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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Veröffentlicht in:BMC cancer Jg. 19; H. 1; S. 1048 - 9
Hauptverfasser: 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
Sprache:Englisch
Veröffentlicht: London BioMed Central 06.11.2019
BioMed Central Ltd
BMC
Schlagworte:
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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Zusammenfassung: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.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1471-2407
1471-2407
DOI:10.1186/s12885-019-6147-6