title: Nomogram Incorporating CD44v6 and Clinicopathological Factors to Predict Lymph Node Metastasis for Early Gastric Cancer.
abstract: BACKGROUND
  Treatment strategy for early gastric cancer depends on the probability of lymph node metastasis. The aim of this study is to develop a nomogram predicting lymph node metastasis in early gastric cancer using clinicopathological factors and biomarkers.
  
  
  METHODS
  A literature review was performed to identify biomarkers related to lymph node metastasis in gastric cancer. Seven markers were selected and immunohistochemistry was performed in 336 early gastric cancer tissues. Based on the multivariable analysis, a prediction model including clinicopatholgical factors and biomarkers was developed, and benefit of adding biomarkers was evaluated using the area under the receiver operating curve and net reclassification improvement. Functional study in gastric cancer cell line was performed to evaluate mechanism of biomarker.
  
  
  RESULTS
  Of the seven biomarkers studied, α1 catenin and CD44v6 were significantly associated with lymph node metastasis. A conventional prediction model, including tumor size, histological type, lymphatic blood vessel invasion, and depth of invasion, was developed. Then, a new prediction model including both clinicopathological factors and CD44v6 was developed. Net reclassification improvement analysis revealed a significant improvement of predictive performance by the addition of CD44v6, and a similar result was shown in the internal validation using bootstrapping. Prediction nomograms were then constructed based on these models. In the functional study, CD44v6 was revealed to affect cell proliferation, migration and invasion.
  
  
  CONCLUSIONS
  Overexpression of CD44v6 was a significant predictor of lymph node metastasis in early gastric cancer. The prediction nomograms incorporating CD44v6 can be useful to determine treatment plans in patients with early gastric cancer.
authors.affiliation: Department of Medicine, Yonsei University Graduate School of Medicine, Seoul, Republic of Korea.|Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Bang Wool
authors.initials: BW
authors.lastname: Eom
authors.affiliation: Cancer Biostatistics Branch, Research Institute for National Cancer Control & evaluation, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Jungnam
authors.initials: J
authors.lastname: Joo
authors.affiliation: Cancer Biostatistics Branch, Research Institute for National Cancer Control & evaluation, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Boram
authors.initials: B
authors.lastname: Park
authors.affiliation: Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Jo
authors.affiliation: Department of Medicine, Yonsei University Graduate School of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D045744:Cell Line, Tumor; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000032:analysis*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; C112697:CD44v6 antigen; D018960:Hyaluronan Receptors