[Evaluation of long-term prognosis of gastric cancer patients by tumor textbook outcome and analysis of related factors].

Objective: To investigate the effect of textbook oncologic outcome(TOO) on long-term survival and its related factors in patients with gastric cancer after operation. Methods: A retrospective cohort study was conducted to collect the clinicopathological data of 463 patients with gastric cancer who underwent radical surgery at the Department of General Surgery of Tianjin Medical University General Hospital from January 2019 to December 2021. There were 341 males and 122 females and the age was (65.7±9.2)years (range: 31 to 87 years).The patients were divided into TOO group(n=127) and non-TOO group(n=336) according to whether they met the TOO standard.Univariate analysis and multivariate Logistic regression model were used to analyze the independent factors affecting the realization of TOO. At the same time,the propensity matching analysis method was used to match the preoperative data of the patients. Kaplan-Meier method was used to compare the survival differences between the two groups after matching and draw the survival curve. Results: Among the 463 patients,127 patients (27.4%) achieved TOO while remaining 336 patients (72.6%) did not. Among them, 431 cases (93.1%) underwent lymph node dissection with ≥15 nodes, 449 cases (97.0%) received R0 resection, 346 cases (74.7%) had a hospital stay of <21 d, and 386 cases (83.3%) did not develop severe postoperative complications. Among the indicators that constitute TOO,the rate of completion of all cycles of chemotherapy in accordance with the guidelines after surgery was the lowest(30.5%, 141 cases). Univariate and multivariate analysis showed that age ≥65 years (OR=0.224,95%CI:0.137 to 0.367, P<0.01), postoperative ICU transfer (OR=0.599, 95%CI: 0.370 to 0.967, P=0.036), postoperative pathological nerve infiltration (OR=0.265, 95%CI: 0.085 to 0.827, P=0.022), and late pTNM stage (OR=0.113, 95%CI: 0.029 to 0.441, P=0.002) were the influencing factors of TOO. There was no difference in baseline data between the two groups after matching. The 1, 2, and 3-year overall survival rates of patients in the TOO group were 100%, 98%,and 95%,respectively. The 1,2,and 3-year overall survival rates of patients in the non-TOO group were 95%,90%,and 85%,respectively. Kaplan-Meier analysis showed that the difference in survival between the two groups was statistically significant(P=0.044). Conclusions: Gastric cancer patients with postoperative TOO have more significant survival benefits. Patients with age <65 years, not transferred to ICU,early pTNM stage and no nerve infiltration were more likely to achieve TOO. The textbook outcome of tumor can be used as a comprehensive index to evaluate the perioperative treatment and long-term prognosis of gastric cancer. Clinically,relevant management strategies should be actively optimized to improve the TOO achievement rate and improve the long-term survival outcome of patients.