A Novel ypTLM Staging System Based on LODDS for Gastric Cancer After Neoadjuvant Therapy: Multicenter and Large-Sample Retrospective Study.
World J Surg
; 47(7): 1762-1771, 2023 07.
Article
in En
| MEDLINE
| ID: mdl-37069317
ABSTRACT
BACKGROUND:
The accuracy of the eighth AJCC ypTNM staging system on the prognosis of gastric cancer (GC) patients after neoadjuvant therapy (NAT) is controversial. This study aimed to develop and validate a novel staging system using the log odds of positive lymph nodes scheme (LODDS).METHODS:
A retrospective analysis of 606 GC patients who underwent radical gastrectomy after neoadjuvant therapy was conducted as the development cohort. (Fujian Medical University Affiliated Union Hospital (n = 183), Qinghai University Affiliated Hospital (n = 169), Mayo Clinic (n = 236), Lanzhou University First Hospital (n = 18)). The validation cohort came from the SEER database (n = 1701). A novel ypTLoddsS (ypTLM) staging system was established using the 3-year overall survival. The predictive performance of two systems was compared.RESULTS:
Two-step multivariate Cox regression analysis in both cohorts showed that ypTLM was an independent predictor of overall survival of GC patients after neoadjuvant therapy (HR 1.57, 95% CI 1.30-1.88, p < 0.001). In the development cohort, ypTLM had better discrimination ability than ypTNM (C-index 0.663 vs 0.633, p < 0.001), better prediction homogeneity (LR 97.7 vs. 70.9), and better prediction accuracy (BIC 3067.01 vs 3093.82; NRI 0.36). In the validation cohort, ypTLM had a better prognostic predictive ability (C-index 0.614 vs 0.588, p < 0.001; LR 11,909.05 vs. 11,975.75; BIC 13,263.71 vs 13,328.24; NRI 0.22). The time-dependent ROC curve shows that the predictive performance of ypTLM is better than ypTNM, and the analysis of the decision curve shows that ypTLM achieved better net benefits.CONCLUSION:
A LODDS-based ypTLM staging system based on multicenter data was established and validated. The predictive performance was superior to the eighth AJCC ypTNM staging system.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Stomach Neoplasms
Type of study:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
World J Surg
Year:
2023
Type:
Article
Affiliation country:
China