Affiliation:
1. Belarusian Medical Academy of Postgraduate Education
2. United Institute of Informatics Problems of the National Academy of Sciences of Belarus
3. N.N. Alexandrov National Cancer Center
Abstract
The study topicality was conditioned by a need to find potential predictors of gastric cancer (GC) clinical progression in view of a high probability of long-term gastric cancer development in the post-surgery period.The study was conducted during 2008-2018 and involved 345 radically operated gastric cancer patients (pT4a-bN0-3M0, types III-IV according to the R. Bormann classification). Out of this cohort, 68 patients underwent intraoperative hyperthermic chemoperfusion (cisplatin 50 mg/m2, doxorubicin 50 mg/m2, 1 hour, 42 °C). Long-term treatment results (progression-free survival (PFS)) were assessed by means of the Kaplan-Meier estimator method and the Cox multivariate analysis.The unfavorable factors resulting in the GC progression included the metastatic damage of the regional lymph node (pN1-2 - RR 1.7 (95 % CI 1.2-2.5), pCox = 0.003; pN1-2 - RR 3.6 (95 % CI 2.5-5.1), pCox < 0.001), the extent of the tumor process requiring either a standard or combined gastrectomy or a combined distal stomach resection in comparison with a standard subtotal stomach resection (RR 1.4 (95 % CI 1.1-1.8), pCox = 0.017), and the situations where the patient treatment volume was limited to only radical surgery (RR 1.6 (95 % CI 1.1-2.2), pCox = 0.012). Based on the results of the Cox regression analysis, the nomogram was developed to predict PFS using the evaluation of the pN category and the volume of administered therapeutic procedures (surgical intervention extent and administration or non-administration of hyperthermic chemoperfusion). The nomogram demonstrated a highly predictive performance scoring a concordance index of 0.67.The proposed nomogram provides a fairly high accuracy of predicting PFS in the infiltrative GC patients (pT4a-bN0-3M0) proceeding from the tumor morphology evaluation and the radical treatment extent.
Publisher
Publishing House Belorusskaya Nauka
Reference24 articles.
1. Okeanov A. E., Moiseev P. I., Levin L. F. Statistics of cancer diseases in the Republic of Belarus (2004-2013). Minsk, Republican Scientific and Practical Center of Oncology and Medical Radiology, 2018. 286 p. (in Russian).
2. Reutovich M. Y., Krasko O. V., Sukonko O. G. Hyperthermic intraperitoneal chemotherapy in prevention of gastric cancer metachronous peritoneal metastases: a systematic review. Journal of Gastrointestinal. Oncology, 2021, vol. 12, suppl. 1, pp. S5-S17. http://doi.org/10.21037/jgo-20-129
3. Matharu G., Tucker O., Alderson D. Systematic review of intraperitoneal chemotherapy for gastric cancer. British Journal of Surgery, 2011, vol. 98, no. 9, pp. 1225-1235. http://doi.org/10.1002/bjs.7586
4. Kattan M. W., Sternberg C. N., Mehmud F., Bhatt K., McCann L., Motzer R. J. Development and validation of a prognostic nomogram for progression-free survival in patients with advanced renal cell carcinoma treated with pazopanib. Onkourologiya = Cancer urology, 2015, vol. 11, no. 4, pp. 16-23 (in Russian).
5. Therneau T., Grambsch P. Modeling Survival Data: Extending the Cox Model. New York, Springer-Verlag, 2000. 350 p.