Liu Zitao, Tian Huakai, Huang Yongshan, Liu Yu, Zou Feilong, Huang Chao
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Front Surg. 2023 Jan 6;9:986806. doi: 10.3389/fsurg.2022.986806. eCollection 2022.
The status of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) is particularly important for the formulation of clinical treatment. The purpose of this study was to construct a nomogram to predict the risk of LNM in EGC before operation.
Univariate analysis and logistic regression analysis were used to determine the independent risk factors for LNM. The independent risk factors were included in the nomogram, and the prediction accuracy, discriminant ability and clinical practicability of the nomogram were evaluated by the receiver operating characteristic curve (ROC), calibration curve and clinical decision curve (DCA), and 100 times ten-fold cross-validation was used for internal validation.
33 (11.3%) cases of AGC were pathologically confirmed as LNM. In multivariate analysis, T stage, presence of enlarged lymph nodes on CT examination, carbohydrate antigen 199 (CA199), undifferentiated histological type and systemic inflammatory response index (SIRI) were risk factors for LNM. The area under the ROC curve of the nomogram was 0.86, the average area under the ROC curve of the 100-fold ten-fold cross-validation was 0.85, and the value of the Hosmer-Lemeshow test was 0.60. In addition, the clinical decision curve, net reclassification index (NRI) and Integrated Discriminant Improvement Index (IDI) showed that the nomogram had good clinical utility.
We found that SIRI is a novel biomarker for preoperative prediction of LNM in EGC, and constructed a nomogram for preoperative prediction of the risk of LNM in EGC, which is helpful for the formulation of the clinical treatment strategies.
早期胃癌（EGC）患者的淋巴结转移（LNM）状态对临床治疗方案的制定尤为重要。本研究旨在构建一种列线图，用于术前预测EGC患者发生LNM的风险。
采用单因素分析和逻辑回归分析确定LNM的独立危险因素。将独立危险因素纳入列线图，并通过受试者工作特征曲线（ROC）、校准曲线和临床决策曲线（DCA）评估列线图的预测准确性、判别能力和临床实用性，采用100次十折交叉验证进行内部验证。
33例（11.3%）AGC病例经病理证实发生LNM。多因素分析显示，T分期、CT检查发现肿大淋巴结、糖类抗原199（CA199）、未分化组织学类型和全身炎症反应指数（SIRI）是LNM的危险因素。列线图的ROC曲线下面积为0.86，100次十折交叉验证的ROC曲线下平均面积为0.85，Hosmer-Lemeshow检验的P值为0.60。此外，临床决策曲线、净重新分类指数（NRI）和综合判别改善指数（IDI）表明列线图具有良好的临床实用性。
我们发现SIRI是术前预测EGC患者LNM的一种新型生物标志物，并构建了术前预测EGC患者LNM风险的列线图，这有助于制定临床治疗策略。
