Nomogram to predict lymph node metastasis in patients with early gastric cancer: A useful clinical tool to reduce gastrectomy after endoscopic resection

Background The indications for endoscopic dissection have been expanded to improve the quality of life of patients with early gastric cancer (EGC). This study aimed to develop a nomogram to predict the status of lymph node metastasis with the aim of avoiding unnecessary gastrectomies. Methods We reviewed the clinicopathological data of 10579 patients who underwent curative resection for EGC. The nomogram was developed by multivariate analysis and was evaluated by external validation. Overall, disease-free and recurrence-free survival were compared between the gastrectomy group of 6641 patients and the endoscopic dissection group of 999 patients to show the efficacy of the nomogram. Results Multivariate analyses revealed that age, tumor size, lymphatic invasion, depth of invasion, and histologic differentiation were all significant prognostic factors for lymph node metastasis. The nomogram had good discriminatory performance, with a concordance index of 0.846.This was supported by the external validation point of 0.813. For patients with low risk of lymph node metastasis on the nomogram (≤3% of the provisional value in this study), the endoscopic dissection and gastrectomy groups had comparable rates of overall (P =0.32), disease-free (P =0.47), and recurrence-free (P =0.09) survival. Conclusions We developed and validated a nomogram that predicts the risk of lymph node metastasis in EGC based on a large database. This precision nomogram is useful to avoid unnecessary gastrectomy after endoscopic dissection, which may ultimately improve the quality of life of patients with EGC.