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Defining a Nomogram for Predicting Early Recurrence in Gastric Cancer Patients After Neoadjuvant Chemotherapy and Radical Gastrectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

To define and predict early recurrence (ER) in patients with gastric cancer (GC) who underwent radical gastrectomy after neoadjuvant chemotherapy (NAC).

Methods

The present study included 573 patients who underwent NAC followed by curative resection for GC between January 2014 and December 2019. The patients were randomly divided into the training (n = 382) and validation (n = 191) cohorts in a 2:1 ratio. The optimal cut-off value of recurrence-free survival for defining ER was determined based on post-recurrence survival (PRS). Risk factors for ER were identified by logistic regression. A nomogram was further constructed and evaluated.

Results

The optimal cut-off value for defining ER was 12 months. Overall, 136 patients (23.7%) experienced ER and had significantly shorter median PRS (4 vs. 13 months, P < 0.001). In the training cohort, factors independently associated with ER included age (P = 0.026), Lauren classification (P < 0.001), preoperative carcinoembryonic antigen (P = 0.029), ypN staging (P < 0.001), major pathological regression (P = 0.004), and postoperative complications (P < 0.001). A nomogram integrating these factors exhibited higher predictive accuracy than the ypTNM stage alone in both the training and validation cohorts. Moreover, the nomogram enabled significant risk stratification in both cohorts; only the high-risk patients could benefit from adjuvant chemotherapy (ER rate: 53.9% vs. 85.7%, P = 0.007).

Conclusion

A nomogram involving preoperative factors can accurately predict the risk of ER and guide individualized treatment strategies for GC patients following NAC, which may assist in clinical decision-making.

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Data Availability

The datasets used during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery and Anal Diseases, Affiliated Hospital of Weifang Medical College, No. 2428 Yuhe Road, Weifang, Shandong Province, China

    Guoqiang Liu, Lugang Zhao & Mengxin Lv

Authors
  1. Guoqiang Liu
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  2. Lugang Zhao
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  3. Mengxin Lv
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Contributions

Liu G, Zhao L, and Liu M conceived of the study and designed the study; Liu M helped collect data; Liu G analyzed the data and wrote the manuscript. Zhao L helped revise the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Guoqiang Liu.

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Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Written informed consent was obtained from all patients being included in the study.

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The authors declare no competing interests.

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Liu, G., Zhao, L. & Lv, M. Defining a Nomogram for Predicting Early Recurrence in Gastric Cancer Patients After Neoadjuvant Chemotherapy and Radical Gastrectomy. J Gastrointest Surg 27, 1766–1777 (2023). https://doi.org/10.1007/s11605-023-05697-7

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  • DOI: https://doi.org/10.1007/s11605-023-05697-7

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