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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2022

26-08-2022 | Gastrectomy | Translational Research

Very Early Recurrence After Curative-Intent Surgery for Gastric Adenocarcinoma

Authors: Gaya Spolverato, MD, Giulia Capelli, MD, Valentina Mari, MD, Giulia Lorenzoni, MD, Dario Gregori, MD, George Poultsides, MD, Ryan C. Fields, MD, Sharon M. Weber, MD, Konstantinos Votanopoulos, MD, Clifford S. Cho, MD, Jin He, MD, Shishir K. Maithel, MD, Salvatore Pucciarelli, MD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

Published in: Annals of Surgical Oncology | Issue 13/2022

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Abstract

Background

Recurrence after curative-intent surgery can occur in more than 50% of gastric cancer (GC) patients. We sought to identify predictors of very early recurrence (VER) among GC patients who underwent curative-intent surgery.

Methods

A multi-institutional database of GC patients undergoing curative-intent surgery between 2000 and 2020 at 8 major institutions was queried. VER was defined as local or distant tumor recurrence within 6 months from surgery. Univariable Cox proportional hazard models were used to evaluate the predictive value of clinical-pathological features on VER. A regularized Cox regression model was employed to build a predictive model of VER and recurrence within 12 months. The discriminant ability of the Cox regularized models was evaluated by reporting a ROC curve together with the calibration plot, considering 200 runs.

Results

Among 1133 patients, 65 (16.0%) patients experienced a VER. Preoperative symptoms (HR 1.198), comorbidities (HR 1.289), tumor grade (HR 1.043), LNR (HR 4.339) and T stage (HR 1.639) were associated with an increased likelihood of VER. Model performance was very good at predicting VER at 6 months (AUC of 0.722) and 12 months (AUC 0.733). Two nomograms to predict 6-month and 12-month VER were built based on the predictive model. A higher nomogram score was associated with worse prognosis. There was good prediction between observed and estimated VER with minimal evidence of overfitting and good performance on internal bootstrapping validation.

Conclusion

One in 6 patients experienced VER following curative-intent surgery for GC. Nomograms to predict risk of VER performed well on internal validation, and stratified patients into distinct prognostic groups relative to 6- and 12-months recurrence.
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Metadata
Title
Very Early Recurrence After Curative-Intent Surgery for Gastric Adenocarcinoma
Authors
Gaya Spolverato, MD
Giulia Capelli, MD
Valentina Mari, MD
Giulia Lorenzoni, MD
Dario Gregori, MD
George Poultsides, MD
Ryan C. Fields, MD
Sharon M. Weber, MD
Konstantinos Votanopoulos, MD
Clifford S. Cho, MD
Jin He, MD
Shishir K. Maithel, MD
Salvatore Pucciarelli, MD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
Publication date
26-08-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12434-y

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