A Risk-scoring Model For Predicting Lymph Node Metastasis In Early Gastric Cancer Patients And External Validation

BackgroundThe possibility of lymph node metastasis(LNM)is critical to the assessment of the indication for endoscopic submucosal dissection.Thus,the aim of this study is to identify the risk factors for LNM and construct a risk-scoring model for patients with early gastric cancer to guide treatment.MethodsFirstly,a systematic search of the relevant literatures from January 2000 to February 2018 was generated.The comparison of the long-term outcomes of ESD treatment and surgical treatment in EGC was studied in this literature.This article aims at analyzing the feasibility and safety of ESD treatment in EGC.Secondly,a retrospective examination of reports and studies carried out January 2000 and December 2014,was conducted.A risk-scoring model for predicting LNM was developed based on the data thus collected.In addition,the model is subject to verification and validation by three external institutions.ResultsFinally,the Meta-analysis included 13 studies,including 4986 cases of early gastric cancer.The OS and DSS of patients with ESD are comparable to that of surgery.There was no significant difference in the 2 group(RRF=0.90,95%CI=0.68-1.19,p=0.46,fixed-effects model),(RR=0.40,95%CI=0.15-1.03,p=0.06,fixed-effect model).However,the DFS in the ESD group was lower than that in the surgery group and the former was 90.19%and the latter was 97.15%(RR=3.40,95%CI=2.39-4.84,p<0.001,fixed-effect model).Further analysis showed that the proportion of patients receiving radical treatment(ER or surgery)was significantly higher in the ESD(ESD group)than those in the gastrectomy.A retrospective study showed that of the 1029 patients,228 patients(22.16%)had LNM.Multivariate analysis showed that female,depressed type,undifferentiated type,submucosa,tumor size and lymphovascular invasion were significantly associated with LNM.An 11-point risk-scoring model was used to predict LNM risk.An area under the receiver-operating characteristic(AUROC)of the risk-scoring model was plotted using the development set and the AUROC of the model[0.761(95%CI:0.73-0.80)]to predict LNM risk.After external validation,the AUROC curve for predicting LNM was 0.771(95%CI:0.68-0.86),0.815(95%CI:0.72-0.91)and 0.823(95%CI:0.70-0.94),respectively.ConclusionsThis Meta-analysis showed that due to comparable long-term outcomes,ESD is comparable to surgery for EGC that meet the expanded indications.But a careful and strict surveillance program after ESD is needed,because of the higher possibility of tumor recurrence after ESD.It is important that female,macroscopic appearance,histological type,tumor size,depth of invasion,LVI were the significant factors associated with LNM in EGC.A risk-scoring model for predicting LNM was developed and validated.It could be of good use in enabling more individualized care for patients with EGC.It is expected to be a reliable prediction model for predicting LNM and provide basis for the treatment of ESD in EGC.