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Prediction of long-term survival after gastrectomy using random survival forests
- Source :
- British Journal of Surgery. 108:1341-1350
- Publication Year :
- 2021
- Publisher :
- Oxford University Press (OUP), 2021.
-
Abstract
- Background No well validated and contemporaneous tools for personalized prognostication of gastric adenocarcinoma exist. This study aimed to derive and validate a prognostic model for overall survival after surgery for gastric adenocarcinoma using a large national dataset. Methods National audit data from England and Wales were used to identify patients who underwent a potentially curative gastrectomy for adenocarcinoma of the stomach. A total of 2931 patients were included and 29 clinical and pathological variables were considered for their impact on survival. A non-linear random survival forest methodology was then trained and validated internally using bootstrapping with calibration and discrimination (time-dependent area under the receiver operator curve (tAUC)) assessed. Results The median survival of the cohort was 69 months, with a 5-year survival of 53.2 per cent. Ten variables were found to influence survival significantly and were included in the final model, with the most important being lymph node positivity, pT stage and achieving an R0 resection. Patient characteristics including ASA grade and age were also influential. On validation the model achieved excellent performance with a 5-year tAUC of 0.80 (95 per cent c.i. 0.78 to 0.82) and good agreement between observed and predicted survival probabilities. A wide spread of predictions for 3-year (14.8–98.3 (i.q.r. 43.2–84.4) per cent) and 5-year (9.4–96.1 (i.q.r. 31.7–73.8) per cent) survival were seen. Conclusions A prognostic model for survival after a potentially curative resection for gastric adenocarcinoma was derived and exhibited excellent discrimination and calibration of predictions.
- Subjects :
- Oncology
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Adenocarcinoma
03 medical and health sciences
0302 clinical medicine
Gastrectomy
Stomach Neoplasms
Internal medicine
Humans
Medicine
Postoperative Period
030212 general & internal medicine
Stage (cooking)
Lymph node
Retrospective Studies
Prothrombin time
Wales
medicine.diagnostic_test
Receiver operating characteristic
business.industry
Stomach
Prognosis
medicine.disease
Survival Rate
medicine.anatomical_structure
England
ROC Curve
030220 oncology & carcinogenesis
Cohort
Surgery
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 13652168 and 00071323
- Volume :
- 108
- Database :
- OpenAIRE
- Journal :
- British Journal of Surgery
- Accession number :
- edsair.doi.dedup.....40576cf9a90d9ee4f583402bd16eee79