A Nomogram for Predicting Lymph Nodal Metastases in Patients with Appendiceal Cancers: An Analysis of SEER Database

Abstract

Backgrounds

Appendiceal cancers are usually diagnosed after appendectomy accidentally. The need for subsequent right hemicolectomy in these patients was determined by the potential risk of regional lymph node (LN) metastasis. Establishing a nomogram to forecast the potential risk of lymph node metastasis of appendiceal cancer could help in the next step of treatment.

Methods

Patients with appendiceal cancer undergoing surgery was queried in the American cancer database of Surveillance, Epidemiology and End Results database from 2004 to 2016. A nomogram was established based on Logistic regression model.

Results

Finally, 3,075 patients were diagnosed with appendectomy cancer from 2004 to 2016. Among them, there were 2028 (65.9%) cases with negative lymph nodes, 1047 (34.1%) cases with positive lymph nodes. Risk factors associated with lymph node metastasis include age, histological type, tissue grade, T stage, distant metastasis, and tumor size. We drew the ROC curves of the training group（0.754, P < 0.001） and the validation group （0.775, P < 0.001） respectively. C-index values of predictions were 0.772 (95%CI, 0.750-0.793) and 0.776 (95%CI, 0.746-0.807), and Brier score were 0.178 and 0.172 in training and validation group respectively. All of them showed excellent performance of the nomogram in our study.

Conclusion

A new nomogram was created to assess the potential risk of LN metastasis in patients of appendiceal cancer by utilizing age, tumor histology, tumor pathologic grade, tumor size, T-stage, and M-stage. The nomogram could provide a strong reference for the right hemicolectomy and facilitate clinic decision.

Keywords:

• Appendiceal cancer
• nodal metastases
• surveillance epidemiology and end results database
• nomogram
• right hemicolectomy
• metastases

This article is referred to by:

Nomograms: Definitive Answer in the Appendiceal Cancer Treatment and Prognosis?

Predicting Lymph Nodal Metastases in Patients with Appendiceal Cancers

Acknowledgments

The authors are grateful for the Surveillance, Epidemiology, and End Results (SEER) project for its efforts in establishing the SEER database. It is the sole responsibility of the author to interpret and report these data.

Disclosure statement

The authors declare that they have no competing interests.

Ethics approval

Due to the public nature of all data, this study does not need the approval of the ethics committee.

Informed consent

As this study is a retrospective study, informed consent of patients was waived.

Additional information

Funding

Contract grant sponsor: The Nature Scientific Foundation of China; Contract grant number: 81702956.