Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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A Nomogram for Predicting Extraperigastric Lymph Node Metastasis in Patients With Early Gastric Cancer

  • Hyun Joo Yoo (Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hayemin Lee (Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Han Hong Lee (Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jun Hyun Lee (Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kyong-Hwa Jun (Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jin-jo Kim (Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kyo-young Song (Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Dong Jin Kim (Division of Gastrointestinal Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2023.04.09
  • Accepted : 2023.04.12
  • Published : 2023.04.30
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Abstract

Background: 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). Materials and Methods: 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. Results: 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. Conclusions: 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.

Keywords

Acknowledgement

This work was partially supported by the Clinical Trials Center of Eunpyeong St. Mary's Hospital, The Catholic University of Korea.

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