Nomograms Involving HER2 for Predicting Lymph Node Metastasis in Early Gastric Cancer

Yu Mei; Shuo Wang; Tienan Feng; Min Yan; Fei Yuan; Zhenggang Zhu; Tian Li; Zhenglun Zhu

doi:10.3389/fcell.2021.781824

Nomograms Involving HER2 for Predicting Lymph Node Metastasis in Early Gastric Cancer

Front Cell Dev Biol. 2021 Dec 24:9:781824. doi: 10.3389/fcell.2021.781824. eCollection 2021.

Authors

Yu Mei¹, Shuo Wang², Tienan Feng³, Min Yan¹, Fei Yuan⁴, Zhenggang Zhu¹, Tian Li⁵, Zhenglun Zhu¹

Affiliations

¹ Department of General Surgery, Gastrointestinal Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵ School of Basic Medicine, Fourth Military Medical University, Xi'an, China.

Abstract

Objective: We aimed to establish a nomogram for predicting lymph node metastasis in early gastric cancer (EGC) involving human epidermal growth factor receptor 2 (HER2). Methods: We collected clinicopathological data of patients with EGC who underwent radical gastrectomy and D2 lymphadenectomy at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between January 2012 and August 2018. Univariate and multivariate logistic regression analysis were used to examine the relationship between lymph node metastasis and clinicopathological features. A nomogram was constructed based on a multivariate prediction model. Internal validation from the training set was performed using receiver operating characteristic (ROC) and calibration plots to evaluate discrimination and calibration, respectively. External validation from the validation set was utilized to examine the external validity of the prediction model using the ROC plot. A decision curve analysis was used to evaluate the benefit of the treatment. Results: Among 1,212 patients with EGC, 210 (17.32%) presented with lymph node metastasis. Multivariable analysis showed that age, tumor size, submucosal invasion, histological subtype, and HER2 positivity were independent risk factors for lymph node metastasis in EGC. The area under the ROC curve of the model was 0.760 (95% CI: 0.719-0.800) in the training set (n = 794) and 0.771 (95% CI: 0.714-0.828) in the validation set (n = 418). A predictive nomogram was constructed based on a multivariable prediction model. The decision curve showed that using the prediction model to guide treatment had a higher net benefit than using endoscopic submucosal dissection (ESD) absolute criteria over a range of threshold probabilities. Conclusion: A clinical prediction model and an effective nomogram with an integrated HER2 status were used to predict EGC lymph node metastasis with better accuracy and clinical performance.

Keywords: HER2; early gastric cancer; lymph node metastasis; nomogram; prediction model.