早期胃癌淋巴结转移的列线图预测模型

Nomogram Model for Predicting Lymph Node Metastasis in Early Gastric Cancer

摘要: 目的：淋巴结转移(Lymph Node Metastasis, LNM)对于早期胃癌(Early Gastric Cancer, EGC)患者的预后有着至关重要的影响。因此需要对LNM患者进行彻底而精确的评估。确定影响LNM的因素，建立EGC患者LNM的预测模型。方法：收集并分析从监测、流行病学和最终结果(SEER)数据库下载的4749例EGC患者的临床信息和病理数据。基于7:3的比例，3324人被随机分为训练组，1425人被随机分配到测试组。根据训练集确定的影响LNM的因素，绘制并验证了列线图。结果：基于多因素分析，诊断时的性别、年龄、种族、分化程度、T期和肿瘤大小、远处转移、原发部位的手术、淋巴结捡取数目、原发肿瘤数目是EGC发生LNM的危险因素。此外，还绘制了列线图来预测EGC患者发生LNM的风险。肿瘤大小是LNM最重要的危险因素。对于训练集和测试集，列线图的受试者操作特征曲线下面积(AUC)分别为0.754和0.724。此外，校准曲线表明，LNM预测模型具有良好的一致性。结论：诊断时的分化程度、T期和肿瘤大小、远处转移、原发部位的手术、淋巴结捡取数目、原发肿瘤数目是EGC患者LNM的独立危险因素。基于上述危险因素，预测模型可能为EGC后续治疗方法的选择提供一些指导意义。

Abstract: Objective Lymph Node Metastasis (LNM) plays an important role in the prognosis of Early Gastric Cancer (EGC). Therefore, a thorough and precise assessment of patients with LNM is required. Determine the factors affecting LNM and establish a predictive model of LNM in EGC patients. Methods: The clinical and pathological data of 4749 patients with EGC downloaded from the Surveillance Epidemiology and Final Outcomes (SEER) database were collected and analyzed. Based on a 7:3 ratio, 3324 were randomly assigned to the training group and 1425 to the test group. Nomograms were plotted and validated based on the factors affecting the LNM identified from the training set. Results Based on multivariate analysis, the risk factors of LNM in EGC were sex, age, race, differentiation degree, T stage and tumor size, distant metastasis, primary site surgery, number of lymph nodes retrieved, and number of primary tumors. In addition, nomograms were plotted to predict the risk of developing LNM in patients with EGC. Tumor size is the most important risk factor for LNM. The area under the operator characteristic curve (AUC) of nomograms was 0.754 and 0.724 for the training and test sets, respectively. In addition, the calibration curve shows that the LNM prediction model has good consistency. Conclusion: Differentiation degree, T stage and tumor size at diagnosis, distant metastasis, primary site surgery, number of lymph nodes retrieved and number of primary tumors are independent risk factors for LNM in EGC patients. Based on the above-mentioned risk factors, the prediction model may provide some guiding significance for the selection of subsequent treatment methods for EGC.