Incidence and pathology-based predictive modeling of lymph node metastasis in early gastric cancer: evidence from a retrospective single-center Chinese surgical cohort with internal validation.
9 affiliations
- 1Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
- 2Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
- 3Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
- 4Beijing Key Laboratory of Cancer Invasion and Metastasis Research, Beijing, China.
- 5National Clinical Research Center for Digestive Diseases, Beijing, China.
- 6State Key Laboratory of Digestive Health, Beijing, China.
- 7Department of Clinical Nutrition, Capital Medical University, Beijing, China.
- 8School of Basic Medical Sciences, Capital Medical University, Beijing, China.
- 9Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Abstract
Lymph node metastasis (LNM) is a critical determinant of prognosis and treatment in early gastric cancer (EGC). Current endoscopic submucosal dissection (ESD) indications, largely derived from Japanese guidelines, remain controversial in Chinese populations given reported differences in LNM rates and tumor heterogeneity. This study aimed to comprehensively evaluate LNM risk and refine stratification strategies in a large Chinese cohort. A retrospective analysis of 918 EGC patients undergoing gastrectomy with systematic lymph node dissection was performed. Clinicopathological variables were assessed, and independent risk factors for LNM were identified using multivariable logistic regression. Subgroup analyses were conducted according to invasion depth and pathological characteristics. A pathology-based nomogram was developed and internally validated. The overall observed pathological LNM rate was 14.3% (131/918). Independent predictors included maximal tumor diameter, undifferentiated histology, mixed histological composition, T1b invasion, ulceration, and lymphovascular invasion. T1a cancers showed an LNM rate of 8.3%, while no LNM was observed in differentiated tumors ≤30 mm [0/170; 95% confidence interval (CI): 0-2.15%]. Differentiated tumors without ulceration showed a low LNM rate of 1.4% (2/148). In T1b cancers, the LNM rate increased to 21.2%. However, submucosal invasion <500 μm (SM1) differentiated tumors without lymphovascular invasion exhibited a relatively low observed LNM rate of 3.9%, with no metastasis observed in lesions ≤20 mm (0/33; 95% CI: 0-10.58%). A nomogram incorporating 6 independent variables demonstrated good discrimination [area under the curve (AUC) 0.810, 95% CI: 0.768-0.851], with an optimism-corrected AUC of 0.801 after 1,000 bootstrap resamples, excellent calibration, and favorable decision-curve performance. The nomogram may support individualized post-resection pathological LNM risk assessment. LNM risk remains substantial in this surgically selected Chinese EGC cohort, particularly in T1b and undifferentiated tumors. These findings highlight the need for caution when interpreting pathological LNM risk and support more individualized post-resection risk stratification. Prospective validation is required before these findings can be used to modify ESD indications.
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BibTeX
@article{xu2026incidence,
title = {{Incidence and pathology-based predictive modeling of lymph node metastasis in early gastric cancer: evidence from a retrospective single-center Chinese surgical cohort with internal validation.}},
author = {Rui Xu and Zimeng Wang and Yi Hou and Zhi Zheng and Bing Yue and Yueyang Jian and Haiqiao Zhang and Xi Wang and Xiaoye Liu and Jie Yin and Jun Cai and Mulan Jin and Guangyong Chen and Peng Li and Jun Zhang},
journal = {Journal of gastrointestinal oncology},
year = {2026},
month = oct,
doi = {10.21037/jgo-2026-0729},
url = {https://europepmc.org/article/MED/42996881},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Incidence and pathology-based predictive modeling of lymph node metastasis in early gastric cancer: evidence from a retrospective single-center Chinese surgical cohort with internal validation.
AU - Rui Xu
AU - Zimeng Wang
AU - Yi Hou
AU - Zhi Zheng
AU - Bing Yue
AU - Yueyang Jian
AU - Haiqiao Zhang
AU - Xi Wang
AU - Xiaoye Liu
AU - Jie Yin
AU - Jun Cai
AU - Mulan Jin
AU - Guangyong Chen
AU - Peng Li
AU - Jun Zhang
PY - 2026
DA - 2026/10/23
JO - Journal of gastrointestinal oncology
DO - 10.21037/jgo-2026-0729
UR - https://europepmc.org/article/MED/42996881
AB - Lymph node metastasis (LNM) is a critical determinant of prognosis and treatment in early gastric cancer (EGC). Current endoscopic submucosal dissection (ESD) indications, largely derived from Japanese guidelines, remain controversial in Chinese populations given reported differences in LNM rates and tumor heterogeneity. This study aimed to comprehensively evaluate LNM risk and refine stratification strategies in a large Chinese cohort. A retrospective analysis of 918 EGC patients undergoing gastrectomy with systematic lymph node dissection was performed. Clinicopathological variables were assessed, and independent risk factors for LNM were identified using multivariable logistic regression. Subgroup analyses were conducted according to invasion depth and pathological characteristics. A pathology-based nomogram was developed and internally validated. The overall observed pathological LNM rate was 14.3% (131/918). Independent predictors included maximal tumor diameter, undifferentiated histology, mixed histological composition, T1b invasion, ulceration, and lymphovascular invasion. T1a cancers showed an LNM rate of 8.3%, while no LNM was observed in differentiated tumors ≤30 mm [0/170; 95% confidence interval (CI): 0-2.15%]. Differentiated tumors without ulceration showed a low LNM rate of 1.4% (2/148). In T1b cancers, the LNM rate increased to 21.2%. However, submucosal invasion <500 μm (SM1) differentiated tumors without lymphovascular invasion exhibited a relatively low observed LNM rate of 3.9%, with no metastasis observed in lesions ≤20 mm (0/33; 95% CI: 0-10.58%). A nomogram incorporating 6 independent variables demonstrated good discrimination [area under the curve (AUC) 0.810, 95% CI: 0.768-0.851], with an optimism-corrected AUC of 0.801 after 1,000 bootstrap resamples, excellent calibration, and favorable decision-curve performance. The nomogram may support individualized post-resection pathological LNM risk assessment. LNM risk remains substantial in this surgically selected Chinese EGC cohort, particularly in T1b and undifferentiated tumors. These findings highlight the need for caution when interpreting pathological LNM risk and support more individualized post-resection risk stratification. Prospective validation is required before these findings can be used to modify ESD indications.
SN - 2078-6891
SN - 2219-679X
ER -