Nomogram to predict lymph node metastasis in patients with early gastric cancer: a useful clinical tool to reduce gastrectomy after endoscopic resection

Su Mi Kim; Byung-Hoon Min; Joong Hyun Ahn; Sin-Ho Jung; Ji Yeong An; Min Gew Choi; Tae Sung Sohn; Jae Moon Bae; Sung Kim; Hyuk Lee; Jun Haeng Lee; Young Woo Kim; Keun Won Ryu; Jae J. Kim; Jun Ho Lee

doi:10.1055/a-1117-3059

Endoscopy, Table of Contents

Endoscopy 2020; 52(06): 435-443
DOI: 10.1055/a-1117-3059

Original article

Nomogram to predict lymph node metastasis in patients with early gastric cancer: a useful clinical tool to reduce gastrectomy after endoscopic resection

Su Mi Kim‡^*

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

²Department of Surgery, CHA Bundang Hospital, CHA University School of Medicine, Seoul, Republic of Korea (current address)

,

Byung-Hoon Min‡^*

³Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Joong Hyun Ahn

⁴Biostatistics, Samsung Medical Center, Seoul, Republic of Korea

,

Sin-Ho Jung

⁵Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA

,

Ji Yeong An

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Min Gew Choi

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Tae Sung Sohn

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Jae Moon Bae

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Sung Kim

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Hyuk Lee

³Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Jun Haeng Lee

³Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Young Woo Kim

⁶Gastric Cancer Branch, Division of Translational & Clinical Research, National Cancer Center, Seoul, Republic of Korea

,

Keun Won Ryu

⁶Gastric Cancer Branch, Division of Translational & Clinical Research, National Cancer Center, Seoul, Republic of Korea

,

Jae J. Kim

³Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

,

Jun Ho Lee

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

› Author Affiliations

Abstract

Background The indications for endoscopic dissection have been expanded to improve the quality of life of patients with early gastric cancer (EGC). This study aimed to develop a nomogram to predict the status of lymph node metastasis with the aim of avoiding unnecessary gastrectomies.

Methods We reviewed the clinicopathological data of 10 579 patients who underwent curative resection for EGC. The nomogram was developed by multivariate analysis and was evaluated by external validation. Overall, disease-free and recurrence-free survival were compared between the gastrectomy group of 6641 patients and the endoscopic dissection group of 999 patients to show the efficacy of the nomogram.

Results Multivariate analyses revealed that age, tumor size, lymphatic invasion, depth of invasion, and histologic differentiation were all significant prognostic factors for lymph node metastasis. The nomogram had good discriminatory performance, with a concordance index of 0.846. This was supported by the external validation point of 0.813. For patients with low risk of lymph node metastasis on the nomogram (≤ 3 % of the provisional value in this study), the endoscopic dissection and gastrectomy groups had comparable rates of overall (P = 0.32), disease-free (P = 0.47), and recurrence-free (P = 0.09) survival.

Conclusions We developed and validated a nomogram that predicts the risk of lymph node metastasis in EGC based on a large database. This precision nomogram is useful to avoid unnecessary gastrectomy after endoscopic dissection, which may ultimately improve the quality of life of patients with EGC.

Full Text

References

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