Risk model for distal gastrectomy when treating gastric cancer on the basis of data from 33,917 Japanese patients collected using a nationwide web-based data entry system

Nobuhiro Kurita, Hiroaki Miyata, Mitsukazu Gotoh, Mitsuo Shimada, Satoru Imura, Wataru Kimura, Naohiro Tomita, Hideo Baba, Yukou Kitagawa, Kenichi Sugihara, Masaki Mori

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Abstract

Objective: To establish a risk model for distal gastrectomy in Japanese patients with gastric cancer. Background: Risk stratification for distal gastrectomy in Japanese patients with gastric cancer improves surgical outcomes. Methods: The National Clinical Database was constructed for risk determination in gastric cancer-related gastrectomy among Japanese individuals. Data from 33,917 gastric cancer cases (1737 hospitals) were used. The primary outcomes were 30-day and operative mortalities. Data were randomly assigned to risk model development (27,220 cases) and test validation (6697 cases) subsets. Stepwise selection was used for constructing 30-day and operative mortality logistic models. Results: The 30-day, in-hospital, and operative mortality rates were 0.52%, 1.16%, and 1.2%, respectively. The morbidity was 18.3%. The 30-day and operative mortality models included 17 and 21 risk factors, respectively. Thirteen variables overlapped: age, need for total assistance in activities of daily living preoperatively or within 30 days after surgery, cerebrovascular disease history, more than 10% weight loss, uncontrolled ascites, American Society of Anesthesiologists score (≥ class 3), white blood cell count more than 12,000/μL or 11,000/μL, anemia (hemoglobin: males, <13.5 g/dL; females, <12.5 g/dL; or hematocrit: males, <37%; females <32%), serum albumin less than 3.5 or 3.8 g/dL, alkaline phosphatase more than 340 IU/L, serum creatinine more than 1.2 mg/dL, serum Na less than 135 mEq/L, and prothrombin time-international normalized ratio more than 1.25 or 1.1. The C-indices for the 30-day and operative mortalities were 0.785 (95% confidence interval, 0.705-0.865; P < 0.001) and 0.798 (95% confidence interval, 0.746-0.851; P < 0.001), respectively. Conclusions: The risk model developed using nationwide Japanese data on distal gastrectomy in gastric cancer can predict surgical outcomes.

Original languageEnglish
Pages (from-to)295-303
Number of pages9
JournalAnnals of Surgery
Volume262
Issue number2
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

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Gastrectomy
Information Systems
Stomach Neoplasms
Mortality
Confidence Intervals
Cerebrovascular Disorders
International Normalized Ratio
Prothrombin Time
Activities of Daily Living
Hospital Mortality
Serum
Ambulatory Surgical Procedures
Leukocyte Count
Hematocrit
Ascites
Serum Albumin
Alkaline Phosphatase
Anemia
Weight Loss
Creatinine

All Science Journal Classification (ASJC) codes

  • Surgery

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Risk model for distal gastrectomy when treating gastric cancer on the basis of data from 33,917 Japanese patients collected using a nationwide web-based data entry system. / Kurita, Nobuhiro; Miyata, Hiroaki; Gotoh, Mitsukazu; Shimada, Mitsuo; Imura, Satoru; Kimura, Wataru; Tomita, Naohiro; Baba, Hideo; Kitagawa, Yukou; Sugihara, Kenichi; Mori, Masaki.

In: Annals of Surgery, Vol. 262, No. 2, 01.01.2015, p. 295-303.

Research output: Contribution to journalArticle

Kurita, Nobuhiro ; Miyata, Hiroaki ; Gotoh, Mitsukazu ; Shimada, Mitsuo ; Imura, Satoru ; Kimura, Wataru ; Tomita, Naohiro ; Baba, Hideo ; Kitagawa, Yukou ; Sugihara, Kenichi ; Mori, Masaki. / Risk model for distal gastrectomy when treating gastric cancer on the basis of data from 33,917 Japanese patients collected using a nationwide web-based data entry system. In: Annals of Surgery. 2015 ; Vol. 262, No. 2. pp. 295-303.
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abstract = "Objective: To establish a risk model for distal gastrectomy in Japanese patients with gastric cancer. Background: Risk stratification for distal gastrectomy in Japanese patients with gastric cancer improves surgical outcomes. Methods: The National Clinical Database was constructed for risk determination in gastric cancer-related gastrectomy among Japanese individuals. Data from 33,917 gastric cancer cases (1737 hospitals) were used. The primary outcomes were 30-day and operative mortalities. Data were randomly assigned to risk model development (27,220 cases) and test validation (6697 cases) subsets. Stepwise selection was used for constructing 30-day and operative mortality logistic models. Results: The 30-day, in-hospital, and operative mortality rates were 0.52{\%}, 1.16{\%}, and 1.2{\%}, respectively. The morbidity was 18.3{\%}. The 30-day and operative mortality models included 17 and 21 risk factors, respectively. Thirteen variables overlapped: age, need for total assistance in activities of daily living preoperatively or within 30 days after surgery, cerebrovascular disease history, more than 10{\%} weight loss, uncontrolled ascites, American Society of Anesthesiologists score (≥ class 3), white blood cell count more than 12,000/μL or 11,000/μL, anemia (hemoglobin: males, <13.5 g/dL; females, <12.5 g/dL; or hematocrit: males, <37{\%}; females <32{\%}), serum albumin less than 3.5 or 3.8 g/dL, alkaline phosphatase more than 340 IU/L, serum creatinine more than 1.2 mg/dL, serum Na less than 135 mEq/L, and prothrombin time-international normalized ratio more than 1.25 or 1.1. The C-indices for the 30-day and operative mortalities were 0.785 (95{\%} confidence interval, 0.705-0.865; P < 0.001) and 0.798 (95{\%} confidence interval, 0.746-0.851; P < 0.001), respectively. Conclusions: The risk model developed using nationwide Japanese data on distal gastrectomy in gastric cancer can predict surgical outcomes.",
author = "Nobuhiro Kurita and Hiroaki Miyata and Mitsukazu Gotoh and Mitsuo Shimada and Satoru Imura and Wataru Kimura and Naohiro Tomita and Hideo Baba and Yukou Kitagawa and Kenichi Sugihara and Masaki Mori",
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AU - Kurita, Nobuhiro

AU - Miyata, Hiroaki

AU - Gotoh, Mitsukazu

AU - Shimada, Mitsuo

AU - Imura, Satoru

AU - Kimura, Wataru

AU - Tomita, Naohiro

AU - Baba, Hideo

AU - Kitagawa, Yukou

AU - Sugihara, Kenichi

AU - Mori, Masaki

PY - 2015/1/1

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N2 - Objective: To establish a risk model for distal gastrectomy in Japanese patients with gastric cancer. Background: Risk stratification for distal gastrectomy in Japanese patients with gastric cancer improves surgical outcomes. Methods: The National Clinical Database was constructed for risk determination in gastric cancer-related gastrectomy among Japanese individuals. Data from 33,917 gastric cancer cases (1737 hospitals) were used. The primary outcomes were 30-day and operative mortalities. Data were randomly assigned to risk model development (27,220 cases) and test validation (6697 cases) subsets. Stepwise selection was used for constructing 30-day and operative mortality logistic models. Results: The 30-day, in-hospital, and operative mortality rates were 0.52%, 1.16%, and 1.2%, respectively. The morbidity was 18.3%. The 30-day and operative mortality models included 17 and 21 risk factors, respectively. Thirteen variables overlapped: age, need for total assistance in activities of daily living preoperatively or within 30 days after surgery, cerebrovascular disease history, more than 10% weight loss, uncontrolled ascites, American Society of Anesthesiologists score (≥ class 3), white blood cell count more than 12,000/μL or 11,000/μL, anemia (hemoglobin: males, <13.5 g/dL; females, <12.5 g/dL; or hematocrit: males, <37%; females <32%), serum albumin less than 3.5 or 3.8 g/dL, alkaline phosphatase more than 340 IU/L, serum creatinine more than 1.2 mg/dL, serum Na less than 135 mEq/L, and prothrombin time-international normalized ratio more than 1.25 or 1.1. The C-indices for the 30-day and operative mortalities were 0.785 (95% confidence interval, 0.705-0.865; P < 0.001) and 0.798 (95% confidence interval, 0.746-0.851; P < 0.001), respectively. Conclusions: The risk model developed using nationwide Japanese data on distal gastrectomy in gastric cancer can predict surgical outcomes.

AB - Objective: To establish a risk model for distal gastrectomy in Japanese patients with gastric cancer. Background: Risk stratification for distal gastrectomy in Japanese patients with gastric cancer improves surgical outcomes. Methods: The National Clinical Database was constructed for risk determination in gastric cancer-related gastrectomy among Japanese individuals. Data from 33,917 gastric cancer cases (1737 hospitals) were used. The primary outcomes were 30-day and operative mortalities. Data were randomly assigned to risk model development (27,220 cases) and test validation (6697 cases) subsets. Stepwise selection was used for constructing 30-day and operative mortality logistic models. Results: The 30-day, in-hospital, and operative mortality rates were 0.52%, 1.16%, and 1.2%, respectively. The morbidity was 18.3%. The 30-day and operative mortality models included 17 and 21 risk factors, respectively. Thirteen variables overlapped: age, need for total assistance in activities of daily living preoperatively or within 30 days after surgery, cerebrovascular disease history, more than 10% weight loss, uncontrolled ascites, American Society of Anesthesiologists score (≥ class 3), white blood cell count more than 12,000/μL or 11,000/μL, anemia (hemoglobin: males, <13.5 g/dL; females, <12.5 g/dL; or hematocrit: males, <37%; females <32%), serum albumin less than 3.5 or 3.8 g/dL, alkaline phosphatase more than 340 IU/L, serum creatinine more than 1.2 mg/dL, serum Na less than 135 mEq/L, and prothrombin time-international normalized ratio more than 1.25 or 1.1. The C-indices for the 30-day and operative mortalities were 0.785 (95% confidence interval, 0.705-0.865; P < 0.001) and 0.798 (95% confidence interval, 0.746-0.851; P < 0.001), respectively. Conclusions: The risk model developed using nationwide Japanese data on distal gastrectomy in gastric cancer can predict surgical outcomes.

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