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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Oncol. | doi: 10.3389/fonc.2019.00846

In-Hospital Mortality Risk Model of Gastric Cancer Surgery: Analysis of a Nationwide Institutional-level Database with 94,277 Chinese Patients

Zhouqiao Wu1,  Huimin Cheng2, Shan Fei1, Xiangji Ying1,  Rulin Miao1, Zhongyuan Zhang2, Ting Shi3,  Ziyu Li1* and  Jiafu Ji1*
  • 1Key Laboratory of Carcinogenesis and Translational Research, Department of Head and Neck, Peking University Cancer Hospital, China
  • 2School of Statistics and Mathematics, Central University of Finance and Economics, China
  • 3Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom

Background: The objective of this study is to identify independent risks and protective factors and to construct a mortality prediction model for gastrectomy in the Chinesepopulation.
Study design: This is a population-based prospective cohort at an institutional level. Seventy-two participating hospitals reported their annual gastrectomy data between 2014 and 2016, while 44 variables covering the institution and surgical information were included in the analysis. We used R software to encode and complete data pre-processing. The first difference model was applied to build the risk model. Data from 2014 and 2015 were assigned to risk model development, while data from 2016 was used for validation.
Results: In the included centers with 94,277 gastric cancer cases, the in-hospital mortality rate was 0.32%.The regression model revealed that provinces with low-middle GDP, hospitals with annual gastrectomy volume between 100-500, greater volume of urgent surgeries performed, larger proportion of males, and a higher proportion of liver metastasis were independent risk factors for mortality following gastric surgeries, while higher laparoscopic resection volume, greater volume of distal gastrectomy with B2 reconstruction, and a larger proportion of palliative surgery were independent protective factors (p<0.05, respectively). In the prediction test, the mean square error of the training set was 0.948, while that of the test set was 0.728, demonstrating the effectiveness of this model.
Conclusions: We constructed the first mortality risk prediction model for gastric cancer surgery in the Chinese population. The identified risk factors will help with the therapy selection, while further informing Chinese medical policy decision-makers.

Keywords: gastric cancer, Surgical safety, Mortality, National database, Prediction model

Received: 28 May 2019; Accepted: 19 Aug 2019.

Copyright: © 2019 Wu, Cheng, Fei, Ying, Miao, Zhang, Shi, Li and Ji. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Prof. Ziyu Li, Key Laboratory of Carcinogenesis and Translational Research, Department of Head and Neck, Peking University Cancer Hospital, Beijing, China, ziyu_li@hsc.pku.edu.cn
Prof. Jiafu Ji, Key Laboratory of Carcinogenesis and Translational Research, Department of Head and Neck, Peking University Cancer Hospital, Beijing, China, jijiafu@hsc.pku.edu.cn