Objective: This study aimed to propose and validate a new and practical lymph node (LN) staging strategy to mitigate staging migration due to examined LN (ELN) retrieval and improve the accuracy of prognostic evaluation for early gastric cancer (EGC) patients. Background: EGC patients often face staging inaccuracies due to inadequate ELNs, as there is no clear standard for ELN retrieval requirements. Methods: From an initial cohort of 7001 EGC patients across fifteen large institutions in China, 6566 eligible patients were included as the training and validation cohort after applying predefined exclusion criteria. We analyzed these data to determine the optimal cutoff value for the number of ELNs, construct a prediction model, and propose a new LN staging method distinct from that of the latest AJCC guidelines. Subsequently, 2094 patients (from 2326 with survival data available in the multicenter dataset) and 1944 patients (from 5262 initially retrieved from the SEER database after exclusions) were included as independent test cohorts to evaluate model performance, including the correlation between ELNs and metastatic LNs (MLNs) and survival differences. Results: This study found that ≤ 20 ELNs were inadequate for accurate LN evaluation in EGC patients. In the test cohort, MLNs was positively associated with ELNs. A model was constructed, and accurate MLNs could be displayed after correction for patients with inadequate ELNs. Survival analysis revealed significant differences between patients with different pN M (pN modified ) stages in both the multicenter test cohort and the SEER test cohort. Conclusion: Model-corrected pN M staging may improve staging migration and survival prediction than the AJCC staging, showing great clinical applicability for EGC patients with ELN ≤ 20. A flowchart outlines a study on early gastric cancer patients, examining lymph nodes and metastasis risks.A study of 6566 early gastric cancer (EGC) patients across 15 Chinese centers determined the optimal examined lymph node (ELN) cutoff for lymph node metastasis (LNM) risk. Data was split into training and validation cohorts. A logistic regression model predicted LNM, correcting for insufficient ELNs and predicting metastatic lymph nodes (MLNs). 2094 multicenter and 1944 SEER EGC patients with survival data were tested. AJCC staging was redefined based on corrected ELNs/MLNs, grouped into PN stages and survival analysis was performed comparing pre- and post-correction differences. Keywords: stomach, neoplasm, lymph node, metastasis, prognosis
Nie et al. (Fri,) studied this question.