Lyu Tong-Dan, Luo Ming-Peng, Hu Hao-Wei
Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Transl Cancer Res. 2024 Oct 31;13(10):5497-5508. doi: 10.21037/tcr-24-692. Epub 2024 Oct 28.
With the advancement of various auxiliary examination techniques, the detection rate of stage I gastric cancer has gradually increased, and its clinical first-choice treatment is surgery. Although patients with stage I gastric cancer generally have a good postoperative survival rate, there is still a certain probability of recurrence. Given the large number of gastric cancer cases, there is a vast population of patients with stage I disease. We are aiming to identify the risk factors for postoperative recurrence of stage I gastric cancer and to establish a reliable predictive model to assess the risk of recurrence in the population for clinical practice.
In this retrospective cohort study, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to investigate predictive factors for recurrence among stage I gastric cancer patients who underwent curative gastrectomy between 2000 and 2018. The cohort was divided into training and validation sets for the development and validation of a nomogram. Prognostic factors were evaluated through univariate and multivariate Cox regression analyses. Significant variables identified by the concordance index (C-index) and calibration plots were used to construct nomograms predicting the probability of 5- and 10-year recurrence.
Risk factors for recurrence included sex, age, race, histology, tumor size, American Joint Committee on Cancer Tumor (AJCC T) and primary site, which were used to construct the nomogram. The C-index for both the training and validation cohorts indicated that the nomogram possessed good calibration and discrimination abilities in predicting the probability of 5- and 10-year recurrence after curative surgery for stage I gastric cancer.
This study established a reliable predictive model for recurrence following curative gastrectomy in stage I gastric cancer based on a population cohort. The findings of this study have the potential to significantly impact clinical practice by providing clinicians with tools for personalized risk assessment and for making informed treatment decisions.
随着各种辅助检查技术的进步，I期胃癌的检出率逐渐提高，其临床首选治疗方法是手术。尽管I期胃癌患者术后生存率通常较好，但仍有一定的复发概率。鉴于胃癌病例数量众多，I期疾病患者群体庞大。我们旨在确定I期胃癌术后复发的危险因素，并建立一个可靠的预测模型，以评估该人群的复发风险，供临床实践使用。
在这项回顾性队列研究中，我们利用监测、流行病学和最终结果（SEER）数据库，调查2000年至2018年间接受根治性胃切除术的I期胃癌患者的复发预测因素。该队列被分为训练集和验证集，用于开发和验证列线图。通过单因素和多因素Cox回归分析评估预后因素。通过一致性指数（C-index）和校准图确定的显著变量用于构建预测5年和10年复发概率的列线图。
复发的危险因素包括性别、年龄、种族、组织学类型、肿瘤大小、美国癌症联合委员会肿瘤（AJCC T）和原发部位，这些因素被用于构建列线图。训练队列和验证队列的C-index均表明，该列线图在预测I期胃癌根治性手术后5年和10年复发概率方面具有良好的校准和区分能力。
本研究基于人群队列建立了一个可靠的I期胃癌根治性胃切除术后复发预测模型。本研究结果有可能通过为临床医生提供个性化风险评估工具和做出明智治疗决策的工具，对临床实践产生重大影响。
