title: Nomogram for predicting lymph node metastasis rate of submucosal gastric cancer by analyzing clinicopathological characteristics associated with lymph node metastasis.
abstract: BACKGROUND
  To combine clinicopathological characteristics associated with lymph node metastasis for submucosal gastric cancer into a nomogram.
  
  
  METHODS
  We retrospectively analyzed 262 patients with submucosal gastric cancer who underwent D2 gastrectomy between 1996 and 2012. The relationship between lymph node metastasis and clinicopathological features was statistically analyzed. With multivariate logistic regression analysis, we made a nomogram to predict the possibility of lymph node metastasis. Receiver operating characteristic (ROC) analysis was also performed to assess the predictive value of the model. Discrimination and calibration were performed using internal validation.
  
  
  RESULTS
  A total number of 48 (18.3%) patients with submucosal gastric cancer have pathologically lymph node metastasis. For submucosal gastric carcinoma, lymph node metastasis was associated with age, tumor location, macroscopic type, size, differentiation, histology, the existence of ulcer and lymphovascular invasion in univariate analysis (all P<0.05). The multivariate logistic regression analysis identified that age ≤50 years old, macroscopic type III or mixed, undifferentiated type, and presence of lymphovascular invasion were independent risk factors of lymph node metastasis in submucosal gastric cancer (all P<0.05). We constructed a predicting nomogram with all these factors for lymph node metastasis in submucosal gastric cancer with good discrimination [area under the curve (AUC) =0.844]. Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.
  
  
  CONCLUSIONS
  We developed a nomogram to predict the rate of lymph node metastasis for submucosal gastric cancer. With good discrimination and internal validation, the nomogram improved individualized predictions for assisting clinicians to make appropriated treatment decision for submucosal gastric cancer patients.
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Zhixue
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Yinan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Lianhai
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Ziyu
authors.initials: Z
authors.lastname: Li
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Aiwen
authors.initials: A
authors.lastname: Wu
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Xiaojiang
authors.initials: X
authors.lastname: Wu
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Yiqiang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Zhaode
authors.initials: Z
authors.lastname: Bu
authors.affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1 Department of Gastrointestinal Surgery, 2 Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
authors.forename: Jiafu
authors.initials: J
authors.lastname: Ji
keywords: Endoscopic resection; lymph node metastasis; nomogram; receiver operating characteristic (ROC); submucosal gastric cancer