title: Predicting recurrence after curative resection for gastric cancer: External validation of the Italian Research Group for Gastric Cancer (GIRCG) prognostic scoring system.
abstract: BACKGROUND
  Most nomograms for Gastric Cancer (GC) were developed to predict overall survival (OS) after curative resection. The Italian Research Group for Gastric Cancer (GIRCG) prognostic scoring system (PSS) was designed to predict the recurrence risk after curative treatment based on pathologic tumor stage and treatment performed (D1-D2/D3 lymphadenectomy). This study was carried out to externally validate the GIRCG's PSS.
  
  
  METHODS
  Adopting the same criteria used by GIRCG to build the PSS, 185 patients with GC operated with curative intention were selected. The median follow-up period was 77.8 months (1.93-150.8) for all patients and 102.5 months (60.9-150.8) for patients free of disease. The NRI (net reclassification improvement) was calculated to estimate the overall improvement in the reclassification of patients using the PSS in place of the TNM stage system.
  
  
  RESULTS
  GC recurrence occurred in 70 (37.8%) patients. The mean time to recurrence was 22.2 (range 1.9-98.1) months. For patients with recurrence, the gain in the proportion of reclassification was 0.257 (p < 0.001), indicating an improvement of 26%. For patients without recurrence, the gain in the proportion of reclassification was -0.122 (p < 0.001), indicating a worsening of 12%. The NRI calculated was 0.135 (p = 0.0527).
  
  
  CONCLUSIONS
  The GIRCG's PSS, which predicts the likelihood of recurrence after radical surgical treatment for GC, is more accurate than TNM system to predict recurrence mainly for high-risk patients. Yet, the PSS does not have the same effectiveness for low-risk patients, overestimating the chance of recurrence occurs even for disease-free patients.
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine - USP Brazil, Av. Dr. Enéas de Aguiar 255 - 9° andar 05403-000, São Paulo, SP, Brazil. Electronic address: leandrobarchi@hotmail.com.
authors.forename: L C
authors.initials: LC
authors.lastname: Barchi
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine - USP Brazil, Av. Dr. Enéas de Aguiar 255 - 9° andar 05403-000, São Paulo, SP, Brazil. Electronic address: okyagi@uol.com.br.
authors.forename: O K
authors.initials: OK
authors.lastname: Yagi
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine - USP Brazil, Av. Dr. Enéas de Aguiar 255 - 9° andar 05403-000, São Paulo, SP, Brazil. Electronic address: cejacob@uol.com.br.
authors.forename: C E
authors.initials: CE
authors.lastname: Jacob
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine - USP Brazil, Av. Dr. Enéas de Aguiar 255 - 9° andar 05403-000, São Paulo, SP, Brazil. Electronic address: drmucerino@uol.com.br.
authors.forename: D R
authors.initials: DR
authors.lastname: Mucerino
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine - USP Brazil, Av. Dr. Enéas de Aguiar 255 - 9° andar 05403-000, São Paulo, SP, Brazil. Electronic address: ulyssesribeiro@terra.com.br.
authors.forename: U
authors.initials: U
authors.lastname: Ribeiro
authors.affiliation: Department of General Surgery and Surgical Oncology, University of Siena, Via Banchi di Sotto, 55, 53100 Siena, SI, Italy. Electronic address: daniele.marrelli@unisi.it.
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Department of General Surgery and Surgical Oncology, University of Siena, Via Banchi di Sotto, 55, 53100 Siena, SI, Italy. Electronic address: franco.roviello@unisi.it.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine - USP Brazil, Av. Dr. Enéas de Aguiar 255 - 9° andar 05403-000, São Paulo, SP, Brazil. Electronic address: icecconello@hotmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Cecconello
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine - USP Brazil, Av. Dr. Enéas de Aguiar 255 - 9° andar 05403-000, São Paulo, SP, Brazil. Electronic address: brunozilb@uol.com.br.
authors.forename: B
authors.initials: B
authors.lastname: Zilberstein
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D049451:Nomograms; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Adenocarcinoma; Gastrectomy; Gastric cancer; Lymphadenectomy; Nomogram; Recurrence; Stomach neoplasm