Table 1_Distant metastasis risk and prognosis in elderly gastric cancer patients after neoadjuvant chemotherapy and surgery.docx

BackgroundGastric cancer imposes a heavy global health burden, and treatment evaluation in elderly patients is often more complex. Although NAC is standard for locally advanced gastric cancer (LAGC), benefits in the elderly are heterogeneous, postoperative distant metastasis (DM) is underexplored, and no nomogram specifically evaluates postoperative DM diagnosis and prognosis in elderly LAGC after NAC.
MethodsThis study extracted data from patients over 70 years of age who were diagnosed with gastric adenocarcinoma and underwent neoadjuvant chemotherapy followed by curative gastrectomy between 2016 and 2022. Independent risk factors for postoperative distant metastasis following neoadjuvant chemotherapy were identified using univariate and multivariate logistic regression analyses, while independent prognostic factors were determined through univariate and multivariate Cox proportional hazards regression analyses. Subsequently, we developed two novel nomograms and evaluated their performance using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).
ResultsA total of 896 elderly gastric adenocarcinoma patients were enrolled, among whom 307 (34.26%) developed postoperative DM. Independent risk factors for DM included N stage, NAC-related adverse events, CA19–9 levels, NLR, tumor nodules, resection margin status, tumor regression grade, as well as intraoperative and postoperative chemotherapy. Among DM patients, independent prognostic predictors included CA72–4 levels, NLR, NAC-to-surgery interval, tumor regression grade, resection margin status, and postoperative chemotherapy. Both nomograms demonstrated high predictive accuracy, supported by ROC analysis, calibration curves, decision curve analysis, and Kaplan-Meier survival analysis in the training and validation sets.
ConclusionsThe two nomograms show promise as effective tools for predicting the risk of postoperative distant metastasis and estimating personalized prognosis in elderly gastric cancer patients following neoadjuvant chemotherapy, thereby potentially informing clinical decision-making.

背景：胃癌在全球范围内造成沉重的疾病负担，老年患者的治疗评估往往更为复杂。尽管新辅助化疗（neoadjuvant chemotherapy, NAC）是局部进展期胃癌（locally advanced gastric cancer, LAGC）的标准治疗方案，但老年患者从中获得的获益存在异质性，术后远处转移（distant metastasis, DM）的相关研究尚不足，目前尚无专门针对新辅助化疗后老年局部进展期胃癌患者的术后远处转移诊断与预后评估的列线图（nomogram）。
方法：本研究提取了2016年至2022年间，确诊为胃腺癌、接受新辅助化疗后行根治性胃切除术的70岁以上患者的临床数据。采用单因素与多因素logistic回归分析识别新辅助化疗后术后远处转移的独立危险因素，通过单因素及多因素Cox比例风险回归（Cox proportional hazards regression）分析确定独立预后因素。随后，本研究构建了两款新型列线图，并利用受试者工作特征（receiver operating characteristic, ROC）曲线、校准曲线及决策曲线分析（decision curve analysis, DCA）评估其预测性能。
结果：本研究共纳入896例老年胃腺癌患者，其中307例（34.26%）发生术后远处转移。术后远处转移的独立危险因素包括N分期、新辅助化疗相关不良事件、CA19-9水平、中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）、肿瘤结节、切缘状态、肿瘤退缩分级（tumor regression grade），以及术中化疗与术后化疗。在发生远处转移的患者中，独立预后预测因素包括CA72-4水平、中性粒细胞与淋巴细胞比值（NLR）、新辅助化疗至手术的间隔时间、肿瘤退缩分级、切缘状态及术后化疗。两款列线图均表现出较高的预测准确性，该结论在训练集与验证集中均得到受试者工作特征曲线分析、校准曲线、决策曲线分析及Kaplan-Meier生存分析的支持。
结论：两款列线图有望成为预测新辅助化疗后老年胃癌患者术后远处转移风险、评估个体化预后的有效工具，从而可为临床决策制定提供参考依据。