Xiaofeng Chen¹, Jing Qian², Yingying Qian², Oluf dimitri Røe³, Yanhong Gu²,  Renhua Guo², Yongmei Yin², Yongqian Shu²

¹Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, ²oncology, the First Affiliated Hospital of Nanjing Medical University, ³Cancer Research and Molecular Medicine, Norwegian University of Science and Technology

Objective:D2 gastrectomy is a standard procedure of curative resection for gastric cancer. This study aims to develop a simple and reliable prognostic scoring system for gastric cancer with D2 gastrectomy. Method:A prognostic scoring system was established based on clinical and laboratory data from 579 local gastric cancer patients with D2 gastrectomy. Result:From the multivariate model for overall survival (OS), five factors were selected for the scoring system: metastatic lymph node rate ≥50%, lympho vascular invasion positive, pTMN Stage II or III, preoperative carcinoembryonic antigen level ≥ 5 ng/mL and preoperative hemoglobin (P<0.001)while Model B differentiated low-, intermediate-, and high-riskpatients for OS (P<0.001). Stage III patients in the low risk group hadhigher survival probabilities than those who were stage II, but at high risk of death. Model A: AUC: 0.74 and Model B: AUC: 0.79 were both better predictors compared with the pTNM classification (AUC:0.62, P<0.001). Patients in the high-risk group could benefit from paclitaxel- or oxaliplatin-based or triplet adjuvant chemotherapy, but not those with low- and intermediate-risk. Conclusion: A more accurate andpractical prognostic risk scoring system has been established to predict OS of gastric cancer with D2 gastrectomy. Itcan identify the high-risk candidates in stage II or III for more intensive schedule and the selected subgroup who may benefit from paclitaxel- oroxaliplatin-based regimen before initiation of adjuvant chemotherapy.

Key Words: gastric cancer  prognosis  score system