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BMC Cancer
Published in: BMC Cancer 1/2023

Open Access 01-12-2023 | Gastric Cancer | Research

Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Authors: L Bobrzynski , K Sędłak , K Rawicz-Pruszyński , P Kolodziejczyk , A Szczepanik , W Polkowski , P Richter , M Sierzega

Published in: BMC Cancer | Issue 1/2023

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Abstract

Background

Textbook outcome (TO) is a composite measure reflecting various aspects of services provided to patients with solid malignancies. We sought to evaluate the importance of various TO components previously proposed for gastric cancer.

Methods

Prospectively maintained electronic databases of 1,743 patients treated in two academic surgical centres were reviewed. Six candidate definitions of TO were evaluated based on their ability to accurately predict patients’ prognosis by Cox proportional hazards modelling.

Results

TO definition combining 10 measures corresponding to complete tumour resection with an uneventful postoperative course showed the best goodness of fit by achieving the lowest values of Akaike (AIC) and Bayesian (BIC) information criteria and the best predictive performance based on the highest value of c-index. The overall median survival was significantly longer for patients with than without textbook outcome (69.0 vs 20.1 months, P < 0.001). TO maintained its prognostic value in a multivariate model controlling for age, sex, comorbidities, treatment, and tumour related variables and was associated with a 39% lower risk of death (HR 0.61, 95%CI 0.51 – 0.73, P < 0.001). Nine variables identified as predictors of TO were used to develop a nomogram showing very good correlation between the predicted and actual probability of achieving TO. The AUC of ROC obtained from the nomogram was 0.752 (95% CI 0.727 to 0.781).

Conclusions

A uniform definition of textbook outcome provides clinically relevant prognostic information and could be used in quality improvement programs for gastric cancer patients.
Appendix
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Metadata
Title
Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer
Authors
L Bobrzynski
K Sędłak
K Rawicz-Pruszyński
P Kolodziejczyk
A Szczepanik
W Polkowski
P Richter
M Sierzega
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-023-11695-4

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