Development and Validation of a Prognostic Model for Postoperative Anastomotic Recurrence in Siewert II or III Adenocarcinomas Without Neoadjuvant Therapy in an East Asian Population.

Autor: Huang MB; Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134 Dongjie, Fuzhou , Fujian Province, 350001, China., Xu C; Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134 Dongjie, Fuzhou , Fujian Province, 350001, China.; Clinical Medical Center for Digestive Diseases of Fujian Provincial Hospital, No. 134 Dongjie, Fuzhou , Fujian Province, 350001, China., Chen H; Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134 Dongjie, Fuzhou , Fujian Province, 350001, China.; Clinical Medical Center for Digestive Diseases of Fujian Provincial Hospital, No. 134 Dongjie, Fuzhou , Fujian Province, 350001, China., Lin JX; Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou , Fujian Province, 350001, China., Zheng CH; Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou , Fujian Province, 350001, China., Chen QX; Department of General Surgery, Zhangzhou Municipal Hospital of Fujian Province, No. 59 Shengli Road, Zhangzhou , Fujian Province, 363099, China., Lian MQ; Department of General Surgery, Zhangzhou Municipal Hospital of Fujian Province, No. 59 Shengli Road, Zhangzhou , Fujian Province, 363099, China., Lian MJ; Department of General Surgery, Zhangzhou Municipal Hospital of Fujian Province, No. 59 Shengli Road, Zhangzhou , Fujian Province, 363099, China., Lv CB; Department of General Surgery, Zhangzhou Municipal Hospital of Fujian Province, No. 59 Shengli Road, Zhangzhou , Fujian Province, 363099, China., Yang SB; Zhangpu Hospital of Zhangzhou City, No. 1 Zhonghua Road, Zhangzhou , Fujian Province, 363299, China., Cai LS; Department of General Surgery, Zhangzhou Municipal Hospital of Fujian Province, No. 59 Shengli Road, Zhangzhou , Fujian Province, 363099, China. chris197409@163.com., Huang CM; Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou , Fujian Province, 350001, China. hcmlr2002@163.com., Xue FQ; Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, No. 134 Dongjie, Fuzhou , Fujian Province, 350001, China. xuefangqingsl@sina.com.; Clinical Medical Center for Digestive Diseases of Fujian Provincial Hospital, No. 134 Dongjie, Fuzhou , Fujian Province, 350001, China. xuefangqingsl@sina.com.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal cancer [J Gastrointest Cancer] 2024 Jun; Vol. 55 (2), pp. 702-713. Date of Electronic Publication: 2024 Jan 04.
DOI: 10.1007/s12029-023-01002-6
Abstrakt: Purpose: Anastomotic recurrence leads to poor prognosis in patients with Siewert II or III adenocarcinoma who undergo radical gastrectomy and do not receive neoadjuvant therapy. We aimed to establish a prognostic model to evaluate the risk of postoperative anastomotic recurrence in patients with Siewert II or III adenocarcinoma who did not receive neoadjuvant therapy.
Methods: We included 366 patients with Siewert II or III adenocarcinoma who were treated with radical gastrectomy without neoadjuvant therapy at Fujian Provincial Hospital (FPH) between 2012 and 2018 as the development cohort. Cox regression was used to verify prognostic factors for anastomotic recurrence, and a nomogram was established. The nomogram was externally validated using a combined cohort of two external centers. Patients were classified into high- or low-risk groups according to the diagnostic threshold and nomogram scores, and recurrence-related survival analysis was analyzed.
Results: The average age was 64.6 years, and 285 patients were male. All surgeries were successfully performed (185 open vs 181 laparoscopic). The 3-year anastomotic recurrence rate was significantly lower in the low-risk group (3.5% vs 18.8%, P < 0.001). The predictive performance was verified in the external validation cohort. This model better stratified patient survival than the American Joint Committee on Cancer (AJCC) TNM staging system.
Conclusions: This novel nomogram with surgical margin, postoperative tumor node metastasis (pTNM) stage, and neural invasion as prognostic factors has a significant predictive performance for the risk of anastomotic recurrence after radical gastrectomy in patients with Siewert II or III adenocarcinoma.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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