A nomogram of the clinical factors associated with lymph node metastasis of early gastric adenocarcinoma before surgery

Abstract Gastric cancer is a relatively occult digestive tract tumour whose incidence and mortality are among the top five in the world. The latest cancer statistics in China show that the incidence and mortality of gastric cancer are on the rise. Recent research has shown that the lymph node metastasis of tumour cells from lymphatic vessels into the systemic circulation is likely to lead to metastasis, and it is the main source of tumour cells for distant metastasis. Lymph node metastasis usually seriously shortens the survival time of cancer patients. For patients with early gastric adenocarcinoma, early prediction and intervention of those who may have lymph node metastasis after surgery through appropriate observation indicators is expected to greatly reduce their mortality, prolong their survival and achieve better therapeutic effects. In this study, we comprehensively evaluated the biological behaviour of early gastric adenocarcinoma with lymph node metastasis after surgery, analysed the associations of routine laboratory indices and histopathological diagnosis with lymph node metastasis, and used the ascending segment of a nomogram to identify the high-risk group for preoperative lymph node metastasis. This case‒control study enrolled 600 patients, including 354 patients with lymph node metastasis and 246 patients without lymph node metastasis in North China. The least absolute shrinkage and selection operator (LASSO) regression model and multivariate logistic regression were used to analyse the risk factors for patients with lymph node metastasis of early gastric adenocarcinoma before surgery. Four variables (diabetes mellitus, pathological stage, tumour size, and CEA level) were input into a nomogram model of disease progression. The C-index, ROC curve, DCA and calibration curve showed that the model had good discrimination and accuracy in the development group and the validation group. The clinical impact diagram showed that the nomogram for patients with preoperative lymph node metastasis of early gastric adenocarcinoma has high clinical application value.