Yoo Hyun Joo, Lee Hayemin, Lee Han Hong, Lee Jun Hyun, Jun Kyong-Hwa, Kim Jin-Jo, Song Kyo-Young, Kim Dong Jin
Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
J Gastric Cancer. 2023 Apr;23(2):355-364. doi: 10.5230/jgc.2023.23.e18.
There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM).
Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation.
Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement.
A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.
目前尚无明确的指南来确定早期胃癌（EGC）是行D1还是D1+淋巴结清扫术。本研究旨在建立一种列线图，用于评估胃周外淋巴结转移（LNM）风险。
2009年至2019年间，本研究纳入了6家附属医院共4482例经病理证实为T1期疾病的患者。比较胃周外LNM阳性组和阴性组的基本临床病理特征。采用单因素和多因素分析评估可能的危险因素。基于这些结果，建立了风险预测模型。使用预测胃周外LNM的列线图进行内部验证。
多因素分析显示，肿瘤大小（临界值3.0 cm，比值比[OR]=1.886，P=0.030）、肿瘤深度（sm2和sm3浸润的肿瘤，OR=1.853，P=0.010）、横断面位置（位于大弯侧的肿瘤，OR=0.490，P=0.0303）、分化程度（分化型肿瘤，OR=0.584，P=0.0070）和淋巴管侵犯（OR=11.125，P<0.001）是胃周外LNM的可能危险因素。从这些危险因素中得出了一个评估胃周外LNM风险的方程。通过比较实际转移率和预测率对该方程进行内部验证，结果显示一致性良好。
成功建立了一种用于评估EGC胃周外LNM风险的列线图。尽管该模型基于病理数据开发应用存在一些局限性，但它可最佳地适用于内镜黏膜下剥离术后需要行根治性胃切除术的患者。
