Division of General and Upper Gastrointestinal Surgery, Department of Surgery, University of Verona, Verona, Italy.
Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Br J Surg. 2017 Aug;104(9):1235-1243. doi: 10.1002/bjs.10551. Epub 2017 May 10.
Prognostic models from Korea and Italy have been developed that predict overall survival and cancer recurrence respectively after radical gastrectomy for gastric cancer. The aim of this study was to validate the two models in independent patient cohorts, and to evaluate which factors may explain differences in prognosis between Korean and Italian patients with gastric cancer.
Patients who underwent radical gastrectomy for gastric cancer between January 2000 and December 2004 at Seoul National University Hospital and at eight centres in Italy were included. Discrimination of the models was tested with receiver operating characteristic (ROC) curves and calculation of area under the curve (AUC). Calibration was evaluated by plotting actual survival probability against predicted survival probability for the Korean nomogram, and actual against predicted risk of recurrence for the Italian score.
Some 2867 and 940 patients from Korea and Italy respectively were included. The Korean nomogram achieved good discrimination in the Italian cohort (AUC 0·80, 95 per cent c.i. 0·77 to 0·83), and the Italian model performed well in the Korean cohort (AUC 0·87, 0·85 to 0·89). The Korean nomogram also achieved good calibration, but this was not seen for the Italian model. Multivariable analyses confirmed that Italian ethnicity was an independent risk factor for cancer recurrence (odds ratio (OR) 1·72, 1·31 to 2·25; P < 0·001), but not for overall survival (OR 1·20, 0·95 to 1·53; P = 0·130).
Both prognostic models performed fairly well in independent patient cohorts. Differences in recurrence rates of gastric cancer may be partially explained by ethnicity.
韩国和意大利已经开发出了预测胃癌根治术后总生存和癌症复发的预后模型。本研究的目的是在独立的患者队列中验证这两个模型，并评估哪些因素可能解释韩国和意大利胃癌患者之间预后的差异。
纳入 2000 年 1 月至 2004 年 12 月期间在首尔国立大学医院和意大利 8 个中心接受胃癌根治术的患者。通过接收者操作特征（ROC）曲线和计算曲线下面积（AUC）来测试模型的区分度。通过绘制韩国列线图的实际生存概率与预测生存概率图，以及意大利评分的实际与预测复发风险图来评估校准情况。
分别纳入了来自韩国和意大利的 2867 例和 940 例患者。韩国列线图在意大利队列中具有良好的区分度（AUC 0·80，95%置信区间 0·77 至 0·83），意大利模型在韩国队列中表现良好（AUC 0·87，0·85 至 0·89）。韩国列线图也具有良好的校准，但意大利模型则不然。多变量分析证实，意大利裔是癌症复发的独立危险因素（比值比（OR）1·72，1·31 至 2·25；P < 0·001），但不是总生存的独立危险因素（OR 1·20，0·95 至 1·53；P = 0·130）。
这两个预后模型在独立的患者队列中表现相当。胃癌复发率的差异部分可以用种族来解释。
