Artificial neural network model enhancing the accuracy of clinical evaluation for high-risk population of lymph node metastasis in non-intestinal type early gastric cancer: a multicenter real-world study in China
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Recent years have witnessed a proliferation of studies aimed at developing clinical models capable of predicting lymph node metastasis (LNM) in early gastric cancer (EGC), yet tools for prediction grounded in the Lauren classification remain scarce. METHODS: Data of 6468 patients diagnosed with EGC from fifteen Chinese high-volume cancer centers between January 2005 and December 2015 were retrospectively analyzed. Utilizing multivariate logistic regression analysis and the multilayer perceptron (MLP) prediction algorithm, a nomogram and an artificial neural network (ANN) model were developed and validated, respectively, for predicting the likelihood of LNM in non-intestinal EGC cases. The models' performances were evaluated and a comparative analysis of their parameters was undertaken. Subsequently, in-depth risk stratification analyses were performed around the two models. RESULTS: Non-intestinal type EGC demonstrated an elevated LNM rate and inferior prognosis compared to the intestinal type. Both nomogram and ANN model were developed and performed well in discrimination, calibration and clinical utility. Notably, the ANN model surpassed the nomogram in specificity (95.8% vs. 71.3%, P < 0.001), positive predictive value (PPV) (62.0% vs. 36.2%, P < 0.001) and overall accuracy (82.7% vs. 70.5%, P < 0.001). Patients with different risk strata derived from the nomogram, ANN model, and their combined application exhibited significantly different outcomes. The extent of lymph node dissection significantly influenced prognoses in high-risk patients identified by the combined model, whereas the anatomical location of metastatic lymph nodes did not. CONCLUSION: The ANN model established in this study can screen the patients at high risk of LNM in non-intestinal type EGC more accurately. Considering the high extragastric LNM rate observed in the high-risk stratum, radical gastrectomy combined with D2 lymph node dissection is strongly recommended.
Source: International Journal of Surgery
Authors: Jiamei Guo, Kecheng Zhang, Gang Ji, Wei Wang, Gang Li, Zhiqiang Liu, Zuli Yang, Zaisheng Ye, Yantao Tian, Tao Zhang, Xiangyu Wang, Kun Yang, Tong Zhou, Qi You, Yong Li, Peng Ren, Rupeng Zhang, Jingyu Deng
Institutions: Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Chinese PLA General Hospital, Xijing Hospital, Air Force Medical University, Sun Yat-sen University Cancer Center, Jiangsu Cancer Hospital, Nanjing Medical University, Anyang Tumor Hospital, Sun Yat-sen University, Sixth Affiliated Hospital of Sun Yat-sen University, Fujian Medical University, Fudan University Shanghai Cancer Center, Fujian Provincial Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Cancer Hospital of Chinese Academy of Medical Sciences, Liaoning Cancer Hospital & Institute, Fujian Provincial Hospital, Sichuan University, West China Medical Center of Sichuan University, West China Hospital of Sichuan University, State Key Laboratory of Biotherapy, Affiliated Hospital of North Sichuan Medical College, Harbin Medical University, Third Affiliated Hospital of Harbin Medical University, Guangdong Provincial People's Hospital, Southern Medical University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W4409696524