A Risk-Scoring Model for Predicting Lymph Node Metastasis in Early
Gastric Cancer Patients: a Retrospective Study and External Validation
Parikshit Asutosh Khadaroo
Received: 18 February 2018 /Accepted: 14 May 2018
2018 The Society for Surgery of the Alimentary Tract
Background The 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.
Methods 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 institutions.
Results Of the 1029 patients, 228 patients (22%) had LNM. Multivariate analysis showed that female, depressed type, undif-
ferentiated 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 [0.76 (95% CI 0.73–0.80)] to predict LNM risk. After
internal and external validation, the AUROC curve for predicting LNM was 0.77 (95% CI 0.68–0.86), 0.82 (95% CI 0.72–0.91),
and 0.82 (95% CI 0.70–0.94), respectively.
Conclusions A risk-scoring model for predicting LNM was developed and validated. It could help with personalized care for
patients with EGC.
Keywords Early gastric cancer
Lymph node metastasis
Endoscopic submucosal dissection
Early gastric cancer (EGC) is classified as adenocarcinoma
confined to the mucosa or submucosa of the stomach, irrespec-
tive of regional lymph node metastasis (LNM).
the patients with EGC, the presence of LNM, one of the stron-
gest prognostic factors of EGC, has been reported to range
To date, radical gastrectomy with lymph
node dissection is considered to be the only known curative
treatment method for EGC.
However, endoscopic resection,
especially endoscopic submucosal dissection (ESD), has been
developed in Asia for low-morbidity treatment of EGC based
on the very low LNM rate indicated by large retrospective
Clinical success of endoscopic resection for EGC crit-
ically depends on the absence of LNM. Determining the likeli-
hood of LNM, therefore, represents an important issue in clin-
ical decision-making for the treatment of EGC patients.
AccordingtotheJapaneseGastric Cancer Association
treatment guidelines, ESD is indicated as the primary method
for the treatment of differentiated EGC without ulcerative
findings, in which the depth of invasion is clinically diagnosed
as mucosa and the diameter is ≤ 2cm.
The expanded indica-
tions for curative endoscopic resection are, en bloc, resection,
negative horizontal and vertical margins, no lymphovascular
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11605-018-3816-8) contains supplementary
material, which is available to authorized users.
* XianFa Wang
Department of General Surgery, Zhejiang University School of
Medicine Sir Run Run Shaw Hospital, No.3, East Qingchun Road,
Hangzhou 310016, Zhejiang, China
Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
Zhejiang University School of Medicine, Zhejiang University,
Hangzhou, Zhejiang, China
Zhuji People’s Hospital, Shaoxing, Zhejiang, China
Journal of Gastrointestinal Surgery