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Published on: February 16, 2024
Personalizing Postoperative Surveillance: A Risk-Stratified Predictive Model for Recurrence of Gastrointestinal
Zhangchao Yao1, Yue Liu1, Jie Fan1
1Department of Geriatrics Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
Background:
Current Ki-67-based prognostic tools have limitations in stratifying recurrence risk for gastrointestinal neuroendocrine neoplasms (GI-NENs) after primary tumor resection (PTR), necessitating personalized predictive models to optimize surveillance.
Methods:
Data from 316 GI-NEN patients undergoing PTR were analyzed. Variables selected via LASSO regression were incorporated into Cox and Random Survival Forest (RSF) models. A nomogram was constructed based on superior model, and cut-off scores stratified patients into three recurrence risk groups.
Results:
The RSF model showed superior accuracy (C-index: 0.854) with good discrimination and calibration. A nomogram integrating eight key predictors stratified patients into low-risk (n = 241), intermediate-risk (n = 57), and high-risk (n = 18) groups. The Kaplan-Meier curves among them were significantly distinct. High-risk group had a median recurrence-free survival of 11.4 months, with nearly all experiencing recurrence or progression within 26 months. Compared with traditional NET grading, this model reclassified some G2 patients into intermediateand even high-risk groups and down-stratified G3 patients with favorable prognoses into the intermediate-risk group.
Conclusions:
This study developed and validated a risk-stratified model that effectively identifies postoperative recurrence risk in GI-NENs, enabling tailored surveillance. High-risk patients require intensive follow-up every 2-3 months and early adjuvant intervention. Low-risk patients can safely extend to annually. Most intermediate-risk patients may recieve follow-up every 6-12 months, though G3 patients near the high-risk threshold may still require surveillance every 3-6 months. This model facilitates personalized follow-up to improve long-term outcomes.
