cancer Lymphovascular invasion Predictive model
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PublicationTitle	BMC cancer
PublicationTitleAbbrev	BMC Cancer
PublicationTitleAlternate	BMC Cancer
PublicationYear	2019
Publisher	BioMed Central BioMed Central Ltd BMC
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References_xml	– volume-title: AJCC Cancer staging manual year: 2017 ident: 6147_CR12 doi: 10.1007/978-3-319-40618-3 – volume: 20 start-page: 978 issue: 6 year: 2017 ident: 6147_CR20 publication-title: Gastric Cancer doi: 10.1007/s10120-017-0709-6 – volume: 168 start-page: 188 issue: 2 year: 2011 ident: 6147_CR11 publication-title: J Surg Res doi: 10.1016/j.jss.2009.10.030 – volume: 49 start-page: 253 issue: 4 year: 2010 ident: 6147_CR15 publication-title: Intern Med doi: 10.2169/internalmedicine.49.2816 – volume: 16 start-page: 92 year: 2016 ident: 6147_CR7 publication-title: BMC Cancer doi: 10.1186/s12885-016-2132-5 – volume: 106 start-page: 493 issue: 4 year: 2010 ident: 6147_CR8 publication-title: BJU Int doi: 10.1111/j.1464-410X.2009.09166.x – volume: 21 start-page: 133 issue: 1 year: 2018 ident: 6147_CR5 publication-title: Gastric Cancer doi: 10.1007/s10120-017-0719-4 – volume: 20 start-page: 583 issue: 4 year: 2017 ident: 6147_CR23 publication-title: Gastric Cancer doi: 10.1007/s10120-016-0645-x – volume: 13 start-page: 221 issue: 2 year: 2006 ident: 6147_CR1 publication-title: Ann Surg Oncol doi: 10.1245/ASO.2006.04.028 – volume: 48 start-page: 225 issue: 2 year: 2001 ident: 6147_CR19 publication-title: Gut doi: 10.1136/gut.48.2.225 – volume: 19 start-page: 1529 issue: 5 year: 2012 ident: 6147_CR10 publication-title: Ann Surg Oncol doi: 10.1245/s10434-011-2115-3 – volume: 243 start-page: 64 issue: 1 year: 2006 ident: 6147_CR21 publication-title: Ann Surg doi: 10.1097/01.sla.0000194087.96582.3e – volume: 11 start-page: e0156207 issue: 5 year: 2016 ident: 6147_CR6 publication-title: PLoS One doi: 10.1371/journal.pone.0156207 – volume: 24 start-page: 171 issue: 1 year: 2010 ident: 6147_CR26 publication-title: Oncol Rep – volume: 293 start-page: 572 issue: 5 year: 2005 ident: 6147_CR30 publication-title: Jama doi: 10.1001/jama.293.5.572 – volume: 3 start-page: 219 issue: 4 year: 2000 ident: 6147_CR3 publication-title: Gastric Cancer doi: 10.1007/PL00011720 – volume: 14 start-page: 101 issue: 2 year: 2011 ident: 6147_CR13 publication-title: Gastric Cancer doi: 10.1007/s10120-011-0041-5 – volume: 97 start-page: 868 issue: 6 year: 2010 ident: 6147_CR16 publication-title: Br J Surg doi: 10.1002/bjs.7033 – volume-title: Classification and regression trees year: 1984 ident: 6147_CR28 – volume: 19 start-page: 860 issue: 3 year: 2016 ident: 6147_CR24 publication-title: Gastric Cancer doi: 10.1007/s10120-015-0535-7 – volume: 20 start-page: 1 issue: 1 year: 2017 ident: 6147_CR2 publication-title: Gastric Cancer doi: 10.1007/s10120-016-0622-4 – volume: 11 start-page: 134 issue: 3 year: 2008 ident: 6147_CR9 publication-title: Gastric Cancer doi: 10.1007/s10120-008-0476-5 – volume: 10 start-page: 1 issue: 1 year: 2007 ident: 6147_CR14 publication-title: Gastric Cancer doi: 10.1007/s10120-006-0408-1 – volume: 264 start-page: 1038 issue: 6 year: 2016 ident: 6147_CR27 publication-title: Ann Surg doi: 10.1097/SLA.0000000000001602 – volume: 22 start-page: 1813 issue: 6 year: 2015 ident: 6147_CR25 publication-title: Ann Surg Oncol doi: 10.1245/s10434-014-4167-7 – volume: 307 start-page: 588 issue: 10 year: 1982 ident: 6147_CR29 publication-title: N Engl J Med doi: 10.1056/NEJM198209023071004 – volume: 58 start-page: 331 issue: 3 year: 2009 ident: 6147_CR17 publication-title: Gut doi: 10.1136/gut.2008.165381 – volume: 32 start-page: 1314 issue: 3 year: 2018 ident: 6147_CR4 publication-title: Surg Endosc doi: 10.1007/s00464-017-5809-1 – volume: 15 start-page: 370 year: 2015 ident: 6147_CR22 publication-title: BMC Cancer doi: 10.1186/s12885-015-1370-2 – volume: 9 start-page: 262 issue: 4 year: 2006 ident: 6147_CR18 publication-title: Gastric Cancer doi: 10.1007/s10120-006-0389-0
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Snippet	Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be... Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be confirmed by... Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI must be... Abstract Background Most lymph node metastasis (LNM) models for early gastric cancer (EGC) include lymphovascular invasion (LVI) as a predictor. However, LVI...
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SubjectTerms	Aged Biomedical and Life Sciences Biomedicine Cancer cancer imaging Cancer metastasis Cancer Research Early Detection of Cancer - methods Early gastric cancer Female Gastrectomy - methods Gastric Mucosa - pathology Gastric Mucosa - surgery Health Promotion and Disease Prevention Humans interventional therapeutics Lymph Node Excision - methods Lymph node metastasis Lymphatic Metastasis Lymphovascular invasion Male Medical research Medicine/Public Health Middle Aged Multivariate Analysis Neoplasm Invasiveness Oncology Predictive model Prognosis Recursive partitioning analysis Regression analysis Research Article Risk Factors Stomach cancer Stomach Neoplasms - diagnosis Stomach Neoplasms - surgery Surgery Surgical Oncology Survival Analysis Tumors
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Title	Risk factors of lymph node metastasis or lymphovascular invasion for early gastric cancer: a practical and effective predictive model based on international multicenter data
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