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A nomogram for predicting the likelihood of lymph node metastasis in early gastric signet ring cell carcinoma

View Article: PubMed Central - PubMed

ABSTRACT

Treatment algorithm has not been established for early gastric cancer with signet ring cell carcinoma (SRC), which has a reported low rate of lymph node metastasis (LNM) similar to differentiated cancer. A cohort of 256 patients with early gastric SRC at our center between January 2002 and December 2015 were retrospectively reviewed. Multivariate logistic regression analysis was used to determine the independent factors of LNM. A nomogram for predicting LNM was constructed and internally validated. Additional external validation was performed using the database from Cancer Institute Ariake Hospital in Tokyo (n = 1273). Clinical performance of the model was assessed by decision analysis of curve. The overall LNM incidence was 12.9% (33/256). The multivariate logistic model identified sex, tumor size, and LVI as covariates associated with LNM. Subsequently, a nomogram consisted of sex, tumor size, and depth of invasion was established. The model showed qualified discrimination ability both in internal validation (area under curve, 0.801; 95% confidence interval [CI], 0.729–0.873) and in external dataset (area under curve, 0.707; 95% CI, 0.657–0.758). Based on the nomogram, treatment algorithm for early gastric SRC was proposed to assist clinicians in making better decisions. We developed a nomogram predicting risk of LNM for early gastric SRC, which should be helpful for patient counseling and surgical decision-making.

No MeSH data available.


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A treatment algorithm for patients with early gastric cancer with signet ring cell carcinoma.
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Figure 3: A treatment algorithm for patients with early gastric cancer with signet ring cell carcinoma.

Mentions: Based on the nomogram, we constructed a treatment algorithm for patients with early gastric SRC as illustrated in Fig. 3. The threshold of risk stratification could be chosen at the preference of clinicians. Those evaluated as low-risk before ESD would be scrutinized again based on pathological analysis. Only those patients who met both low risk and negative LVI, were suggested a regular surveillance. In decision analysis of curve described as Vickers et al,[18] our algorithm showed superiority to the current strategy (mucosal SRC without LVI, and size ≤2 cm) in most range (Fig. 4A). If 10% was arbitrary chose as a cutoff, 140 patients would be regarded as low risk in accordance with the final pathology analysis. Incidence of LNM was 2.9% (4/140) in the low-risk subgroup, and 25.0% (29/116) in the high-risk subgroup. Moreover, about 39 patients will spare an unnecessary resection without missing cancers compared with the strategy that resection on all patients in theory (Fig. 4B).


A nomogram for predicting the likelihood of lymph node metastasis in early gastric signet ring cell carcinoma
A treatment algorithm for patients with early gastric cancer with signet ring cell carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120931&req=5

Figure 3: A treatment algorithm for patients with early gastric cancer with signet ring cell carcinoma.
Mentions: Based on the nomogram, we constructed a treatment algorithm for patients with early gastric SRC as illustrated in Fig. 3. The threshold of risk stratification could be chosen at the preference of clinicians. Those evaluated as low-risk before ESD would be scrutinized again based on pathological analysis. Only those patients who met both low risk and negative LVI, were suggested a regular surveillance. In decision analysis of curve described as Vickers et al,[18] our algorithm showed superiority to the current strategy (mucosal SRC without LVI, and size ≤2 cm) in most range (Fig. 4A). If 10% was arbitrary chose as a cutoff, 140 patients would be regarded as low risk in accordance with the final pathology analysis. Incidence of LNM was 2.9% (4/140) in the low-risk subgroup, and 25.0% (29/116) in the high-risk subgroup. Moreover, about 39 patients will spare an unnecessary resection without missing cancers compared with the strategy that resection on all patients in theory (Fig. 4B).

View Article: PubMed Central - PubMed

ABSTRACT

Treatment algorithm has not been established for early gastric cancer with signet ring cell carcinoma (SRC), which has a reported low rate of lymph node metastasis (LNM) similar to differentiated cancer. A cohort of 256 patients with early gastric SRC at our center between January 2002 and December 2015 were retrospectively reviewed. Multivariate logistic regression analysis was used to determine the independent factors of LNM. A nomogram for predicting LNM was constructed and internally validated. Additional external validation was performed using the database from Cancer Institute Ariake Hospital in Tokyo (n = 1273). Clinical performance of the model was assessed by decision analysis of curve. The overall LNM incidence was 12.9% (33/256). The multivariate logistic model identified sex, tumor size, and LVI as covariates associated with LNM. Subsequently, a nomogram consisted of sex, tumor size, and depth of invasion was established. The model showed qualified discrimination ability both in internal validation (area under curve, 0.801; 95% confidence interval [CI], 0.729–0.873) and in external dataset (area under curve, 0.707; 95% CI, 0.657–0.758). Based on the nomogram, treatment algorithm for early gastric SRC was proposed to assist clinicians in making better decisions. We developed a nomogram predicting risk of LNM for early gastric SRC, which should be helpful for patient counseling and surgical decision-making.

No MeSH data available.


Related in: MedlinePlus