A nomogram model for predicting the risk for recurrence of early gastric cancer in elderly patients undergoing endoscopic submucosal dissection / 中华老年医学杂志

ABSTRACT

Objective:To examine a nomogram model for individualized prediction of the risk for recurrence of early gastric cancer(EGC)in elderly patients undergoing endoscopic submucosal dissection(ESD).Methods:This was a retrospective cohort study, with a total of 3 987 elderly EGC patients who underwent ESD treatment between January 2000 and December 2016 after admission to the gastroenterology department of our hospital.Twenty-eight relapsed patients with complete clinicopathological data and follow-up data were selected as the relapse group, and 276 non-relapsed patients were selected as the control group.General data of all patients were collected and a logistic regression analysis was performed to analyze independent risk factors for the recurrence of EGC in patients after ESD.A corresponding nomogram risk prediction model was established by using the R software.Results:Among the 3 987 elderly EGC patients, 29 relapsed after an average follow-up of 2.7 years, and the recurrence rate was 0.73%(29/3 987). The differences in baseline data such as age(≥75 years old), lesion size(≥3 mm), T stage and lymph node metastasis between the recurrence group and the control group were statistically significant(11 cases or 39.3% vs.171 cases or 62.0%, 19 cases or 67.9% vs.111 cases or 40.0%, 9 cases or 32.1% vs.153 cases or 55.4%, 19 cases or 67.9% vs.102 cases or 39.0%, P<0.05). Logistic regression analysis showed that age over 75 years( OR=2.128, 95% CI 1.373-3.624), T stage( OR=1.763, 95% CI 1.079-2.934), lesion size≥3 mm( OR=2.604, 95% CI 1.363-4.217), and lymph node metastasis( OR=2.871, 95% CI 1.425-5.639)were independent risk factors for the recurrence after ESD in EGC patients( P<0.05). The nomogram model was established based on the above risk factors, and the validation results showed that the predicted value was basically the same as the actual measured value and had good predictive performance.The internal validation results showed that the consistency index was 0.817(95% CI 0.722-0.941), suggesting that the model had a high accuracy and discrimination. Conclusions:Before ESD for elderly EGC patients is performed, factors such as age, tumor size, T stage and lymph node metastasis should be fully considered to comprehensively evaluate the recurrence rate of EGC after the procedure.This predictive model can improve the diagnostic efficacy of postoperative recurrence and has high clinical value.