Construction of a prediction model for non-curative resection after endoscopic submucosal dissection in elderly patients with early gastric cancer
10.3760/cma.j.issn.0254-9026.2025.05.007
- VernacularTitle:老年早期胃癌患者内镜黏膜下剥离术术后非治愈性切除的预测模型构建
- Author:
Rui WANG
1
;
Duo LI
1
;
Lijun CUI
1
Author Information
1. 河北北方学院附属第一医院消化内科，张家口 075000
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Endoscopy, digestive system;
Endoscopic submucosal dissection;
Non-curative excision
- From:
Chinese Journal of Geriatrics
2025;44(5):610-615
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the occurrence and relevant factors associated with non-curative resection following endoscopic submucosal dissection(ESD)in elderly patients with early gastric cancer(EGC), as well as to establish a predictive model.Methods:Elderly patients diagnosed with EGC and treated at the First Affiliated Hospital of Hebei North University between January 2019 and January 2023 were retrospectively selected for this study.All patients underwent ESD surgery and were categorized based on the occurrence of non-curative resection( n=44)versus curative resection( n=284).Relevant factors contributing to non-curative resection after ESD surgery in elderly EGC patients were analyzed using both univariate and multivariate analyses.A predictive model was developed, and the receiver operating characteristic(ROC)curve was generated to assess its efficacy. Results:In this study, we analyzed a cohort of 328 elderly patients diagnosed with EGC, aged between 60 and 88 years, with a mean age of 70.87±2.67 years, of which 211 were male.Non-curative resection was performed in 44 cases, accounting for 13.41% of the cohort.Compared to the curative group, the non-curative group exhibited a significantly larger lesion diameter, greater infiltration depth into the submucosa, a lower degree of differentiation, a higher prevalence of undifferentiated types, and an increased fold interruption ratio(all P<0.05).Multivariate logistic regression analysis identified increased lesion diameter( OR=2.380, 95% CI: 1.361-4.160), invasion depth into the submucosa( OR=1.824, 95% CI: 1.120-2.971), undifferentiated degree( OR=1.960, 95% CI: 1.286-2.987), and fold interruption( OR=2.094, 95% CI: 1.384-3.166)as significant predictors of non-curable resection following ESD in elderly patients with EGC(all P<0.05).These factors were incorporated into a predictive model represented by the equation: logit( P)=-6.307+ (lesion diameter × 0.867)+ (infiltration depth into submucosa × 0.601)+ (undifferentiated degree × 0.673)+ (fold interruption × 0.739).The ROC curve analysis yielded an area under the curve(AUC)of 0.859, with diagnostic sensitivity and specificity of 84.09% and 74.65%, respectively. Conclusions:There are numerous relevant factors influencing non-curable resection following ESD surgery in elderly patients with EGC.The prediction model developed herein can serve as a foundation for identifying high-risk patients and formulating effective clinical intervention strategies.
