Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy.
Department of Surgery, Stanford University, Stanford, CA, USA.
Ann Surg Oncol. 2022 Dec;29(13):8653-8661. doi: 10.1245/s10434-022-12434-y. Epub 2022 Aug 26.
Recurrence after curative-intent surgery can occur in more than 50% of gastric cancer (GC) patients. We sought to identify predictors of very early recurrence (VER) among GC patients who underwent curative-intent surgery.
A multi-institutional database of GC patients undergoing curative-intent surgery between 2000 and 2020 at 8 major institutions was queried. VER was defined as local or distant tumor recurrence within 6 months from surgery. Univariable Cox proportional hazard models were used to evaluate the predictive value of clinical-pathological features on VER. A regularized Cox regression model was employed to build a predictive model of VER and recurrence within 12 months. The discriminant ability of the Cox regularized models was evaluated by reporting a ROC curve together with the calibration plot, considering 200 runs.
Among 1133 patients, 65 (16.0%) patients experienced a VER. Preoperative symptoms (HR 1.198), comorbidities (HR 1.289), tumor grade (HR 1.043), LNR (HR 4.339) and T stage (HR 1.639) were associated with an increased likelihood of VER. Model performance was very good at predicting VER at 6 months (AUC of 0.722) and 12 months (AUC 0.733). Two nomograms to predict 6-month and 12-month VER were built based on the predictive model. A higher nomogram score was associated with worse prognosis. There was good prediction between observed and estimated VER with minimal evidence of overfitting and good performance on internal bootstrapping validation.
One in 6 patients experienced VER following curative-intent surgery for GC. Nomograms to predict risk of VER performed well on internal validation, and stratified patients into distinct prognostic groups relative to 6- and 12-months recurrence.
根治性手术后超过 50%的胃癌（GC）患者会出现复发。我们试图确定接受根治性手术的 GC 患者中非常早期复发（VER）的预测因素。
检索了 8 家主要机构 2000 年至 2020 年期间接受根治性手术的 GC 患者的多机构数据库。VER 定义为手术后 6 个月内局部或远处肿瘤复发。采用单变量 Cox 比例风险模型评估临床病理特征对 VER 的预测价值。采用正则化 Cox 回归模型建立 12 个月内 VER 和复发的预测模型。通过报告 ROC 曲线和校准图考虑 200 次运行，评估 Cox 正则化模型的判别能力。
在 1133 例患者中，有 65 例（16.0%）患者发生 VER。术前症状（HR 1.198）、合并症（HR 1.289）、肿瘤分级（HR 1.043）、LNR（HR 4.339）和 T 分期（HR 1.639）与 VER 发生的可能性增加相关。该模型在预测 6 个月（AUC 为 0.722）和 12 个月 VER 时性能非常好（AUC 分别为 0.733）。基于预测模型构建了预测 6 个月和 12 个月 VER 的两个列线图。列线图评分越高，预后越差。观察到的和估计的 VER 之间存在良好的预测，几乎没有过度拟合的证据，并且在内部引导验证中表现良好。
每 6 例接受 GC 根治性手术的患者中就有 1 例发生 VER。预测 VER 风险的列线图在内部验证中表现良好，并根据 6 个月和 12 个月的复发情况将患者分层为不同的预后组。
