2-year relapse-free survival in gastric cancer patients after upfront surgery vs. neoadjuvant chemotherapy
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads: Pacientiem ar lokāli izplatītu kuņģa vēzi (KV) pēc ķirurģiskas operācijas (ĶO), salīdzinājumā ar neoadjuvantu ķīmijterapiju un operāciju (NAT+ O) ievērojami atšķiras prognoze. Pētījuma mērķis bija noteikt nozīmīgus prognostiskos faktorus, kas ietekmē divu gadu bezrecidīva izdzīvotību (BRI), pacientiem ar IB-IIIC stadijas KV pēc ĶO un NAT+O. Turklāt, mūsu papildus mērķis bija izstrādāt un apstiprināt jaunu nomogrammu, kas prognozē 2 gadu BRI pacientiem pēc IB-IIIC stadijas kuņģa vēža radikālas operācijas.
Materiāls un metodes: Retrospektīvajā kohortas pētījumā tika iekļauti 203 pacienti ar IB-IIIC stadijas KV, kuriem tika veikta radikāla kuņģa rezekcija laika posmā no 2016. gada janvāra līdz 2020. gada decembrim Paula Stradiņa Klīniskajā universitātes slimnīcā, Latvijā. 126 (62,1%) pacientiem tika veikta operācija bez neoadjuvantas ķīmijterapijas, bet 77 (37,9%) pacientiem pirms kuņģa rezekcijas tika veikta neoadjuvanta ķīmijterapija. Lai salīdzinātu izdzīvotību un noteiktu 2 gadu BRI ietekmējošos prognostiskos faktorus, tika izmantots Kaplana-Meijera novērtējums un Cox proporcionālo risku regresijas modelis. Neatkarīgie prognostiskie faktori tika iekļauti nomogrammā, kas prognozē 2 gadu BRI pēc radikālas KV rezekcijas. Lai novērtētu nomogrammas diskrimināciju un kalibrēšanu, tika veikta iekšējā validācija.
Rezultāti: Cox proporcionālo risku regresijas analīze neuzrādīja statistiski nozīmīgu agrīnu recidīva riska atšķirību pacientiem, kam NAT tika lietota pirms KV rezekcijas, salīdzinājumā ar pacientiem bez NAT (HR=0,68; 95%CI=0,470-1,01; p=0,058). Turklāt, NAT saņemšana būtiski neietekmēja kopējo dzīvildzi, salīdzinot ar ĶO grupu. Svarīgi atzīmēt, ka NAT+ O grupā līdz novērošanas perioda beigām netika sasniegta 50 % mirstība. Aprēķinātā 5-gadu kopējā izdzīvotība (KI) bija 43,3 % pret 53,3 % ĶO un NAT+O grupās (HR=0,723; 95% CI=0,483-1,083; p=0,110). Multifaktoriālā analīze parādīja, ka (y)pT, limfmezglu attiecība, pirmsoperācijas trombocītu skaits, pēcoperācijas CA 19-9 līmenis un vaskulārā invāzija bija neatkarīgi 2 gadu BRI prognostiskie faktori. Nomogrammas modeļa iekšējā validācija uzrādīja Somersa D statistiku 0,458 un C indeksa vērtību 0,729 (95 % IK; 0,720-0,747). Turklāt, kalibrēšana izrādījās precīza, salīdzinot nomogrammas prognozes un faktiskos novērojumus par divu gadu BRI.
Secinājumi: Mēs izstrādājām un apstiprinājām nomogrammu, kas prognozē 2 gadu BRI pēc radikālas rezekcijas IB-IIIC stadijas kuņģa vēža pacientiem. Šo nomogrammu var izmantot, lai novērtētu pacienta individuālo recidīva risku, izvērtējot papildu terapiju klīniskajā praksē.
Background: Prognoses vary substantially among patients with locally advanced gastric cancer (GC) following upfront surgery (UFS) vs. neoadjuvant chemotherapy and surgery (NAT+S). The objective of this study was to identify significant prognostic factors of 2-year relapse-free survival (RFS) in patients with stage IB-IIIC GC after UFS vs. NAT+S. Furthermore, we aim to develop and validate a novel nomogram that predicts 2-year RFS following curative resection of stage IB-IIIC gastric cancer. Methods: This retrospective cohort study enrolled 203 patients with stage IB-IIIC GC who underwent curative-intent resection at Paul Stradiņš Clinical University Hospital in Latvia between January 2016 and December 2020. A total of 126 (62.1%) patients had upfront surgery, and 77 (37.9%) patients received chemotherapy prior to GC resection. Kaplan-Meier estimate and Cox proportional hazards regression model were used to compare survival and identify significant prognostic factors of 2-year RFS. Independent prognostic factors were incorporated into a novel nomogram that predicts 2-year RFS following curative-intent resection of GC. Discrimination and calibration of the nomogram were evaluated by internal validation. Results: Cox proportional hazards regression analysis showed no statistically significant difference in the hazard of early relapse for those given NAT prior to resection of GC compared with upfront resection (HR=.68; 95%CI=.470-1.01; p=.058). Moreover, the receipt of NAT exhibited no significant effect on overall survival when compared with the UFS group. Important to note that 50% mortality was not reached in NAT+S group by the end of the follow-up. The estimated OS at 5 years was 43.3% vs 53.3% for the UFS and NAT+S groups (HR=.723; 95% CI=.483-1.083; p=.110). Multivariate analysis revealed that (y)pT, lymph node ratio, preoperative PLT count, postoperative CA 19-9, and vascular invasion were independent prognostic factors of 2-year RFS. Internal validation of the nomogram model yielded a Somers’ D statistic of 0.458 and C-index value of 0.729 (95% CI; 0.720-0.747). Calibration appeared accurate when comparing nomogram predictions and actual observations of 2-year RFS. Conclusion: We developed and validated a nomogram that predicts 2-year RFS after curative resection in stage IB-IIIC gastric cancer patients. The nomogram may be utilized to assess a patient's individual risk of recurrence when considering additional therapy in clinical practice.
Background: Prognoses vary substantially among patients with locally advanced gastric cancer (GC) following upfront surgery (UFS) vs. neoadjuvant chemotherapy and surgery (NAT+S). The objective of this study was to identify significant prognostic factors of 2-year relapse-free survival (RFS) in patients with stage IB-IIIC GC after UFS vs. NAT+S. Furthermore, we aim to develop and validate a novel nomogram that predicts 2-year RFS following curative resection of stage IB-IIIC gastric cancer. Methods: This retrospective cohort study enrolled 203 patients with stage IB-IIIC GC who underwent curative-intent resection at Paul Stradiņš Clinical University Hospital in Latvia between January 2016 and December 2020. A total of 126 (62.1%) patients had upfront surgery, and 77 (37.9%) patients received chemotherapy prior to GC resection. Kaplan-Meier estimate and Cox proportional hazards regression model were used to compare survival and identify significant prognostic factors of 2-year RFS. Independent prognostic factors were incorporated into a novel nomogram that predicts 2-year RFS following curative-intent resection of GC. Discrimination and calibration of the nomogram were evaluated by internal validation. Results: Cox proportional hazards regression analysis showed no statistically significant difference in the hazard of early relapse for those given NAT prior to resection of GC compared with upfront resection (HR=.68; 95%CI=.470-1.01; p=.058). Moreover, the receipt of NAT exhibited no significant effect on overall survival when compared with the UFS group. Important to note that 50% mortality was not reached in NAT+S group by the end of the follow-up. The estimated OS at 5 years was 43.3% vs 53.3% for the UFS and NAT+S groups (HR=.723; 95% CI=.483-1.083; p=.110). Multivariate analysis revealed that (y)pT, lymph node ratio, preoperative PLT count, postoperative CA 19-9, and vascular invasion were independent prognostic factors of 2-year RFS. Internal validation of the nomogram model yielded a Somers’ D statistic of 0.458 and C-index value of 0.729 (95% CI; 0.720-0.747). Calibration appeared accurate when comparing nomogram predictions and actual observations of 2-year RFS. Conclusion: We developed and validated a nomogram that predicts 2-year RFS after curative resection in stage IB-IIIC gastric cancer patients. The nomogram may be utilized to assess a patient's individual risk of recurrence when considering additional therapy in clinical practice.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Kuņģa vēzi, neoadjuvantu ķīmijterapiju, ķirurģiskas operācijas, prognostiskos faktorus, bezrecidīva izdzīvotību, nomogrammu, Gastric cancer, neoadjuvant chemotherapy, upfront surgery, prognostic factors, relapse-free survival, nomogram