Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy.
Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy.
Gastric Cancer. 2022 May;25(3):629-639. doi: 10.1007/s10120-021-01268-4. Epub 2021 Nov 22.
A model that quantifies the risk of peritoneal recurrence would be a useful tool for improving decision-making in patients undergoing curative-aim gastrectomy for gastric cancer (GC).
Five Italian centers participated in this study. Two risk scores were created according to the two most widely used pathologic classifications of GC (the Lauren classification and the presence of signet-ring-cell features). The risk scores (the PERI-Gastric 1 and 2) were based on the results of multivariable logistic regressions and presented as nomograms (the PERI-Gram 1 and 2). Discrimination was assessed with the area under the curve (AUC) of receiver operating curves. Calibration graphs were constructed by plotting the actual versus the predicted rate of peritoneal recurrence. Internal validation was performed with a bootstrap resampling method (1000 iterations).
The models were developed based on a population of 645 patients (selected from 1580 patients treated from 1998 to 2018). In the PERI-Gastric 1, significant variables were linitis plastica, stump GC, pT3-4, pN2-3 and the Lauren diffuse histotype, while in the PERI-Gastric 2, significant variables were linitis plastica, stump GC, pT3-4, pN2-3 and the presence of signet-ring cells. The AUC was 0,828 (0.778-0.877) for the PERI-Gastric 1 and 0,805 (0.755-0.855) for the PERI-Gastric 2. After bootstrap resampling, the PERI-Gastric 1 had a mean AUC of 0.775 (0.721-0.830) and a 95%CI estimate for the calibration slope of 0.852-1.505 and the PERI-Gastric 2 a mean AUC of 0.749 (0.693-0.805) and a 95%CI estimate for the slope of 0.777-1.351. The models are available at www.perigastric.org .
We developed the PERI-Gastric and the PERI-Gram as instruments to determine the risk of peritoneal recurrence after curative-aim gastrectomy. These models could direct the administration of prophylactic intraperitoneal treatments.
对于接受根治性胃切除术治疗胃癌（GC）的患者，一种能够量化腹膜复发风险的模型将是一种有用的决策工具。
五个意大利中心参与了这项研究。根据两种最广泛使用的 GC 病理分类（Lauren 分类和印戒细胞特征的存在）创建了两个风险评分。风险评分（PERI-Gastric 1 和 2）基于多变量逻辑回归的结果，并以列线图的形式呈现（PERI-Gram 1 和 2）。通过接收者操作曲线的曲线下面积（AUC）评估区分度。通过绘制实际与预测腹膜复发率的校准图来构建校准图。使用自举重采样方法（1000 次迭代）进行内部验证。
该模型是基于 1998 年至 2018 年间治疗的 1580 名患者中选择的 645 名患者的数据开发的。在 PERI-Gastric 1 中，显著变量为弥漫型组织学、残胃癌、pT3-4、pN2-3 和 Lauren 弥漫型组织学，而在 PERI-Gastric 2 中，显著变量为弥漫型组织学、残胃癌、pT3-4、pN2-3 和印戒细胞的存在。PERI-Gastric 1 的 AUC 为 0.828（0.778-0.877），PERI-Gastric 2 的 AUC 为 0.805（0.755-0.855）。经过自举重采样后，PERI-Gastric 1 的平均 AUC 为 0.775（0.721-0.830），校准斜率的 95%CI 估计值为 0.852-1.505，PERI-Gastric 2 的平均 AUC 为 0.749（0.693-0.805），斜率的 95%CI 估计值为 0.777-1.351。该模型可在 www.perigastric.org 上获得。
我们开发了 PERI-Gastric 和 PERI-Gram，作为确定根治性胃切除术后腹膜复发风险的工具。这些模型可以指导预防性腹腔内治疗的应用。
