Pan Siwei, An Wen, Tan Yuen, Chen Qingchuan, Liu Pengfei, Xu Huimian
Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China.
Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China.
J Cancer. 2021 Jul 25;12(18):5583-5592. doi: 10.7150/jca.56702. eCollection 2021.
Patients with early gastric cancer (EGC) must suffer reoperation if diagnosed with a high possibility of lymph node (LN) metastasis. The purpose of the current study was to develop and validate a model to predict the risk of LN metastasis in elderly patients before endoscopic resection. A total of 1911 EGC patients who had undergone radical surgery were selected and assigned randomly (2:1) to either the training cohort or the validation cohort. A nomogram was established based on the univariate and multivariate logistic regression models using the training cohort. Cox proportional hazards regression models were applied to identify the prognostic factors in univariate and multivariable analyses. Three variables-tumor size, grade, and T stage-were derived from the multivariate analyses in the training cohort and incorporated into the nomogram. The AUC of the nomogram was 0.732 in the training cohort and 0.706 in the validation cohort. There were significant differences in survival among patients with different degrees of LN metastasis risk (training cohort: five-year disease-specific survival (DSS): low risk 88.1% vs. moderate risk 80.0% vs. high risk 72.9%, P < 0.001; validation cohort five-year DSS: low risk 89.0% vs. moderate risk 84.3% vs. high risk 72.2%, P < 0.001). The LN metastasis risk assessed from the model was also an independent prognostic factor. We established a nomogram that accurately predicts LN metastasis risk for elderly patients with EGC before endoscopic resection to avoid further injury from reoperation.
早期胃癌（EGC）患者若被诊断为有高淋巴结（LN）转移可能性，则必须接受再次手术。本研究的目的是开发并验证一种模型，以预测老年患者在内镜切除术前LN转移的风险。共选取1911例接受根治性手术的EGC患者，并随机（2:1）分配至训练队列或验证队列。基于训练队列，使用单变量和多变量逻辑回归模型建立了列线图。应用Cox比例风险回归模型在单变量和多变量分析中识别预后因素。从训练队列的多变量分析中得出肿瘤大小、分级和T分期这三个变量，并纳入列线图。列线图在训练队列中的AUC为0.732，在验证队列中的AUC为0.706。不同LN转移风险程度的患者在生存率上存在显著差异（训练队列：五年疾病特异性生存率（DSS）：低风险88.1% vs. 中度风险80.0% vs. 高风险72.9%，P < 0.001；验证队列五年DSS：低风险89.0% vs. 中度风险84.3% vs. 高风险72.2%，P < 0.001）。从该模型评估的LN转移风险也是一个独立的预后因素。我们建立了一种列线图，可准确预测老年EGC患者在内镜切除术前的LN转移风险，以避免再次手术造成进一步损伤。
