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*
1   Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
2   Department of Surgery, CHA Bundang Hospital, CHA University School of Medicine, Seoul, Republic of Korea (current address)
,
Byung-Hoon Min*
3   Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Joong Hyun Ahn
4   Biostatistics, Samsung Medical Center, Seoul, Republic of Korea
,
Sin-Ho Jung
5   Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
,
Ji Yeong An
1   Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Min Gew Choi
1   Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Tae Sung Sohn
1   Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Jae Moon Bae
1   Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Sung Kim
1   Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Hyuk Lee
3   Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Jun Haeng Lee
3   Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Young Woo Kim
6   Gastric Cancer Branch, Division of Translational & Clinical Research, National Cancer Center, Seoul, Republic of Korea
,
Keun Won Ryu
6   Gastric Cancer Branch, Division of Translational & Clinical Research, National Cancer Center, Seoul, Republic of Korea
,
Jae J. Kim
3   Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Jun Ho Lee
1   Department 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.

* Contributed equally to this work




Publication History

Received: 06 September 2019

Accepted: 17 January 2020

Article published online:
11 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
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