ORIGINAL RESEARCH
Oncology
doi: 10.25005/2074-0581-2025-27-2-327-339
PREOPERATIVE PREDICTION OF WALL INVASION DEPTH OF PRIMARY TUMOR (PT) IN GASTRIC CANCER PATIENTS

M.YU. REUTOVICH1, O.V. KRASKO2, A.I. PATSEIKA3, H.S. HUSSEIN3

1Belarusian State Medical University, Minsk, Republic of Belarus
2United Institute of Informatics Problems, National Academy of Sciences, Minsk, Republic of Belarus
3N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus

Objective: To create a prognostic nomogram that evaluates the likelihood of serosal invasion of the primary tumor in the stomach wall (рТ4) by analyzing preoperative data. This model aims to optimize treatment plans and enhance the effectiveness of treatment for LAGC.

Methods: A retrospective analysis was conducted on the treatment outcomes of 1,054 patients who underwent radical surgery for metastatic gastric cancer (mGC). The study examined the relationship between the depth of primary tumor invasion into the gastric wall (GVI) and various preoperative clinical, morphological, and laboratory parameters. Significant risk factors identified in the univariate analysis were further assessed as independent variables in a multivariate logistic regression analysis. These variables were then incorporated into a nomogram. The clinical validation of the model was performed by evaluating the long-term treatment outcomes.

Results: : It has been established that the following factors are prognostically significant for assessing the likelihood of invasion of the serosa of the stomach by the primary tumor (рТ4) preoperatively: 1. Size of the primary tumor (natural logarithm) – odds ratio (OR) 5.5 (95% CI 3.8-8.3), p<0.001. 2. Infiltrative variant of the macroscopic growth form – OR 1.9 (95% CI 1.3-3.0), p=0.002. 3. Total or subtotal involvement of the stomach – OR 1.8 (95% CI 1.1-3.0), p=0.029. 4. Non-cohesive adenocarcinoma (high grade, GIII) – OR 1.7 (95% CI 1.1-2.9), p=0.029. 5. Fibrinogen level increase of 1 g/l – OR 1.5 (95% CI 1.2-1.8), p<0.001. Based on a linear combination of these predictors, a prognostic model in the form of a nomogram was developed. This model demonstrates high predictive accuracy, with a concordance index of 0.826 (95% CI 0.78-0.86).

Conclusion: Careful consideration of the clinical and morphological features of the tumor process within the framework of applying the developed prognostic model increases the accuracy of determining the preoperative T category, bringing the predicted clinical T-stage (prT) as close as possible to the proper рТ stage determined by histopathological examination (HPE).

Keywords: Locally advanced gastric cancer, preoperative pT4 prediction, nomogram.

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Authors' information:

Reutovich Mikhail Yurievich,
Doctor of Medical Sciences, Associate Professor, Professor of the Department of Oncology with a Course of Advanced Training and Retraining; Dean of the Faculty of General Medicine, Belarusian State Medical University
Researcher ID: FQX-0187-2023
Scopus ID: 55255280900
ORCID ID: 0000-0001-7202-6902
SPIN: 1738-0528
Author ID: 759877
E-mail: mihail_revtovich@yahoo.com

Krasko Olga Vladimirovna,
Candidate of Technical Sciences, Associate Professor, Leading Researcher, United Institute of Informatics Problems, National Academy of Sciences
Researcher ID: X-1955-2019
Scopus ID: 6506610243
ORCID ID: 0000-0002-4150-282X
SPIN: 7464-8750
Author ID: 958073
E-mail: olga.krasko.ok@gmail.com

Patseika Aliaksandr Ivanovich,
Surgical Oncologist, Oncology Division of Gastroesophageal Abnormalities, N.N. Alexandrov National Cancer Centre of Belarus
Researcher ID: LIF-1287-2024
ORCID ID: 0009-0000-7271-3913
SPIN: 9383-8626
Author ID: 1228275
E-mail: drpatseika@gmail.com

Hussein Hussein Saad,
Surgical Oncologist, Oncology Division of Hepaticopancreatobiliary Abnormalities, N.N. Alexandrov National Cancer Centre of Belarus
Researcher ID: MEO-7020-2025
ORCID ID: 0009-0003-7114-7579
E-mail: husseinsaad.hpb.onco@mail.ru

Information about support in the form of grants, equipment, medications

The research was carried out in accordance with the research plan of Belarusian State Medical University “To develop prognostic models for preoperative assessment of pT and pN categories in non-metastatic gastric cancer” (state registration number – 20231578 dated October 15, 2023). The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Reutovich Mikhail Yurievich
Doctor of Medical Sciences, Associate Professor, Professor of the Department of Oncology with a Course of Advanced Training and Retraining; Dean of the Faculty of General Medicine, Belarusian State Medical University

220083, Republic of Belarus, Minsk, Dzerzhinsky Ave., 83, building 1, room 502

Tel.: +375 (447) 712330

E-mail: mihail_revtovich@yahoo.com


This work is licensed under a Creative Commons Attribution 4.0 International License.

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