Prognostic Model for Survival After Upfront R0 Gastrectomy in Peritoneal Oligometastatic Gastric Cancer.
8 affiliations
- 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
- 2Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
- 3Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
- 4Department of Surgery, Chonnam National University School of Medicine, Gwangju, Korea.
- 5Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 6Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- 7Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea. [email protected].
- 8Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. [email protected].
Abstract
Purpose
Peritoneal metastasis from gastric cancer (GC) is generally considered incurable. Although conversion surgery is the preferred strategy, surgeons frequently encounter clinical scenarios requiring upfront surgery. Currently, objective criteria for predicting prognosis after upfront R0 gastrectomy remain undefined.Materials and methods
This retrospective multicenter cohort study analyzed data from 792 patients derived from the PASS-META cohort and an independent validation dataset collected between 2014 and 2021. The final analysis included 80 patients with peritoneal oligometastasis (P1/P2) who underwent upfront R0 gastrectomy for risk stratification, and 632 controls who underwent R2 gastrectomy or no gastrectomy for survival comparison. A component-wise gradient-boosting survival model was developed and simplified into an 8-item risk scoring system.Results
The machine learning (ML) model demonstrated robust discrimination in external validation (concordance index, 0.811; 95% confidence interval, 0.677-0.955) and stratified patients into low- and high-risk groups with significantly different survival outcomes (log-rank P<0.001), independent of systemic chemotherapy compliance. Low-risk patients achieved a 5-year survival rate exceeding 30%, whereas high-risk patients showed survival rates comparable to those of patients who underwent R2 gastrectomy or no gastrectomy. The simplified 8-item risk groups showed high concordance with the ML model risk groups (F1-score, 0.975).Conclusions
We developed and validated a prediction model and an 8-item risk scoring system that effectively stratified patients with peritoneal oligometastatic GC according to their prognosis after upfront R0 gastrectomy. Although prospective validation is warranted, this framework provides objective prognostic guidance that may support intraoperative decision-making, distinguishing patients with favorable long-term outcomes from those whose survival is comparable to that of noncurative approaches.
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BibTeX
@article{lee2026prognostic,
title = {{Prognostic Model for Survival After Upfront R0 Gastrectomy in Peritoneal Oligometastatic Gastric Cancer.}},
author = {Seungho Lee and Yun Ho Roh and Ho-Jung Shin and Jeong Ho Song and Sung Eun Kim and In-Seob Lee and Han Hong Lee and Oh Jeong and Mi Ran Jung and Hoon Hur and Ye Seob Jee and Hyoung-Il Kim},
journal = {Journal of gastric cancer},
year = {2026},
month = oct,
doi = {10.5230/jgc.2026.26.e40},
url = {https://europepmc.org/article/MED/42845254},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Prognostic Model for Survival After Upfront R0 Gastrectomy in Peritoneal Oligometastatic Gastric Cancer.
AU - Seungho Lee
AU - Yun Ho Roh
AU - Ho-Jung Shin
AU - Jeong Ho Song
AU - Sung Eun Kim
AU - In-Seob Lee
AU - Han Hong Lee
AU - Oh Jeong
AU - Mi Ran Jung
AU - Hoon Hur
AU - Ye Seob Jee
AU - Hyoung-Il Kim
PY - 2026
DA - 2026/10/01
JO - Journal of gastric cancer
DO - 10.5230/jgc.2026.26.e40
UR - https://europepmc.org/article/MED/42845254
AB - Purpose Peritoneal metastasis from gastric cancer (GC) is generally considered incurable. Although conversion surgery is the preferred strategy, surgeons frequently encounter clinical scenarios requiring upfront surgery. Currently, objective criteria for predicting prognosis after upfront R0 gastrectomy remain undefined.Materials and methods This retrospective multicenter cohort study analyzed data from 792 patients derived from the PASS-META cohort and an independent validation dataset collected between 2014 and 2021. The final analysis included 80 patients with peritoneal oligometastasis (P1/P2) who underwent upfront R0 gastrectomy for risk stratification, and 632 controls who underwent R2 gastrectomy or no gastrectomy for survival comparison. A component-wise gradient-boosting survival model was developed and simplified into an 8-item risk scoring system.Results The machine learning (ML) model demonstrated robust discrimination in external validation (concordance index, 0.811; 95% confidence interval, 0.677-0.955) and stratified patients into low- and high-risk groups with significantly different survival outcomes (log-rank P<0.001), independent of systemic chemotherapy compliance. Low-risk patients achieved a 5-year survival rate exceeding 30%, whereas high-risk patients showed survival rates comparable to those of patients who underwent R2 gastrectomy or no gastrectomy. The simplified 8-item risk groups showed high concordance with the ML model risk groups (F1-score, 0.975).Conclusions We developed and validated a prediction model and an 8-item risk scoring system that effectively stratified patients with peritoneal oligometastatic GC according to their prognosis after upfront R0 gastrectomy. Although prospective validation is warranted, this framework provides objective prognostic guidance that may support intraoperative decision-making, distinguishing patients with favorable long-term outcomes from those whose survival is comparable to that of noncurative approaches.
SN - 2093-582X
SN - 2093-5641
ER -