Integrating textbook outcomes with risk stratification for personalized prognostication in gastric cancer: a multicenter retrospective cohort analysis

The textbook outcome (TO), a composite metric used to assess surgical quality, has demonstrated prognostic value in gastric cancer (GC). However, there is currently no independent prognostic evaluation system specifically designed for patients who achieve TO or do not. Consistent with previous reports, the TO metrics consisted of six parameters. This multicenter retrospective study enrolled 5,317 GC patients (TO group: 4191; nTO group: 1126), all of whom underwent radical gastrectomy. Univariate and multivariate Cox proportional hazards regression models were employed to identify independent predictors and risk scores were derived to construct prognostic models for both the TO and nTO groups. The performance of these models was compared to pTNM staging using receiver operating characteristic (ROC) curves. Patients achieving TO exhibited superior five-year overall survival (OS) rates compared to those who did not in both the training and validation cohorts (training cohort: 62.9% vs. 60.9%, P < 0.001; validation cohort: 78.7% vs. 60.8%, P = 0.025). By identifying independent prognostic predictors for patients in both the TO and nTO groups, we developed two distinct scoring models for prognostic evaluation. Notably, these novel scoring models demonstrated higher prognostic accuracy, with significantly higher area under the curve (AUC) values, compared to pTNM staging in both TO and nTO groups across the two cohorts. This study developed refined multiparameter-based prognostic models for GC patients stratified by TO status. These models demonstrated superior prognostic discrimination compared with pTNM staging in both TO and nTO groups.