Obiekt
Tytuł: Analysis of factors affecting treatment outcomes of gastric cancer patients
Abstrakt:
Gastric cancer remains one of the significant problems in modem oncology due to its high incidence and mortality rates. However, despite many clinical trials published to date, some aspects of surgical treatment remain controversial. Therefore, the present study aimed to evaluate the relevance of selected factors affecting the results of the therapeutic process. The study was planned as a retrospective clinical-control study using data retrieved from medical records and available databases. The study population consisted of four patient cohorts. The primary cohort included patients undergoing gastric resections for cancer in the First Department of Surgery of the Jagiellonian University Medical College between 1990 and 2020. The other three cohorts, used to validate the models developed from the primary cohort, included patients from the Polish and US populations. Tumor typing and grading were adjusted to the current WHO classification. Tumor staging was assessed based on the TNM classification formulated by the American Joint Committee on Cancer (AJCC). The location and macroscopic appearance of the tumor and the extent of surgical treatment were defined based on current Japanese Gastric Cancer Association (JGCA) guidelines. The postoperative course was analyzed using the Clavien- Dindo classification system. Statistical analysis was performed using IBM® SPSS® Statistics v28 ( ; IBM Corporation) and RStudio (Integrated Development Environment for R) software. A textbook outcome (TO) concept, reflecting the complexity of patient care, was used to evaluate the results of therapeutic interventions among patients with gastric cancer. Comparing six previously published definitions of TO, a significant correlation was found between the number of individual components of the indicator and patients ’prognosis. Ultimately, a definition including 10 parameters related to safety (intraoperative and postoperative complications, reoperation, mortality, intensive care unit stay, length of hospital stay, re hospitalization) and treatment efficacy (resection margins, number of lymph nodes evaluated) proved to most accurately reflect the probability of achieving long-term survival. In addition, a nomogram was developed to estimate the probability of achieving TO. Another aspect of the study was to evaluate outcomes of patients with locally advanced gastric cancer with suspected infiltration of adjacent organs (cT4b). Multiorgan resections were associated with a significantly increased complication rate, mainly determined by distal pancreatectomy and partial colectomy. Both resection types significantly increased the odds ratios of major complications, reaching 2.53 for distal pancreatectomy and 2.29 for colon resection. In contrast, there was no correlation between th ; e extent of multi-organ resection and mortality. There was also no correlation between the type of organ resected and the prognosis of patients; however, multiorgan resection increased the likelihood of margin-free resections. The final component of the study was to evaluate the usefulness of the AJCC TNM classification used for gastric cancer. We found that the 8 ^ edition of the classification showed better discriminatory power than the earlier TNM system, but only in the population of patients with the number of evaluated lymph nodes >16. A nomogram based on five predictor variables was developed to accurately estimate the probability of 5-year overall survival in this group of patients. The nomogram showed better discriminatory power compared to the 7^ and 8™ editions of the AJCC system.
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Dyscyplina:
chirurgia ; choroby układu trawiennego ; onkologia
Instytucja nadająca tytuł:
Rada Dyscypliny Nauki medyczne
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Data ostatniej modyfikacji:
5 mar 2026
Data dodania obiektu:
5 mar 2026
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http://149.156.57.56:8080/publication/6113
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| Nazwa wydania | Data |
|---|---|
| ZB-143074 | 5 mar 2026 |
Obiekty
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Ścisło, Lucyna
