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Development and evaluation of a ceMDCT-based preoperative risk stratification model to predict disease-free survival after radical surgery in patients with gastric cancer

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Abstract

Purpose

To develop and evaluate a preoperative risk stratification model for predicting disease-free survival (DFS) based on contrast-enhanced multidetector computed tomography (ceMDCT) images in patients with gastric cancer (GC) undergoing radical surgery.

Methods

We retrospectively enrolled patients with GC who underwent ceMDCT followed by radical surgery. A preoperative risk stratification model was constructed (including risk factor selection, risk status scoring, and risk level assignment) using Cox proportional hazard regression and log-rank analyses in the training cohort; the model was tested in the validation cohort. A nomogram was used to compare the preoperative risk stratification model with a postoperative DFS prediction model.

Results

A total of 462 patients (training/validation: 271/191) were included. The ceMDCT features of T category (score of 0 or 2), N category (0, 1, 2, or 3), extramural vessel invasion (0 or 2), and tumor location (0 or 1) were selected to construct the preoperative risk stratification model, with 4 risk levels defined based on risk score. There were significant differences in DFS among the risk levels in both cohorts (p < 0.001). The predictive value of the preoperative model was similar to that of the postoperative model, with concordance indices of 0.791 (95% CI, 0.743–0.837) and 0.739 (95% CI, 0.666–0.812), respectively, in the training cohort and 0.762 (95% CI, 0.696–0.828) and 0.738 (95% CI, 0.684–0.792), respectively, in the validation cohort.

Conclusion

A preoperative risk stratification model based on ceMDCT images could be used to predict DFS and thus classify GC cases into various risk levels.

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Acknowledgements

We appreciate Xiaohua Zhou, Ph.D (azhou@bicmr.pku.edu.cn) for statistical consulting of this article. We also appreciate Ms. Megan Griffiths (megangriffiths97@gmail.com) for conducting a linguistic revision of this article.

Funding

This work was supported by the National Natural Science Foundation of China (Grant Number 81901819) and Peking University People's Hospital Research and Development Funds (RDX2019-01).

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Author notes

  1. Caizhen Feng and Jin Cheng have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Peking University People’s Hospital, 11 Xizhimen South St, Beijing, 100044, China

    Caizhen Feng, Jin Cheng, Xiao Zeng, Nan Hong & Yi Wang

  2. Department of Pathology, Peking University People’s Hospital, 11 Xizhimen South St, Beijing, 100044, China

    Yinli Zhang

  3. Department of Gastrointestinal Surgery, Peking University People’s Hospital, 11 Xizhimen South St, Beijing, 100044, China

    Yingjiang Ye

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  1. Caizhen Feng
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  2. Jin Cheng
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Contributions

CF Investigation, Methodology, Writing—Original draft preparation; JC Conceptualization, Original draft preparation, Methodology, Funding acquisition; ZX Methodology; YZ Investigation; YY, NH Supervision; YW Conceptualization, Writing—Reviewing and Editing.

Corresponding author

Correspondence to Yi Wang.

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The authors declare no conflict of interest.

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This retrospective study was approved by our local institutional review boards, which waived the requirement for obtaining informed consent.

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Feng, C., Cheng, J., Zeng, X. et al. Development and evaluation of a ceMDCT-based preoperative risk stratification model to predict disease-free survival after radical surgery in patients with gastric cancer. Abdom Radiol 46, 4079–4089 (2021). https://doi.org/10.1007/s00261-021-03049-0

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