USING A MULTIVARIABLE MODEL FOR PREDICTION AND DIAGNOSIS

Aim: In the present study, we aimed to clarify the parameters that can be used for clinically relevant treatment decisions.Patients and methods: During the period from July 1985 to April 2005, 283 pT1 cancers were selected for this study. Risk factors for lymph node (LN) metastasis were evaluated as follows: endoscopic appearance, tumor size, location, lymphatic permeation, venous invasion, patterns of cancer invasion into the submucosal layer, and depth of vertical invasion in the submucosal layer.Results: Results of the logistic regression analysis from these significant parameters were as follows: infiltrating growth pattern (odds ratio: 12.63); lymphatic permeation positive (odds ratio: 5.726); sigmoid colon (odds ratio: 4.585); tumor size (odds ratio: 1.718). However, the leading edge of only one cancer with LN metastasis in the expanding growth group was also cribriform pattern.Conclusion: The invasive growth patterns of infiltrating growth, lymphatic permeation, tumor location of the sigmoid colon, and maximum tumor size were independent and significant risk factors for LN metastasis in our logistic regression analysis. In particular, the former three factors (infiltrating growth, lymphatic permeation and sigmoid colon) revealed high odds ratio and covered all cases of LN metastasis. From the results of our study, the indication for operative intervention after EMR in pT1 cancer is those lesions which possess at least one factor among the three (infiltrating growth, lymphatic permeation and sigmoid colon). Also, assessment of the leading edge with a cribriform pattern should be dealt with carefully.

Predictive Factors for Lymph Node Metastasis in Clinical Stage I Part-Solid Lung Adenocarcinoma

The purpose of this study was to identify preoperative clinicopathological predictive factors for lymph node (LN) metastasis in women diagnosed with uterine papillary serous carcinoma (UPSC). Women diagnosed with UPSC in our institution from 1997 to 2012 were identified. All patients underwent hysterectomy and bilateral salpingo-oophorectomy plus pelvic and/or para-aortic lymphadenectomy. The predictive values of the risk factors for LN metastasis were analyzed using χ and multivariate logistic regression analyses. A total of 94 patients met our study criteria. A CA-125 cutoff of 47.5 IU/mL on the receiver operating characteristic curve provided the best sensitivity and specificity (56.5% vs 90.1%, respectively) for LN metastasis prediction. The sensitivities and specificities of old age (≥60 years), body mass index of 25 kg/m or greater, deep myometrial invasion, tumor size greater than 2 cm, tumor size greater than 4 cm, preoperative CA-125 greater than 47.5 IU/mL, LN metastasis on imaging, and extrauterine spread on imaging for the presence of a positive LN were 39.1%, 34.8%, 30.4%, 34.8%, 21.7%, 56.5%, 43.5%, and 52.2%, and 52.1%, 45.1%, 78.9%, 57.7%, 83.1%, 90.1%, 93.0%, and 90.1%, respectively. Preoperative CA-125 (P < 0.001), LN metastasis on preoperative imaging (P < 0.001), and extrauterine spread on preoperative imaging (P = 0.009) were risk factors for LN metastasis on univariate analysis. Multivariate analysis revealed that preoperative CA-125 (P = 0.001) was the only independent risk factor for LN metastasis. Preoperative CA-125 is a preoperative predictive factor for LN metastasis in UPSC.

Preoperative serum inflammation-based scores in medullary thyroid cancer

Predictive Factors for Lymph Node Metastasis and Prognostic Factors for Survival in Rectal Neuroendocrine Tumors

An accurate assessment of potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the number of invasive procedures used in cancer therapy is critical for improving the patient's quality of life. To evaluate the clinicopathological features associated with lymph node metastasis of early gastric cancer in patients from a single institution in China. A retrospective review of data from 410 patients surgically treated for early gastric cancer at the First Affiliated Hospital (Nanjing, China) between 1998 and 2007, was conducted. The clinicopathological variables associated with lymph node metastasis were evaluated. Lymph node metastasis was observed in 12.20% of patients. The macroscopic type, tumour size, location in the stomach, depth of gastric carcinoma infiltration, and presence of vascular or lymphatic invasion showed a positive correlation with the incidence of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For intramucosal cancer, tumour size was the unique risk factor for lymph node metastasis. For submucosal cancer, histological classification and tumour size were independent risk factors for lymph node metastasis. Histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in patients with early gastric cancer in China. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible for highly selected cancers.

Objective To identify the clinicopathological features correlated to lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). Methods Clinical data of 785 PTMC patients who underwent surgical treatment at the Lishui Municipal Central Hospital from September 2008 to December 2017 were retrospectively analyzed. Clinical and pathological risk factors for lymph node metastasis (LNM), central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) were analyzed. Results LNM was found in 236 (30.2%) patients. Multivariate logistic regression analysis revealed that in PTMC, male gender, age < 55 years, tumor size > 5 mm, bilateral lesions, and extrathyroidal extension were independent risk factors for LNM in general and for CLNM. For LLNM, tumor size > 5 mm, multifocal lesions, and extrathyroidal extension were independent risk factors. Conclusions Identification of risk factors for cervical LNM could assist individualization of clinical management for PTMC.

The aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in patients with uterine serous cancer (USC) who underwent systematic staging surgery. Eighty patients who were operated on for pure uterine serous papillary carcinoma between 2008 and 2020 in our clinic were retrospectively analysed. The effects of demographic information and clinicohistopathological characteristics of the included patients on LNM were examined. The median age of the patients included in the study was 64.3 and the tumour diameter was 3.8 cm. At the time of diagnosis, 65.8% of the cases were in the advanced stage, while 34.2% were in the early stage. There was no LNM in 42 (52.5%) of the cases, only pelvic in six (7.5%), only paraaortic LNM in four (5%) patients, and both pelvic and paraaortic LNM in 24 (30%) patients. When factors that may affect LNM were evaluated with multivariate analysis, lymphovascular space invasion (LVSI) and cytology positivity were found to be independent risk factors (p < 0.05). In addition, the rate of isolated paraaortic lymph node involvement in LNM positive patients is 5%, which is 100% associated with LVSI. Impact Statement What is already known on this subject? Uterine papillary serous carcinomas (UPSC) are an uncommon and aggressive histological subtype of endometrial cancer. The high risk of recurrence and tendency to migrate into the abdomen of these tumours is not always connected with lymph node and distant organ metastasis, tumour size, LVSI positive and depth of myometrial invasion. What do the results of this study add? Most patients with UPSC are diagnosed at an advanced stage. In this study, in which 80 patients with pure serous histology were evaluated retrospectively, and LVSI and peritoneal cytology positivity were found to be two important prognostic factors for lymph node metastasis. What are the implications of these findings for clinical practice and/or further research? In this study, cytology and LVSI positivity were identified as two predictive markers for LNM, and it is seen that cytology positivity still maintains its importance in these tumours with peritoneal spread. Furthermore, patients with isolated paraaortic lymph node involvement were shown to be LVSI positive, and isolated paraaortic LNM should be investigated in patients with LVSI positivity.

Objective: To investigate risk factors for postoperative lymph node metastasis in patients with intrahepatic cholangiocarcinoma (ICC) after curative resection. Methods: This retrospective case-series study consecutively enrolled 230 patients who underwent initial curative hepatectomy and were pathologically confirmed as ICC at Peking University People's Hospital between January 2015 and September 2025. The cohort comprised 120 men (52.2%) and 110 women (47.8%), with an age (M(IQR)) of 59 (14) years (range:31 to 83 years). Multivariable logistic regression was performed to identify independent risk factors for lymph node metastasis. Overall survival (OS) and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method and Cox proportional hazards models. Subgroup analyses based on lymph node status (N0, N1, and Nx) were conducted to explore the impact of lymphadenectomy extent and postoperative adjuvant therapy on prognosis across subgroups. Restricted cubic spline (RCS) analysis was used to assess the association between lymph node ratio (LNR) and survival outcomes. Results: Among the 230 ICC patients, 144 underwent lymphadenectomy, with a lymph node metastasis rate of 38.9% (56/144). Multivariable logistic regression identified carcinoembryonic antigen >4.7 μg/L (OR=5.895, P=0.030), preoperative radiological lymphadenopathy (OR=11.822, P=0.006), and large duct type histological subtype (OR=18.224, P=0.001) as independent risk factors for lymph node metastasis. Survival analyses showed that lymph node metastasis was associated with shortened OS and RFS (both P<0.01). In subgroup analyses of lymphadenectomy, retrieval of ≥6 lymph nodes prolonged RFS in the N1 group (P=0.004) but did not improve OS; in the N0 group, retrieval of <6 lymph nodes was associated with better OS and RFS compared with ≥6 nodes (both P<0.05). RCS analysis demonstrated a significant linear association between LNR and RFS (P=0.006), whereas no association was observed between LNR and OS (P=0.451). Regarding adjuvant therapy, adjuvant treatment improved OS in the overall cohort (P=0.039) but did not prolong RFS (P>0.05). In the N1 group, adjuvant therapy improved OS (P=0.031); in the N0 group, it improved RFS (P=0.031); however, no survival benefit was observed in the Nx group (both P>0.05). Conclusions: Elevated carcinoembryonic antigen, preoperative lymphadenopathy, and large duct type histological subtype are independent risk factors for postoperative lymph node metastasis in ICC. Lymph node status significantly affects prognosis. Patients with lymph node-positive disease may benefit from retrieval of ≥6 lymph nodes and postoperative adjuvant therapy, whereas excessive lymphadenectomy should be avoided in lymph node-negative patients, in whom adjuvant therapy mainly contributes to delaying recurrence.

Background: Assessment of potential lymph node metastasis is mandatory in the appropriate treatment of early gastric cancers. This study analysed factors associated with lymph node metastasis to identify differences between node-negative and node-positive patients and between T1a and T1b cancers. Methods: The clinicopathological features of 129 early gastric cancer patients who had undergone radical gastrectomy were analysed to identify predictive factors for lymph node metastasis. Results: Lymph node metastasis was detected in 76 (59.0%) patients. Node-positive patients were younger (58.1 ± 11.3 years) than those without metastasis (61.9 ± 9.6 years, p = 0.02). Greater tumour sizes were observed in patients with lymph node metastasis (3.6 ± 1.0 cm) compared to node-negative patients (1.9 ± 0.5 cm, p = 0.00001). Depressed form, ulceration, diffuse histological type, and undifferentiated lesions were more frequent in node-positive patients than in the node-negative group. Tumour size > 3.0 cm showed a correlation with lymph node metastasis in both T1a (p = 0.0001) and T1b (p = 0.006) cancer. The male sex (p = 0.006) had a significant correlation with lymph node metastasis in T1a cancer. Depressed appearance (p = 0.02), ulceration (p = 0.03), differentiation (p = 0.0001), diffuse type (p = 0.0002), and lower third location (p = 0.005) were associated with lymph node metastasis in T1b cancer. Conclusions: Tumour size > 3 cm, undifferentiated lesions, ulceration, diffuse type, lower third location, and submucosal invasion are risk factors for lymph node metastasis in early gastric cancer.

BACKGROUNDLymph node metastasis (LNM) affects the application and outcomes of endoscopic resection in T1 esophageal squamous cell carcinoma (ESCC). However, reports of the risk factors for LNM have been controversial.AIMTo evaluate risk factors for LNM in T1 ESCC. METHODSWe searched Embase, PubMed and Cochrane Library to select studies related to LNM in patients with T1 ESCC. Included studies were divided into LNM and non-LNM groups. We performed a meta-analysis to examine the relationship between LNM and clinicopathologic features. Odds ratio (OR), mean differences and 95% confidence interval (CI) were assessed using a fixed-effects or random-effects model.RESULTSSeventeen studies involving a total of 3775 patients with T1 ESCC met the inclusion criteria. After excluding studies with heterogeneity based on influence analysis, tumor size (OR = 1.93, 95%CI = 1.49-2.50, P < 0.001), tumor location (OR = 1.46, 95%CI = 1.17-1.82, P < 0.001), macroscopic type (OR = 3.17, 95%CI = 2.33-4.31, P < 0.001), T1 substage (OR = 6.28, 95%CI = 4.93-8.00, P < 0.001), differentiation (OR = 2.11, 95%CI = 1.64-2.72, P < 0.001) and lymphovascular invasion (OR = 5.86, 95%CI = 4.60-7.48, P < 0.001) were found to be significantly associated with LNM. Conversely, sex, age and infiltrative growth pattern were not identified as risk factors for LNM.CONCLUSIONA tumor size > 2 cm, lower location, nonflat macroscopic type, T1b stage, poor differentiation and lymphovascular invasion were associated with LNM in patients with T1 ESCC.

Objective: To investigate the relationship between systemic inflammatory markers such as neutrophil/lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR), and lymph node metastasis in patients with cN0 gastric cancer. To establish a nomogram model to predict the risk of lymph node metastasis in patients with cN0 gastric cancer. Methods: The preoperative systemic inflammatory markers and clinical data of 134 patients with cN0 gastric cancer were retrospectively analyzed, and these markers of patients with negative (pN0) or positive (pN+ ) lymph node metastasis in postoperative pathological diagnosis were compared. The receiver operating characteristic (ROC) curve was used to evaluate the predictive effect of preoperative systemic inflammatory markers on lymph node metastasis. The influencing factors for lymph node metastasis were assessed by univariate analysis and multivariate logistic regression analysis. A nomogram subsequently established by R software was validated by Bootstrap resampling as internal validation. Results: Compared with pN0 group, NE (P=0.022), CRP (P<0.001), NLR (P<0.001), PLR (P=0.003) and CAR (P<0.001) were higher, LY (P=0.003) and Alb (P=0.042) were lower in pN+ group. ROC curve analysis showed that the area under the curve (AUC) of postoperative pathological lymph node metastasis in patients with cN0 gastric cancer diagnosed by NLR, PLR and CAR were 0.687, 0.651 and 0.694, respectively, and the best cutoff values were 2.12, 113.59 and 0.02, respectively. The corresponding sensitivity and specificity were 62.9% and 72.2%, 77.4% and 48.6%, 74.2% and 58.3%, respectively. Univariate analysis showed that tumor size, depth of invasion, NLR, PLR and CAR were associated with lymph node metastasis in cN0 gastric cancer patients (all P<0.05). Multivariate analysis showed that depth of invasion, NLR and CAR were independent influencing factors of lymph node metastasis in patients with cN0 gastric cancer. OR were 8.084, 3.540 and 3.092, respectively (all P<0.05). The C-index of the nomogram model was 0.847 (95% CI: 0.782-0.915). The predicting calibration curve was properly fit with the ideal curve in calibration chart. Conclusion: Combination of NLR and CAR to establish a nomogram model has a good consistency and can accurately predict the risk of lymph node metastasis in patients with cN0 gastric cancer.

BACKGROUNDSuperficial esophageal squamous cell carcinoma (ESCC) is defined as cancer infiltrating the mucosa and submucosa, regardless of regional lymph node metastasis (LNM). Endoscopic resection of superficial ESCC is suitable for lesions that have no or low risk of LNM. Patients with a high risk of LNM always need further treatment after endoscopic resection. Therefore, accurately assessing the risk of LNM is critical for additional treatment options.AIMTo analyze risk factors for LNM and develop a nomogram to predict LNM risk in superficial ESCC patients.METHODSClinical and pathological data of superficial ESCC patients undergoing esophagectomy from January 1, 2009 to January 31, 2016 were collected. Logistic regression analysis was used to predict LNM risk factors, and a nomogram was developed based on risk factors derived from multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to obtain the accuracy of the nomogram model.RESULTSA total of 4660 patients with esophageal cancer underwent esophagectomy. Of these, 474 superficial ESCC patients were enrolled in the final analysis, with 322 patients in the training set and 142 patients in the validation set. The prevalence of LNM was 3.29% (5/152) for intramucosal cancer and increased to 26.40% (85/322) for submucosal cancer. Multivariate logistic analysis showed that tumor size, invasive depth, tumor differentiation, infiltrative growth pattern, tumor budding, and lymphovascular invasion were significantly correlated with LNM. A nomogram using these six variables showed good discrimination with an area under the ROC curve of 0.789 (95%CI: 0.737-0.841) in the training set and 0.827 (95%CI: 0.755-0.899) in the validation set.CONCLUSIONWe developed a useful nomogram model to predict LNM risk for superficial ESCC patients which will facilitate additional decision-making in treating patients who undergo endoscopic resection.

This study seeks to evaluate lateral pelvic lymph node (LPLN) and perirectal lymph node (PRLN) status on magnetic resonance imaging (MRI) as potential risk factors for lymph node metastasis. The subjects were 394 patients with lower rectal cancer who underwent MRI prior to mesorectal excision (combined with lateral pelvic lymph node dissection in 272 patients) at 6 institutes. No patients received neoadjuvant therapy. Cases were classified as cN(+) and cN(-) based on the short axis of the largest lymph node ≥5 and <5mm, respectively. LPLN and PRLN status and other clinicopathologic factors were analyzed by multivariate logistic regression. The importance of identified risk factors for lymph node metastasis was examined using the area under the curve (AUC). Independent risk factors for right LPLN metastasis included histopathological grade (G3+G4), pPRLN(+), M1, cLPLN(+) [odds ratio (OR) 10.73, 95% confidence interval (CI) 4.59-27.1], and those for left LPLN metastasis were age (<64), histopathological grade (G3+G4), pPRLN(+), and cLPLN(+) (OR 24.53, 95% CI 9.16-77.7). ORs for cLPLN(+) were highest. The AUCs for right and left cLPLN status of 0.7484 (95% CI 0.6672-0.8153) and 0.7904 (95% CI 0.7088-0.8538), respectively, were significantly higher than those for other risk factors. In contrast, the ORs for cPRLN(+) and cPRLN status of 2.46 (95% CI 1.47-4.18) and 0.6396 (95% CI 0.5917-0.6848) were not much higher than for other factors. An LPLN-positive status with a short axis ≥5mm on MRI is an important predictor of LPLN metastasis, but PRLN status is not a strong predictor of PRLN metastasis.

To investigate risk factors of lymph node metastasis (LNM) in Chinese early gastric carcinoma (EGC) patients diagnosed using the World Health Organization (WHO) criteria and compare the differences in those factors between proximal (PGC) and distal gastric carcinoma (DGC). Among 3 176 gastric cancer resections we identified 379 (11.9%) consecutive EGC (104 PGC and 275 DGC) with lymphadenectomy performed at the Affiliated Nanjing Drum Tower Hospital of Nanjing University (Nanjing, Jiangsu Province, China) between January 2005 and December 2012. Endoscopic and clinicopathological features related to LNM were analyzed. LNM occurred in 49 (12.9%) EGC, including three PGC and 46 DGC. In early DGC, middle age (41-60 years), tumor size ≥3.1 cm, submucosal invasion, poorly cohesive carcinoma, micropapillary adenocarcinoma and lymphovascular invasion were risk factors by univariate analysis. In contrast, no risk factors of LNM were identified in early PGC. By multivariate analysis, female sex (odds ratio [OR] 2.4), DGC (OR 8.1), poorly cohesive carcinoma (OR 8.8) and lymphovascular invasion (OR 38.8) were found to be significant independent risk factors for LNM. The risk of LNM was effectively stratified using a scoring model of mild (score ≤3.5), moderate (score 4.0-8.5) and high (score ≥16) risk groups. LNM occurred in 12.9% of EGC diagnosed with the WHO criteria in Chinese patients. Independent risk factors of LNM were identified in early DGC only and included female sex, DGC, poorly cohesive carcinoma and lymphovascular invasion. Early PGC has a much lower risk for LNM than early DGC.