Analysis Of Risk Factors And Construction Of Predictive Model For Occult Lymph Node Metastasis In CN0 Gingival Squamous Cell Carcinoma

Objective: Through retrospective analysis of the clinical data of 135 patients with clinical lymph node negative(cN0)gingival squamous cell carcinoma(GSCC),the relationship between clinicopathological characteristics of these patients and occult lymph node metastasis in the neck was explored,related risk factors were found.The prediction model was established and verified.It is expected to provide an intuitive and convenient decision-making aid for the clinical treatment of patients with cN0 GSCC.Methods: The clinicopathological data of cN0 GSCC patients diagnosed in the Department of Stomatology,Shengjing Hospital,China Medical University from January2009 to December 2018 were collected..After a follow-up period of at least two years,135 patients were randomly divided into train group and test group according to the ratio of 4:1.Logistic regression analysis was used in the train group to determine the risk factors for cervical occult lymph node metastasis in cN0 GSCC.And a risk prediction model for the cervical occult lymph node metastasis in cN0 GSCC was established(Nomogram).This study evaluated the discrimination and calibration of the prediction model and verified the conformity of the prediction model by including the test group data,the Consistency Index(C-index)and the Calibration Curve.Results: Among 135 patients,43 cases had cervical lymph node metastasis,with a positive rate of 31.9%.Multivariate Logistic regression analysis showed that neurological symptoms,tumor maximum diameter,bone invasion,and tumor differentiation could be used as independent predictors of cervical occult lymph node metastasis in patients with cN0 GSCC(all P <0.05).The risk prediction model has a high degree of discrimination(C-index=0.929)and calibration(Brier Scope=0.112) through the evaluation and verification of the consistency coefficient and the calibration curve,which can provide a basis for the clinical treatment of patients with cN0 GSCC.Conclusion: The occurrence of cervical OLNM in cN0 GSCC has nothing to do with gender,age,time of disease development,and location of primary tumor.Neurological symptoms,tumors with a maximum diameter of more than 4 cm,bone invasion breaking through the cortical bone,and poor differentiation are high-risk factors for cervical OLNM in cN0 GSCC.For these patients,selective lymph node dissection is recommended.The constructed prediction model can be used to predict the probability of cervical lymph node metastasis in cN0 GSCC patients before surgery,and help clinicians make decisions.