Recurrence outcome and prediction model of patients with gastric cancer underwent laparoscopic-assisted total gastrectomy: A retrospective study.

Abstract

In recent years, the use of laparoscopic techniques in total gastrectomy has gradually increased. Strong evidence is urgently needed to confirm the long-term oncological outcomes of laparoscopic-assisted total gastrectomy for resectable gastric cancer. The training set contained 811 gastric cancer patients from Fujian Medical University Union Hospital, and 267 gastric cancer patients in Putian University Affiliated Hospital were used as an external validation set. A minimum P value approach was used to evaluate the optimal threshold of recurrence-free survival to divide the patients into early and late recurrence cohorts based on the length of the postrecurrence survival. The training set had a 5-year actual overall survival rate of 62.5% and a 5-year actual recurrence-free survival rate of 60.3%. Of the 811 patients, 324 (40.0%) experienced recurrence, with the highest percentage of distant metastases (n = 199; 61.4%). Univariate and multivariate Cox regression analyses showed that pT stage, pN stage, nerve/lymphatic invasion, preoperative carcinoembryonic antigen, preoperative immunoinflammatory index (systemic immune-inflammatory index), and postoperative adjuvant chemotherapy were independent prognostic factors associated with overall survival and recurrence-free survival (all P < .05). The optimal cutoff time for distinguishing between early recurrence (n = 113; 34.9%) and late recurrence (n = 211; 65.1%) was the 12th postoperative month (P = .011). Factors associated with early recurrence included pT stage, pN stage, preoperative cancer antigen 72-4, cancer antigen 199, cancer antigen 125, and systemic immune-inflammatory index, based on which we constructed an early recurrence prediction model. The predictive evaluation indices of this model were significantly better than those of the American Joint Committee on Cancer Eighth Edition pTNM staging system; these results were also found in the external validation cohort. In this retrospective analysis, we found that laparoscopic-assisted total gastrectomy in patients with resectable gastric cancer had good long-term oncological outcomes, with an optimal cutoff time of 12 months postoperatively for early recurrence and late recurrence after laparoscopic-assisted total gastrectomy. The early recurrence prediction model constructed for patients with laparoscopic-assisted total gastrectomy may inform clinicians to develop more precise treatment and follow-up strategies.