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Stratification of Postsurgical Computed Tomography Surveillance Based on the Extragastric Recurrence of Early Gastric Cancer

 Nieun Seo  ;  Kyunghwa Han  ;  Woo Jin Hyung  ;  Yong Eun Chung  ;  Chan Hyuk Park  ;  Jie-Hyun Kim  ;  Sang Kil Lee  ;  Myeong-Jin Kim  ;  Sung Hoon Noh  ;  Joon Seok Lim 
 ANNALS OF SURGERY, Vol.272(2) : 319-325, 2020-08 
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MINI: A risk-scoring system for predicting extragastric recurrence after surgical resection of early gastric cancer was developed. The low-risk group showed an extremely rare extragastirc recurrence and higher extragastric recurrence-free survival than the high-risk group. Postsurgical computed tomography surveillance may be unnecessary in the low-risk group after curative resection of early gastric cancer. Objective: To stratify the postsurgical computed tomography (CT) surveillance based on a risk-scoring system for predicting extragastric recurrence after surgical resection of early gastric cancer (EGC). Summary of background data: Postsurgical CT surveillance should not be routinely performed in all patients because of the low incidence of extragastric recurrence and potential risk of radiation exposure. Methods: Data from 3162 patients who underwent surgical resection for EGC were reviewed to develop a risk-scoring system to predict extragastric recurrence. Risk scores were based on the predictive factors for extragastric recurrence, which were determined using Cox proportional hazard regression model. The risk-scoring system was validated by Uno censoring adjusted C-index. External validation was performed using an independent dataset (n = 430). Results: The overall incidence of extragastric recurrence was 1.4% (44/3162). Five risk factors (lymph node metastasis, indications for endoscopic resection, male sex, positive lymphovascular invasion, and elevated macroscopic type), which were significantly associated with extragastric recurrence, were incorporated into the risk-scoring system, and the patients were categorized into 2 risk groups. The 10-year extragastric recurrence-free survival differed significantly between low- and high-risk groups (99.7% vs 96.5%; P < 0.001). The predictive accuracy of the risk-scoring system in the development cohort was 0.870 [Uno C-index; 95% confidence interval (95% CI), 0.800-0.939]. Discrimination was good after internal (0.859) and external validation (0.782, 0.549-1.000). Conclusion: This risk-scoring system might be useful to predict extragastric recurrence of EGC after curative surgical resection. We suggest that postsurgical CT surveillance to detect extragastric recurrence should be avoided in the low-risk group.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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