Blast from the past: Perioperative use of the Maruyama computer program for prediction of lymph node involvement in the surgical treatment of gastric cancer following neoadjuvant chemotherapy |
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| Affiliation: | 1. Department of Surgical Oncology, Medical University of Lublin, Radziwiłowska 13 St., 20-080, Lublin, Poland;2. 2nd Department and Clinic of General, Gastroenterological and Gastrointestinal Cancer Surgery, Medical University of Lublin, Staszica 16 St., 20-081, Lublin, Poland;3. Department of Clinical Oncology, St. John of Dukla Lublin Region Cancer Center, Jaczewskiego 7 St., 20-090, Lublin, Poland;13. Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia / Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Spain;14. Epidemiologia Clínica y Cribado de Cáncer, Corporacio Sanitaria Parc Taulı, Sabadell / Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Spain;15. Servicio de Laboratorio, Hospital Costa del Sol, REDISSEC, Málaga, Spain;p. Unidad de Epidemiologia, Distrito Sevilla, Servicio Andaluz de Salud, Spain;q. Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, REDISSEC, Madrid, Spain;r. Unidad de Investigación, Hospital Universitario Donostia /Instituto de Investigación Sanitaria Biodonostia, REDISSEC, Donostia, Spain;s. Unidad de Investigación, Hospital Universitario Basurto, REDISSEC, Bilbao, Spain;t. Servicio de Epidemiologia, Hospital Costa del Sol, REDISSEC, Málaga, Spain;u. Department of Preventive Medicine and Public Health, Univesity of Valencia / CIBER de Epidemiologia y Salud Pública (CIBERESP), CSISP-FISABIO, Valencia, Spain;v. Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid, Spain;w. Unidad Apoyo a Docencia-Investigación, Dirección Técnica Docencia e Investigación, Gerencia Adjunta Planificación, Gerencia de Atención Primaria de la Consejería de Sanidad de la Comunidad Autónoma de Madrid, Spain;x. Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPVREDISSEC, Spain;y. Epidemiologia Clínica y Cribado de Cáncer, Corporació Sanitaria Parc Taulı´, REDISSEC, Sabadell, Spain;z. Servicio de Oncología, Hospital Universitario Basurto, Bilbao, Spain;11. Servicio de Cirugía General, Hospital Universitario Basurto, Bilbao, Spain;12. Servicio de Anatomía Patológica, Hospital Galdakao-Usansolo, Galdakao, Spain;13. Servicio de Cirugía General, Hospital Universitario Araba, Vitoria-Gasteiz, Spain;14. Servicio de Gastroenterología, Hospital Universitario de Canarias, La Laguna, Spain;15. Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Spain;16. IMAS-Hospital del Mar, Barcelona, Spain;17. Servicio de Cirugía General y Digestiva, Hospital Universitario, Donostia, Spain;18. Instituto de Investigación Sanitaria Biodonostia, Donostia, Spain;19. Servicio de Cirugía General y Digestiva, Hospital de Mendaro, Spain;110. Servicio de Cirugía General y Digestiva, Hospital de Zumárraga, Spain;111. Servicio de Cirugía General y Digestiva, Hospital del Bidasoa, Spain;112. Servicio de Oncología Médica, Hospital Universitario Donostia, Spain;113. Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain;114. Servicio de Cirugía, Hospital Universitario Virgen de Valme, Sevilla, Spain;115. Servicio de Cirugía General y Aparato Digestivo, Hospital Dr. Pesset, Valencia, Spain;1p. Servicio de Cirugía General y Aparato Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Spain;1q. Servicio de Oncología Médica, Agencia Sanitaria Costa del Sol, Marbella, Spain;1r. Servicio de Cirugía, Hospital de Antequera, Spain;1s. Coloproctology Unit, General and Digestive Surgery Service, Corporacio´ Sanitaria Parc Taulı´, Sabadel, Spain;1t. Digestive Diseases Department, Corporacio´ Sanitaria Parc Taulı´, Sabadell, Spain;1u. Pathology Service, Corporacio´ Sanitaria Parc Taulı´, Sabadell, Spain;1v. Medical Oncology Department, Corporacio´ Sanitaria Parc Taulı´, REDISSEC, Sabadell, Spain;1w. General and Digestive Surgery Service, Parc de Salut Mar, Barcelona, Spain;1x. General and Digestive Surgery Service, Althaia- Xarxa Assistencial Universitaria, Manresa, Spain;1y. Catalonian Cancer Strategy Unit, Department of Health, Institut Català d’Oncología, Spain;1z. Medical Oncology Department, Institut Català d’Oncología, Spain;21. Agency for Health Quality and Assessment of Catalonia–AquAS- and REDISSEC, Spain;22. Agency for Health Quality and Assessment of Catalonia–AQuAS, CIBER de Epidemiologia y Salud Publica, CIBERESP, Spain;23. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid, Spain;24. Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Clínico San Carlos, Madrid, Spain;25. Servicio Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain;26. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain;27. REDISSEC, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Madrid, Spain;28. REDISSEC, Unidad de Gestión Sanitaria, Hospital del Alto Deba, Mondragon-Arrasate, Spain;1. Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain;2. Instituto de Investigación Biomedica de Málaga (IBIMA), Spain;3. Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Spain;4. Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Department of Oncohaematology, Costa del Sol Hospital, Marbella, Spain;5. Clinical Epidemiology and Cancer Screening, Corporació Sanitaria ParcTaulí, REDISSEC, Sabadell, Spain;6. Department of Preventive Medicine and Public Health, University of Valencia, Spain, CIBERESP, Valencia, Spain;7. Servicio de Anatomía Patológica, Hospital de Galdakao, Galdakao, Vizcaya, Spain;8. Servicio de Anatomía Patológica, Hospital de Antequera, Málaga, Spain;9. Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain;10. Departamento de Patología, Complejo Hospitalario de Granada, Instituto de Investigación Biosanitaria y Universidad de Granada, Granada, Spain;11. Research Unit, Basurto University Hospital, REDISSEC, Bilbao, Spain;12. Research Unit, Galdakao-Usansolo Hospital, Galdakao-Usansolo Hospital, REDISSEC, Spain;1. Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan;2. Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium;3. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Japan;4. Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Belgium;1. Department of Urologic Surgery, Tianjin Medical University Second Hospital, Tianjin, China;2. Department of Urologic Pathology, Tianjin Urologic Institute, Tianjin, China;3. Department of Radiology, Tianjin Medical University Second Hospital, Tianjin, China;1. ESSO Clinical Research Committee, Brussels, Belgium;2. Charité Comprehensive Cancer Center, Berlin, Germany;3. Hospital Universitario de Fuenlabrada, Madrid, Spain;4. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden;5. Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands;6. Centre Léon Bérard, Lyon, France;7. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria;8. Dept. of General HPB and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium;9. Social Medical Center South, HPB Center Vienna Clincs, Vienna, Austria;10. Frankfurt University Hospital, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Frankfurt/Main, Germany;11. Universitätsmedizin Mannheim, Mannheim, Germany;12. Leiden University Medical Center, Leiden, Netherlands;13. Aintree University Hospital NHS Trust, Liverpool, United Kingdom;14. Oncology Institute of Vojvodina, Sremska Kamenica, Universty of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;15. Hyogo College of Medicine, Hyogo, Japan;p. EORTC, Brussels, Belgium;q. Gustave Roussy, Université Paris Saclay, Villejuif, France;r. Institut Bergonié, Université de Bordeaux, Bordeaux, France;1. Breast & Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, NSW, 2060, Australia;2. The University of Sydney, Northern Clinical School, NSW, 2006, Australia;3. The Mater Hospital, North Sydney, NSW, 2060, Australia;4. Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;5. Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia;6. Chris O''Brien Lifehouse, Camperdown, NSW, 2050, Australia;7. Institute of Academic Surgery, Royal Prince Alfred Hospital, NSW, 2050, Australia;8. The University of Sydney, Professional Medical Education, Faculty of Medicine and Health, Camperdown, NSW, 2060, Australia;1. Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625, AD, Delft, the Netherlands;2. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, the Netherlands;3. Department of Geriatric Medicine, Elisabeth – TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022, GC, Tilburg, the Netherlands;4. Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623, EJ, Eindhoven, the Netherlands;5. Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands;6. Department of Public Health, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands |
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| Abstract: | ![]()
BackgroundSurgical quality assurance is a key element of gastric cancer treatment. The Maruyama Computer Program (MCP) allows to predict lymph node involvement in stations no. 1–16. The aim of the current study was to evaluate the accuracy of the MCP predictions in GC patients treated with neoadjuvant chemotherapy (nCTH) followed by gastrectomy with adequate lymphadenectomy.Methods101 patients who underwent preoperative nCTH followed by D2 gastrectomy with curative intent were analysed. The response to nCTH was measured using the tumour regression grade system.ResultsTest sensitivity, specificity, PPV, NPV and accuracy of the MCP were 92%, 33%, 41%, 89%, and 53%, respectively. In patients with response to nCTH, number of false positive (FP) results was significantly higher than in patients who did not respond to nCTH both in the N1 (56.3% vs 28.9%, p < 0.0001) and in the N2 (59% vs 41%, p < 0.0001) trier. The risk for FP results was 6 times higher in N1 (OR = 6.50, 95%CI: 3.91–10.82,; p < 0.0001) and N2 (OR = 5.84, 95%CI: 2.85–11.96; p < 0.0001) triers. In patients with intestinal type GC, the risk for FP results was 4 times higher than in other histologic types of GC in both N1 (OR = 4.23, 95%CI: 2.58–6.95; p < 0.0001) and N2 (OR = 4.23, 95%CI: 2.02–9.62; p = 0.0002) triers.ConclusionsMCP predictions in the GC patients treated with nCTH have low specificity due to significantly high number of FP results. Noticeably low accuracy level of predictions indicate a need for new prediction models, based on Laurén classification, since it may provide some information on expected regression grade. |
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| Keywords: | Gastric cancer Neoadjuvant chemotherapy Maruyama computer program WinEstimate 2.5 Surgical quality assurance |
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