title: A nomogram composed of clinicopathologic features and preoperative serum tumor markers to predict lymph node metastasis in early gastric cancer patients.
abstract: Predicting lymph node metastasis (LNM) accurately is of great importance to formulate optimal treatment strategies preoperatively for patients with early gastric cancer (EGC). This study aimed to explore risk factors that predict the presence of LNM in EGC. A total of 697 patients underwent gastrectomy enrolled in this study, were divided into training and validation set, and the relationship between LNM and other clinicopathologic features, preoperative serum combined tumor markers (CEA, CA19-9, CA125) were evaluated. Risk factors for LNM were identified using logistic regression analysis, and a nomogram was created by R program to predict the possibility of LNM in training set, while receiver operating characteristic (ROC) analysis was applied to assess the predictive value of the nomogram model in validation set. Consequently, LNM was significantly associated with tumor size, macroscopic type, differentiation type, ulcerative findings, lymphovascular invasion, depth of invasion and combined tumor marker. In multivariate logistic regression analysis, factors including of tumor size, differentiation type, ulcerative findings, lymphovascular invasion, depth of invasion and combined tumor marker were demonstrated to be independent risk factors for LNM. Moreover, a predictive nomogram with these independent factors for LNM in EGC patients was constructed, and ROC curve demonstrated a good discrimination ability with the AUC of 0.847 (95% CI: 0.789-0.923), which was significantly larger than those produced in previous studies. Therefore, including of these tumor markers which could be convenient and feasible to obtain from the serum preoperatively, the nomogram could effectively predict the incidence of LNM for EGC patients.
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.|West China School of Medicine, Sichuan University, China.
authors.forename: Lin-Yong
authors.initials: LY
authors.lastname: Zhao
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yin
authors.affiliation: West China School of Medicine, Sichuan University, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Li
authors.affiliation: West China School of Medicine, Sichuan University, China.
authors.forename: Chen-Jing
authors.initials: CJ
authors.lastname: Zhu
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.|West China School of Medicine, Sichuan University, China.
authors.forename: Yi-Gao
authors.initials: YG
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.|West China School of Medicine, Sichuan University, China.
authors.forename: Wei-Han
authors.initials: WH
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.
authors.forename: Xin-Zu
authors.initials: XZ
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.|West China School of Medicine, Sichuan University, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.
authors.forename: Zhi-Xin
authors.initials: ZX
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.
authors.forename: Jia-Ping
authors.initials: JP
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.
authors.forename: Zong-Guang
authors.initials: ZG
authors.lastname: Zhou
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, China.
authors.forename: Jian-Kun
authors.initials: JK
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D049451:Nomograms; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012372:ROC Curve; D013274:Stomach Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
keywords: early gastric cancer; lymph node metastasis; nomogram; prediction; tumor markers