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. 2016 May 26;11(5):e0156207.
doi: 10.1371/journal.pone.0156207. eCollection 2016.

A Risk Prediction Model Based on Lymph-Node Metastasis in Poorly Differentiated-Type Intramucosal Gastric Cancer

Jeung Hui Pyo  1 , Hyuk Lee  1 , Byung-Hoon Min  1 , Jun Haeng Lee  1 , Min Gew Choi  2 , Jun Ho Lee  2 , Tae Sung Sohn  2 , Jae Moon Bae  2 , Kyoung-Mee Kim  3 , Hyeon Seon Ahn  4 , Sin-Ho Jung  4   5 , Sung Kim  2 , Jae J Kim  1
Affiliations

A Risk Prediction Model Based on Lymph-Node Metastasis in Poorly Differentiated-Type Intramucosal Gastric Cancer

Jeung Hui Pyo et al. PLoS One. .

Abstract

Background and aim: Endoscopic submucosal dissection (ESD) for undifferentiated type early gastric cancer is regarded as an investigational treatment. Few studies have tried to identify the risk factors that predict lymph-node metastasis (LNM) in intramucosal poorly differentiated adenocarcinomas (PDC). This study was designed to develop a risk scoring system (RSS) for predicting LNM in intramucosal PDC.

Methods: From January 2002 to July 2015, patients diagnosed with mucosa-confined PDC, among those who underwent curative gastrectomy with lymph node dissection were reviewed. A risk model based on independent predicting factors of LNM was developed, and its performance was internally validated using a split sample approach.

Results: Overall, LNM was observed in 5.2% (61) of 1169 patients. Four risk factors [Female sex, tumor size ≥ 3.2 cm, muscularis mucosa (M3) invasion, and lymphatic-vascular involvement] were significantly associated with LNM, which were incorporated into the RSS. The area under the receiver operating characteristic curve for predicting LNM after internal validation was 0.69 [95% confidence interval (CI), 0.59-0.79]. A total score of 2 points corresponded to the optimal RSS threshold with a discrimination of 0.75 (95% CI 0.69-0.81). The LNM rates were 1.6% for low risk (<2 points) and 8.9% for high-risk (≥2 points) patients, with a negative predictive value of 98.6% (95% CI 0.98-1.00).

Conclusions: A RSS could be useful in clinical practice to determine which patients with intramucosal PDC have low risk of LNM.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The number of lymph node metastases according to the total risk score.
LNM, lymph node metastasis.
Fig 2
Fig 2. Receiver operating characteristic curve of the total score.
Fig 3
Fig 3. Receiver operating characteristic curve of the risk scoring system.
See this image and copyright information in PMC

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