Department of General Surgery, Shaoxing People's Hospital, Shaoxing, China.
Zhejiang University School of Medicine, Hangzhou, China.
Medicine (Baltimore). 2023 Oct 20;102(42):e35585. doi: 10.1097/MD.0000000000035585.
There are few studies on the predictive factors of early recurrence (ER) and late recurrence (LR) of advanced gastric cancer (GC) after curative surgery. Our study aims to explore the independent predictors influencing the prognosis between ER and LR in patients with advanced GC after curative intent surgery respectively. And we will further develop nomograms for prediction of post recurrence survival (PRS). Data of patients with GC who received radical gastrectomy was retrospectively collected. Recurrence was classified into ER and LR according to the 2 years after surgery as the cutoff value. Multivariate Cox regression analyses were used to explore significant predictors in our analysis. Then these significant predictors were integrated to construct nomograms. The 1-, 2- and 3-year probabilities of PRS in patients with ER were 30.00%, 16.36% and 11.82%, respectively. In contrast, the late group were 44.68%, 23.40%, and 23.30%, respectively. Low body mass index (hazard ratio [HR] = 0.86, P = .001), elevated monocytes count (HR = 4.54, P = .003) and neutrophil-lymphocyte ratio (HR = 1.03, P = .037) at the time of recurrence were risk factors of PRS after ER. Decreased hemoglobin (HR = 0.97, P = .008) and elevated neutrophil-lymphocyte ratio (HR = 1.06, P = .045) at the time of recurrence were risk factors of PRS after LR. The calibration curves for probability of 1-, 2-, and 3-year PRS showed excellent predictive effect. Internal validation concordance indexes of PRS were 0.722 and 0.671 for ER and LR respectively. In view of the different predictive factors of ER and LR of GC, the practical predictive model may help clinicians make reasonable decisions.
根治性手术后，关于晚期胃癌（GC）早期复发（ER）和晚期复发（LR）的预测因素的研究较少。我们的研究旨在分别探讨影响根治术后晚期 GC 患者 ER 和 LR 预后的独立预测因素，并进一步建立预测复发后生存（PRS）的列线图。回顾性收集接受根治性胃切除术的 GC 患者的数据。根据术后 2 年作为截点，将复发分为 ER 和 LR。多变量 Cox 回归分析用于探讨分析中的显著预测因子。然后将这些显著预测因子整合到列线图中。ER 患者的 1 年、2 年和 3 年 PRS 概率分别为 30.00%、16.36%和 11.82%。相比之下，晚期组分别为 44.68%、23.40%和 23.30%。复发时低体重指数（风险比 [HR] = 0.86，P =.001）、升高的单核细胞计数（HR = 4.54，P =.003）和中性粒细胞-淋巴细胞比值（HR = 1.03，P =.037）是 ER 后 PRS 的危险因素。复发时血红蛋白降低（HR = 0.97，P =.008）和中性粒细胞-淋巴细胞比值升高（HR = 1.06，P =.045）是 LR 后 PRS 的危险因素。1 年、2 年和 3 年 PRS 概率的校准曲线显示出良好的预测效果。ER 和 LR 的 PRS 的内部验证一致性指数分别为 0.722 和 0.671。鉴于 GC 的 ER 和 LR 的预测因素不同，实用的预测模型可能有助于临床医生做出合理的决策。
