Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy
Abstract Background Lacking quantitative evaluations of clinicopathological features and the risk factors for loco-regional recurrence (LRR) in gastric cancer after D2 gastrectomy, we aimed to develop a competing risk nomogram to identify the risk predictors for initial LRR. Methods We retrospective...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-07-01
|
| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-019-1332-y |
| _version_ | 1818848489504768000 |
|---|---|
| author | Shu-Bei Wang Wei-Xiang Qi Jia-Yi Chen Cheng Xu Youlia M. Kirova Wei-Guo Cao Rong Cai Lu Cao Min Yan Gang Cai |
| author_facet | Shu-Bei Wang Wei-Xiang Qi Jia-Yi Chen Cheng Xu Youlia M. Kirova Wei-Guo Cao Rong Cai Lu Cao Min Yan Gang Cai |
| author_sort | Shu-Bei Wang |
| collection | DOAJ |
| description | Abstract Background Lacking quantitative evaluations of clinicopathological features and the risk factors for loco-regional recurrence (LRR) in gastric cancer after D2 gastrectomy, we aimed to develop a competing risk nomogram to identify the risk predictors for initial LRR. Methods We retrospectively analysed 1105 patients who underwent radical gastrectomy with D2 resection for stage I-III gastric cancer. A nomogram predicting initial LRR of gastric cancer was conducted based on Fine and Grey’s competing risk analysis. The predictive accuracy and discriminative ability of the model were determined using the concordance index (C-index) and calibration curve. Decision tree analysis was performed for patient grouping. Results At a median follow-up of 28.4 months, 274 patients developed 373 first recurrence events (local, regional, and distant disease). The median recurrence-free survival (RFS) was 16.7 months. Multivariate competing risk analysis showed that age (SHR, 1.72; 95% CI, 1.10–2.83, p = 0.031), CEA (SHR, 1.94; 95% CI, 1.09–3.46, p = 0.024), pT4 (SHR, 2.77; 95% CI, 1.01–7.57, p = 0.047), lymph node metastasis (SHR 1.92, 95% CI: 1.09–3.38, p = 0.024) and LVI (SHR, 1.84; 95% CI, 1.06–3.20, p = 0.028) were independent risk factors for LRR (all p < 0.05). The nomogram incorporating these factors achieved good agreement between prediction and actual observation with a concordance index of 0.738 (95% CI, 0.767 to 0.709). In a subgroup analysis of node-positive patients, pN3b was associated with increased peritoneal and distant metastasis (p = 0.048). The para-aortic lymph nodes were the most frequent sites (n = 71) of LRR, and among them, the 16a2 and 16b1 nodes exhibited even more prevalence (90.1 and 81.7%). Conclusions Adjuvant radiotherapy might be recommended in gastric cancer patients ≥65 years old or those with pN+, pT4, LVI, or increased CEA levels, particularly in high-risk or pN1-3a patients. The competing risk nomograms may be considered as convenient and individualized predictive tools for LRR in gastric cancer after D2 gastrectomy. It is also recommended that the clinical target volume (CTV) include 16a2 and 16b1 regions of para-aortic lymph nodes. |
| first_indexed | 2024-12-19T06:18:09Z |
| format | Article |
| id | doaj.art-92b4ae21dcbb4fb2893b66768ac931ed |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-19T06:18:09Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-92b4ae21dcbb4fb2893b66768ac931ed2022-12-21T20:32:47ZengBMCRadiation Oncology1748-717X2019-07-0114111110.1186/s13014-019-1332-yCompeting risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomyShu-Bei Wang0Wei-Xiang Qi1Jia-Yi Chen2Cheng Xu3Youlia M. Kirova4Wei-Guo Cao5Rong Cai6Lu Cao7Min Yan8Gang Cai9Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Institute CurieDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of MedicineDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineAbstract Background Lacking quantitative evaluations of clinicopathological features and the risk factors for loco-regional recurrence (LRR) in gastric cancer after D2 gastrectomy, we aimed to develop a competing risk nomogram to identify the risk predictors for initial LRR. Methods We retrospectively analysed 1105 patients who underwent radical gastrectomy with D2 resection for stage I-III gastric cancer. A nomogram predicting initial LRR of gastric cancer was conducted based on Fine and Grey’s competing risk analysis. The predictive accuracy and discriminative ability of the model were determined using the concordance index (C-index) and calibration curve. Decision tree analysis was performed for patient grouping. Results At a median follow-up of 28.4 months, 274 patients developed 373 first recurrence events (local, regional, and distant disease). The median recurrence-free survival (RFS) was 16.7 months. Multivariate competing risk analysis showed that age (SHR, 1.72; 95% CI, 1.10–2.83, p = 0.031), CEA (SHR, 1.94; 95% CI, 1.09–3.46, p = 0.024), pT4 (SHR, 2.77; 95% CI, 1.01–7.57, p = 0.047), lymph node metastasis (SHR 1.92, 95% CI: 1.09–3.38, p = 0.024) and LVI (SHR, 1.84; 95% CI, 1.06–3.20, p = 0.028) were independent risk factors for LRR (all p < 0.05). The nomogram incorporating these factors achieved good agreement between prediction and actual observation with a concordance index of 0.738 (95% CI, 0.767 to 0.709). In a subgroup analysis of node-positive patients, pN3b was associated with increased peritoneal and distant metastasis (p = 0.048). The para-aortic lymph nodes were the most frequent sites (n = 71) of LRR, and among them, the 16a2 and 16b1 nodes exhibited even more prevalence (90.1 and 81.7%). Conclusions Adjuvant radiotherapy might be recommended in gastric cancer patients ≥65 years old or those with pN+, pT4, LVI, or increased CEA levels, particularly in high-risk or pN1-3a patients. The competing risk nomograms may be considered as convenient and individualized predictive tools for LRR in gastric cancer after D2 gastrectomy. It is also recommended that the clinical target volume (CTV) include 16a2 and 16b1 regions of para-aortic lymph nodes.http://link.springer.com/article/10.1186/s13014-019-1332-yGastric carcinomaLoco-regional recurrencePara-aortic lymph nodesRadiation target volumeCompeting risk nomogram |
| spellingShingle | Shu-Bei Wang Wei-Xiang Qi Jia-Yi Chen Cheng Xu Youlia M. Kirova Wei-Guo Cao Rong Cai Lu Cao Min Yan Gang Cai Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy Radiation Oncology Gastric carcinoma Loco-regional recurrence Para-aortic lymph nodes Radiation target volume Competing risk nomogram |
| title | Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy |
| title_full | Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy |
| title_fullStr | Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy |
| title_full_unstemmed | Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy |
| title_short | Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy |
| title_sort | competing risk nomogram predicting initial loco regional recurrence in gastric cancer patients after d2 gastrectomy |
| topic | Gastric carcinoma Loco-regional recurrence Para-aortic lymph nodes Radiation target volume Competing risk nomogram |
| url | http://link.springer.com/article/10.1186/s13014-019-1332-y |
| work_keys_str_mv | AT shubeiwang competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT weixiangqi competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT jiayichen competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT chengxu competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT youliamkirova competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT weiguocao competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT rongcai competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT lucao competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT minyan competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy AT gangcai competingrisknomogrampredictinginitiallocoregionalrecurrenceingastriccancerpatientsafterd2gastrectomy |