Integrating No.3 lymph nodes and primary tumor radiomics to predict lymph node metastasis in T1-2 gastric cancer

Abstract Background This study aimed to develope and validate a radiomics nomogram by integrating the quantitative radiomics characteristics of No.3 lymph nodes (LNs) and primary tumors to better predict preoperative lymph node metastasis (LNM) in T1-2 gastric cancer (GC) patients. Methods A total of 159 T1-2 GC patients who had undergone surgery with lymphadenectomy between March 2012 and November 2017 were retrospectively collected and divided into a training cohort (n = 80) and a testing cohort (n = 79). Radiomic features were extracted from both tumor region and No. 3 station LNs based on computed tomography (CT) images per patient. Then, key features were selected using minimum redundancy maximum relevance algorithm and fed into two radiomic signatures, respectively. Meanwhile, the predictive performance of clinical risk factors was studied. Finally, a nomogram was built by merging radiomic signatures and clinical risk factors and evaluated by the area under the receiver operator characteristic curve (AUC) as well as decision curve. Results Two radiomic signatures, reflecting phenotypes of the tumor and LNs respectively, were significantly associated with LN metastasis. A nomogram incorporating two radiomic signatures and CT-reported LN metastasis status showed good discrimination of LN metastasis in both the training cohort (AUC 0.915; 95% confidence interval [CI] 0.832–0.998) and testing cohort (AUC 0.908; 95% CI 0.814–1.000). The decision curve also indicated its potential clinical usefulness. Conclusions The nomogram received favorable predictive accuracy in predicting No.3 LNM in T1-2 GC, and the nomogram showed positive role in predicting LNM in No.4 LNs. The nomogram may be used to predict LNM in T1-2 GC and could assist the choice of therapy.

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Development and Validation a Nomogram for Predicting the Third Station Lymph Node Metastasis in Early Gastric Cancer

10.21203/rs.3.rs-142894/v1 ◽

2021 ◽

Author(s):

Xiaoxiao Wang ◽

Cong Li ◽

Mengjie Fang ◽

Liwen Zhang ◽

Lianzhen Zhong ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Validation Cohort ◽

Predictive Accuracy ◽

Clinical Risk Factors ◽

Node Metastasis ◽

Clinical Risk

Abstract Background:This study aimed to evaluate the value of radiomic nomogram in predicting lymph node metastasis in T1-2 gastric cancer according to the No. 3 station lymph nodes.Methods:A total of 159 T1-2 gastric cancer (GC) patients who had undergone surgery with lymphadenectomy between March 2012 and November 2017 were retrospectively collected and divided into a primary cohort (n = 80) and a validation cohort (n = 79). Radiomic features were extracted from both tumor region and No. 3 station lymph nodes (LN) based on computed tomography (CT) images per patient. Then, key features were selected using minimum redundancy maximum relevance algorithm and fed into two radiomic signatures, respectively. Meanwhile, the predictive performance of clinical risk factors was studied. Finally, a nomogram was built by merging radiomic signatures and clinical risk factors and evaluated by the area under the receiver operator characteristic curve (AUC) as well as decision curve.Results: Two radiomic signatures, reflecting phenotypes of the tumor and LN respectively, were significantly associated with LN metastasis. A nomogram incorporating two radiomic signatures and CT-reported LN metastasis status showed good discrimination of LN metastasis in both the primary cohort (AUC: 0.915; 95% confidence interval [CI]: 0.832-0.998) and validation cohort (AUC: 0.908; 95%CI: 0.814-1.000). The decision curve also indicated its potential clinical usefulness.Conclusions:The nomogram received favorable predictive accuracy in predicting No.3 station LN metastasis in T1-2 GC, and could assist the choice of therapy.

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Consolidation Tumor Ratio Combined With Pathological Features Could Predict Status of Lymph Nodes of Early-Stage Lung Adenocarcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.749643 ◽

2022 ◽

Vol 11 ◽

Author(s):

Liang Zhao ◽

Guangyu Bai ◽

Ying Ji ◽

Yue Peng ◽

Ruochuan Zang ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Validation Cohort ◽

Frozen Sections ◽

Paraffin Sections ◽

Training Cohort ◽

Node Metastasis ◽

The Status

IntroductionStage IA lung adenocarcinoma manifested as part-solid nodules (PSNs), has attracted immense attention owing to its unique characteristics and the definition of its invasiveness remains unclear. We sought to develop a nomogram for predicting the status of lymph nodes of this kind of nodules.MethodsA total of 2,504 patients between September 2018 to October 2020 with part-solid nodules in our center were reviewed. Their histopathological features were extracted from paraffin sections, whereas frozen sections were reviewed to confirm the consistency of frozen sections and paraffin sections. Univariate and multivariate logistic regression analyses and Akaike information criterion (AIC) variable selection were performed to assess the risk factors of lymph node metastasis and construct the nomogram. The nomogram was subjected to bootstrap internal validation and external validation. The concordance index (C-index) was applied to evaluate the predictive accuracy and discriminative ability.ResultsWe enrolled 215 and 161 eligible patients in the training cohort and validation cohort, respectively. The sensitivity between frozen and paraffin sections on the presence of micropapillary/solid subtype was 78.4%. Multivariable analysis demonstrated that MVI, the presence of micropapillary/solid subtype, and CTR >0.61 were independently associated with lymph node metastasis (p < 0.01). Five risk factors were integrated into the nomogram. The nomogram demonstrated good accuracy in estimating the risk of lymph node metastasis, with a C-index of 0.945 (95% CI: 0.916–0.974) in the training cohort and a C-index of 0.975 (95% CI: 0.954–0.995) in the validation cohort. The model’s calibration was excellent in both cohorts.ConclusionThe nomogram established showed excellent discrimination and calibration and could predict the status of lymph nodes for patients with ≤3 cm PSNs. Also, this prediction model has the prediction potential before the end of surgery.

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Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: A meta-analysis

10.21203/rs.3.rs-37172/v1 ◽

2020 ◽

Author(s):

Jun Du ◽

Yangchao Shen ◽

Wenwu Yan ◽

Jinguo Wang

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Tumor Size ◽

Vascular Invasion ◽

Meta Analysis ◽

Splenic Hilum ◽

Node Metastasis

Abstract Background It remains controversial whether splenic hilum lymph nodes (SHLNs) should be excised in radical gastrectomy with D2 lymph node dissection. In this study, we evaluated the role of clinicopathological features in patients with gastric cancer in predicting splenic hilum lymph nodes metastasis.Methods We searched the Medline, Embase, PubMed and Web of Science databases from inception to May 2020 and consulted related references. 15 articles with a total of 4377 patients were included finally. The odds ratios (ORs) of each risk factor and the corresponding 95% confidence interval (CI) were determined using Revman 5.3 software. Results Meta-analysis showed that tumor size greater than 5 cm (p < 0.01), tumor localization in the greater curvature (p < 0.01), diffuse type (Lauren’s type) (p < 0.01), Borrman type 3–4 (p < 0.01), poor differentiation and undifferentiation (p < 0.01), depth of invasion T3–T4 (p < 0.01), number of lymph node metastases N2–N3 (p < 0.01), distance metastasis M1 (p < 0.01), TNM stage 3–4 (p < 0.01), vascular invasion (p = 0.01), and lymphatic invasion (p < 0.01) were risk factors of SHLNs metastasis. Moreover, No. 1-, 2-, 3-, 4sa-, 4sb-, 4d-, 6-, 7-, 9-, 11-, and 16-positive lymph node metastasis are strongly associated with splenic hilum lymph nodes metastasis.Conclusions Tumor size, tumor location, Lauren’s type, Borrman type, degree of differentiation, T stage, N stage, M stage, TNM stage, vascular invasion, lymphatic infiltration, and other positive lymph nodes metastasis were risk factors for SHLNs.

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Risk Factors of Lymph Node Metastasis and Its Prognostic Significance in Early Gastric Cancer: A Multicenter Study

Frontiers in Oncology ◽

10.3389/fonc.2021.649035 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jinfeng Wang ◽

Liang Wang ◽

Sha Li ◽

Fei Bai ◽

Hailong Xie ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Prognostic Significance ◽

Clinicopathological Factors ◽

Node Dissection ◽

Node Metastasis ◽

Group 2

BackgroundEarly gastric cancer (EGC) is invasive gastric cancer that invades no deeper than the submucosa, regardless of lymph node metastasis (LNM). It is mainly treated by surgery. Recently, the resection range of EGC has been minimized, but cancer recurrence and overall survival in some patients should be given high status. LNM is an important indicator of prognosis and treatment in gastric cancer. The law of the number and location of metastatic lymph nodes in EGC is not yet clear. Therefore, we aimed to identify the risk factors of LNM in radically resected EGC and guide treatment.MethodsThe clinicopathological factors of 611 patients with EGC were retrospectively analyzed in six hospitals between January 2010 and December 2016. The relationship between clinicopathological factors and LNM, as well as their prognostic significance, were analyzed by univariate and multivariate analyses.ResultsThe rate of LNM was 20.0% in the 611 EGC patients. The depth of invasion, differentiation type, tumor diameter, morphological ulceration, and lymphovascular invasion were independent risk factors for LNM (P<0.05) by logistic regression analysis. Tumor location in the proximal third of the stomach and morphological ulceration were significant factors for group 2 LNM. Moreover, the 5-year survival rate was 94.9% for patients with no positive nodes, 88.5% for patients with 1-2 positive nodes, 64.3% for patients with 3-6 positive nodes, and 41.8% for patients with >6 metastatic nodes. Interestingly, the 7-year risk of relapse diminished for patients with no LNM or retrieved no less than 15 lymph nodes.ConclusionsFifteen lymph node dissection and D2 radical operation are the surgical options in case of high risk factors for LNM. Extended lymph node dissection (D2+) is recommended for morphological ulceration or disease located in the proximal third of the stomach due to their high rate of group 2 LNM. Furthermore, LNM is a significant prognostic factor of EGC. Moreover, lymph nodes can also play a significant role in the chemotherapeutic and radiotherapy approach for non-surgical patients with EGC.

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Evaluation of lymph node metastasis in patients with gastric cancer: a comparison of the directionality of lymph node metastasis and the total number of metastatic lymph nodes

Surgery Today ◽

10.1007/s00595-012-0454-8 ◽

2012 ◽

Vol 43 (2) ◽

pp. 130-135 ◽

Cited By ~ 3

Author(s):

Maki Kitagawa ◽

Daisuke Ichikawa ◽

Shuhei Komatsu ◽

Kazuma Okamoto ◽

Atsushi Shiozaki ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Metastatic Lymph Nodes ◽

Node Metastasis ◽

Metastatic Lymph

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Indications of Lymph Node Metastasis and Survival Analysis in T1N+M0 Gastric Cancer: a Population-Based Study

10.21203/rs.3.rs-36648/v1 ◽

2020 ◽

Author(s):

Peng Jin ◽

Yang Li ◽

Shuai Ma ◽

Wenzhe Kang ◽

Hao Liu ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Survival Analysis ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Size ◽

Multivariate Analyses ◽

Invasion Depth ◽

Node Metastasis ◽

Definition Of

Abstract Background Since the definition of early gastric cancer (EGC) was first proposed in 1971, the treatment of gastric cancer with or without lymph node metastasis (LNM) has changed a lot. The present study aims to identify risk factors for LNM and prognosis, and to further evaluate the indications for adjuvant chemotherapy (AC) in T1N + M0 gastric cancer. Methods A total of 1291 patients with T1N + M0 gastric cancer were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to identify risk factors for LNM. The effect of LNM on overall survival (OS) and cancer-specific survival (CSS) was compared with patients grouped into T1N0-1 and T1N2-3, as the indications for AC. Results The rate of LNM was 19.52%. Multivariate analyses showed age, tumor size, invasion depth, and type of differentiation and retrieved LNs were associated with LNM (p < 0.05). Cox multivariate analyses indicated age, sex, tumor size, N stage were independent predictors of OS and CSS (p < 0.05), while race was indicator for OS (HR 0.866; 95%CI 0.750–0.999, p = 0.049), but not for CSS (HR 0.878; 95% CI 0.723–1.065, p = 0.187). In addition, survival analysis showed the proportion of patients in N+/N0 was better distributed than N0-1/N2-3b. There were statistically significant differences in OS and CSS between patients with and without chemotherapy in pT1N1M0 patients (p༜0.05). Conclusions Both tumor size and invasion depth are associated with LNM and prognosis. LNM is an important predictor of prognosis. pT1N + M0 may be appropriate candidates for AC. Currently, the treatment and prognosis of T1N0M0/T1N + M0 are completely different. An updated definition of EGC, taking into tumor size, invasion depth and LNM, may be more appropriate in an era of precision medicine.

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