title: A new predictive model combined of tumor size, lymph nodes count and lymphovascular invasion for survival prognosis in patients with lymph node-negative gastric cancer.
abstract: BACKGROUND
  Various factors may affect the clinical prognosis of lymph node-negative gastric cancer (GC) patients. This study aimed to provide evaluable prognostic information of combination of tumor size (Ts), lymph nodes count (LNs) and lymphovascular invasion (LVI) in lymph node-negative GC patients.
  
  
  METHODS
  A total of 1,019 node-negative GC patients were enrolled in this retrospective study from 2000 to 2010. The cutoff points of Ts and LNs were determined using X-tile and patients were randomly categorized into training and validation sets by the sample size ratio 1:1. The clinicopathologic characteristics were analyzed and survival prognostic factors were identified, whereas the survival prediction accuracy was also compared by C-index during the different independent prognostic factors.
  
  
  RESULTS
  The cutoff points for Ts were 3cm and 5cm, while 14 was the cutoff point for LNs. Age, T stage, Ts, LNs and LVI were identified as independent prognostic factors in node-negative GC patients, and a new prognostic predictive model, TsNL staging system which was composed of Ts, LNs and LVI, was proposed in this study. Compared with T staging system, significant improvement of predictive accuracy for TsNL system was found. Furthermore, nomogram based on TsNL was more accurate in prognostic prediction than that based on Ts, LNs and LVI, separately.
  
  
  CONCLUSIONS
  Age, T stage, Ts, LNs and LVI were independent prognostic factors in lymph node-negative GC patients. The TsNL staging system, composed of Ts, LNs and LVI, which was closely associated with clinicopathologic features, may improve the prognostic prediction accuracy in node-negative GC patients.
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China School of Medicine, Sichuan University, Chengdu, China.
authors: Lin-Yong
authors: LY
authors: Zhao
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors: Xiao-Long
authors: XL
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China School of Medicine, Sichuan University, Chengdu, China.
authors: Yi-Gao
authors: YG
authors: Wang
authors: West China School of Medicine, Sichuan University, Chengdu, China.
authors: Yue
authors: Y
authors: Xin
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China School of Medicine, Sichuan University, Chengdu, China.
authors: Wei-Han
authors: WH
authors: Zhang
authors: West China School of Medicine, Sichuan University, Chengdu, China.
authors: Yin-Su
authors: YS
authors: Wang
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors: Xin-Zu
authors: XZ
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors: Kun
authors: K
authors: Yang
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors: Kai
authors: K
authors: Liu
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China School of Medicine, Sichuan University, Chengdu, China.
authors: Lian
authors: L
authors: Xue
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors: Bo
authors: B
authors: Zhang
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors: Zhi-Xin
authors: ZX
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors: Jia-Ping
authors: JP
authors: Chen
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors: Zong-Guang
authors: ZG
authors: Zhou
authors: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors: Jian-Kun
authors: JK
authors: Hu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D047368:Tumor Burden
keywords: gastric cancer; lymph nodes count; lymphovascular invasion; predictive model; tumor size