Journal Article

Development and External Validation of Web-Based Models to Predict the Prognosis of Remnant Gastric Cancer after Surgery: A Multicenter Study

Guo, Kai-Qing, Huang, Ze-Ning, Lin, Mi, Dang, Xue-Yi, Lin, Wei, Huang, Chang-Ming, Cai, Li-Sheng, Su, Guo-Qiang, Tu, Ru-Hong, Lin, Shuang-Ming, Lu, Jun, Xie, Jian-Wei, Liu, Zhi-Yu, He, Qing-Liang, Cao, Long-Long, Xu, Dong-Bo, Zheng, Chao-Hui, Li, Ping, Zhou, Jun-Feng, Li, Teng-Wen, Qiu, Xian-Tu, Lin, Ju-Li, Chen, Qi-Yue, Wang, Jia-Bin, Zhong, Qing, Chen, Qiu-Xian, Lin, Jian-Xian

2019

Overview

Background. Remnant gastric cancer (RGC) is a rare malignant tumor with poor prognosis. There is no universally accepted prognostic model for RGC. Methods. We analyzed data for 253 RGC patients who underwent radical gastrectomy from 6 centers. The prognosis prediction performances of the AJCC7th and AJCC8th TNM staging systems and the TRM staging system for RGC patients were evaluated. Web-based prediction models based on independent prognostic factors were developed to predict the survival of the RGC patients. External validation was performed using a cohort of 49 Chinese patients. Results. The predictive abilities of the AJCC8th and TRM staging systems were no better than those of the AJCC7th staging system (c-index: AJCC7th vs. AJCC8th vs. TRM, 0.743 vs. 0.732 vs. 0.744; P>0.05). Within each staging system, the survival of the two adjacent stages was not well discriminated (P>0.05). Multivariate analysis showed that age, tumor size, T stage, and N stage were independent prognostic factors. Based on the above variables, we developed 3 web-based prediction models, which were superior to the AJCC7th staging system in their discriminatory ability (c-index), predictive homogeneity (likelihood ratio chi-square), predictive accuracy (AIC, BIC), and model stability (time-dependent ROC curves). External validation showed predictable accuracies of 0.780, 0.822, and 0.700, respectively, in predicting overall survival, disease-specific survival, and disease-free survival. Conclusions. The AJCC TNM staging system and the TRM staging system did not enable good distinction among the RGC patients. We have developed and validated visual web-based prediction models that are superior to these staging systems.

• Publisher: Hindawi,John Wiley & Sons, Inc
• Subject: Cancer / Chemotherapy / Gastric cancer / Histology / Hospitals / Lymphatic system / Medical prognosis / Metastasis / Oncology, Experimental / Patients / Performance evaluation / Prognosis / Software / Stomach cancer / Surgery / Tumor staging