Analysis of risk factors for recurrence after endoscopic submucosal dissection in gastric adenocarcinoma of the fundic gland type and development of a Nomogram model
Objective This paper attempts to analyze the risk factors for recurrence of gastric adenocarcinoma of the fundic gland type(GA-FG)after endoscopic submucosal dissection(ESD)and to develop a Nomogram prediction model.Methods A total of 110 patients with GA-FG who underwent ESD treatment at the 908th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army between December 2016 and December 2021 were selected as the research subjects.The patients were randomly divided into a training set(88 cases)and a validation set(22 cases)in a ratio of 8:2.Demographic,clinical,and pathological characteristics,laboratory data,and surgical information were collected.A 2-year follow-up was conducted via outpatient visits,and patients were divided into recurrence and non-recurrence groups based on their recurrence status.The Cox proportional hazards regression model was used to analyze the risk factors for postoperative recurrence of GA-FG,and a Nomogram model was constructed and validated.The ROC curve was used to assess the performance of the Nomogram model in predicting postoperative recurrence.Results Among the 88 GA-FG patients in the training set,24 experienced recurrence,with a recurrence rate of 27.27%.Compared to the non-recurrence group,the recurrence group has a higher proportion of patients with diabetes,poor differentiation,and elevated levels of diamine oxidase(DAO),epidermal growth factor(EGF),and the apoptosis inhibitor Livin,with statistically significant differences(P＜0.05).Multivariate Cox proportional hazards regression analysis shows that the combination of diabetes,poor differentiation,DAO,EGF,and Livin are independent risk factors for postoperative recurrence of GA-FG(P＜0.05).The ROC curve analysis yields an area under the curve(AUC)of 0.883(95%CI:0.824-0.936),with a sensitivity of 0.827(95%CI:0.736-0.914)and a specificity of 0.832(95%CI:0.749-0.912).The model validation results show that the Nomogram model has good discriminability,and the calibration curve closely matches the ideal curve.Conclusions The combination of diabetes,poor differentiation,DAO,EGF,and Livin are independent risk factors for the postoperative recurrence of GA-FG.The Nomogram model,based on these five influencing factors,has a high predictive accuracy for postoperative recurrence of GA-FG.
Gastric adenocarcinoma of fundic gland typeSubmucosal layerEndoscopic submucosal dissectionRecurrenceNomogram model
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