Omission of adjuvant therapy after gastric cancer resection: development of a validated risk model.

摘要: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer recommend adjuvant chemotherapy with or without radiotherapy following after resection of gastric adenocarcinoma (GA) patients who have not received neoadjuvant therapy. Despite frequent noncompliance nationally, risk factors underlying therapy omission (ATom) been well characterized. We developed an internally validated preoperative instrument stratifying by incremental ATom. The National Data Base was queried stage IB-III GA undergoing gastrectomy; those receiving were excluded. Multivariable models identified associated ATom between 2006 and 2011. Internal validation performed using bootstrap analysis; model discrimination calibration assessed k-fold cross-validation Hosmer-Lemeshow procedures, respectively. Using weighted β-coefficients, a simplified Omission Risk Score (ORS) created to stratify risk. impact on overall survival (OS) examined ORS risk-stratified cohorts. In 4,728 (median age, 70 years; 64.8% male), 53.7% had bootstrap-validated advancing comorbidity, underinsured/uninsured status, proximal tumor location, clinical T1/2 N0 tumors as independent predictors, demonstrating good discrimination. ORS, into low-, moderate-, high-risk categories, predicted (30% vs 53% 80%, respectively) progressive delay initiation time, 51 55 61 days, respectively). Patients at moderate/high-risk demonstrated worsening risk-adjusted mortality compared low-risk OS, 26.4 29.2 months). This may aid rational selection multimodality treatment sequence GA.