{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:05:15Z","timestamp":1773219915298,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T00:00:00Z","timestamp":1720137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Radical gastrectomy remains the main treatment for gastric cancer, despite its high mortality. A clinical predictive model of 90-day mortality (90DM) risk after gastric cancer surgery based on the Spanish EURECCA registry database was developed using a matching learning algorithm. We performed an external validation of this model based on data from an international multicenter cohort of patients. Methods: A cohort of patients from the European GASTRODATA database was selected. Demographic, clinical, and treatment variables in the original and validation cohorts were compared. The performance of the model was evaluated using the area under the curve (AUC) for a random forest model. Results: The validation cohort included 2546 patients from 24 European hospitals. The advanced clinical T- and N-category, neoadjuvant therapy, open procedures, total gastrectomy rates, and mean volume of the centers were significantly higher in the validation cohort. The 90DM rate was also higher in the validation cohort (5.6%) vs. the original cohort (3.7%). The AUC in the validation model was 0.716. Conclusion: The externally validated model for predicting the 90DM risk in gastric cancer patients undergoing gastrectomy with curative intent continues to be as useful as the original model in clinical practice.<\/jats:p>","DOI":"10.3390\/cancers16132463","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T11:46:05Z","timestamp":1720179965000},"page":"2463","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["International External Validation of Risk Prediction Model of 90-Day Mortality after Gastrectomy for Cancer Using Machine Learning"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0558-2244","authenticated-orcid":false,"given":"Mariagiulia","family":"Dal Cero","sequence":"first","affiliation":[{"name":"Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0742-0759","authenticated-orcid":false,"given":"Joan","family":"Gibert","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hospital Universitario del Mar, Cancer Research Program, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain"}]},{"given":"Luis","family":"Grande","sequence":"additional","affiliation":[{"name":"Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3237-9927","authenticated-orcid":false,"given":"Marta","family":"Gimeno","sequence":"additional","affiliation":[{"name":"Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}]},{"given":"Javier","family":"Osorio","sequence":"additional","affiliation":[{"name":"Section of Esophagogastric and Bariatric Surgery, Hospital Clinic, Department of Surgery, Universitat de Barcelona, 08193 Barcelona, Spain"}]},{"given":"Maria","family":"Bencivenga","sequence":"additional","affiliation":[{"name":"Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, 37126 Verona, Italy"}]},{"given":"Uberto","family":"Fumagalli Romario","sequence":"additional","affiliation":[{"name":"Digestive Surgery, European Institute of Oncology, IRCCS, 20122 Milan, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2608-5749","authenticated-orcid":false,"given":"Riccardo","family":"Rosati","sequence":"additional","affiliation":[{"name":"Department of GI Surgery, IRCCS, San Raffaele Hospital, Vita-Salute University, 20135 Milan, Italy"}]},{"given":"Paolo","family":"Morgagni","sequence":"additional","affiliation":[{"name":"GB Morgagni-L Pierantoni Surgical Department, 47121 Forli, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9655-7601","authenticated-orcid":false,"given":"Suzanne","family":"Gisbertz","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center, 1007 Amsterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6455-5636","authenticated-orcid":false,"given":"Wojciech P.","family":"Polkowski","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland"}]},{"given":"Lucio","family":"Lara Santos","sequence":"additional","affiliation":[{"name":"Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, 4200-072 Porto, Portugal"}]},{"given":"Piotr","family":"Ko\u0142odziejczyk","sequence":"additional","affiliation":[{"name":"Department of Surgery I, Jagiellonian University, 31-007 Krakow, Poland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6116-6504","authenticated-orcid":false,"given":"Wojciech","family":"Kielan","sequence":"additional","affiliation":[{"name":"2nd Department of General and Oncological Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0603-9953","authenticated-orcid":false,"given":"Rossella","family":"Reddavid","sequence":"additional","affiliation":[{"name":"Department of Oncology, Division of Surgical Oncology and Digestive Surgery, University of Turin, San Luigi University Hospital, Orbassano, 10043 Turin, Italy"}]},{"given":"Johanna W.","family":"van Sandick","sequence":"additional","affiliation":[{"name":"Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 Amsterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2402-2178","authenticated-orcid":false,"given":"Gian Luca","family":"Baiocchi","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Clinical and Experimental Sciences, University of Brescia, ASST Cremona, 26100 Cremona, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7423-713X","authenticated-orcid":false,"given":"Ines","family":"Gockel","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany"}]},{"given":"Andrew","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Digestive Surgery, Guy\u2019s & St Thomas\u2019 National Health Service Foundation Trust, London SE1 7EH, UK"}]},{"given":"Bas P. L.","family":"Wijnhoven","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9736-3307","authenticated-orcid":false,"given":"Daniel","family":"Reim","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7550-8285","authenticated-orcid":false,"given":"Paulo","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculdade de Medicina, Universidade de Lisboa, Hospital Garcia de Orta, 1649-028 Lisboa, Portugal"}]},{"given":"William H.","family":"Allum","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK"}]},{"given":"Guillaume","family":"Piessen","sequence":"additional","affiliation":[{"name":"Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, 59037 Lille, France"}]},{"given":"John V.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trinity College Dublin, St. James\u2019s Hospital, D08 W9RT Dublin, Ireland"}]},{"given":"Stefan P.","family":"M\u00f6nig","sequence":"additional","affiliation":[{"name":"Division of Abdominal Surgery, University Hospital of Geneva, 1205 Geneva, Switzerland"}]},{"given":"Paul M.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, 5000 Zurich, Switzerland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3132-4756","authenticated-orcid":false,"given":"Elisenda","family":"Garsot","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universitat Aut\u00f2noma de Barcelona, Hospital Universitari Germans Trias i Pujol, 08916 Barcelona, Spain"}]},{"given":"Emma","family":"Eizaguirre","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de Donostia, 20014 Donostia, Spain"}]},{"given":"M\u00f2nica","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitari de Bellvitge, 08907 L\u2019Hospitalet de Llobregat, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8518-749X","authenticated-orcid":false,"given":"Sandra","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universitat Aut\u00f3noma de Barcelona, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}]},{"given":"Coro","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitario de Navarra, 31008 Pamplona, Spain"}]},{"given":"Xavier","family":"Monzonis-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hospital Universitario del Mar, Cancer Research Program, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9449-1810","authenticated-orcid":false,"given":"Manuel","family":"Pera","sequence":"additional","affiliation":[{"name":"Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}]},{"name":"on behalf of the Spanish EURECCA Esophagogastric Cancer Group and the European GASTRODATA Study Group","sequence":"additional","affiliation":[]}],"member":"1968","published-online":{"date-parts":[[2024,7,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1038\/s41571-023-00747-0","article-title":"Global burden of gastric cancer: Epidemiological trends, risk factors, screening and prevention","volume":"20","author":"Thrift","year":"2023","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.annonc.2022.07.004","article-title":"Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"33","author":"Lordick","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Schneider, M.A., Kim, J., Berlth, F., Sugita, Y., Grimminger, P.P., Sano, T., Rosati, R., Baiocchi, G.L., Bencivenga, M., and De Manzoni, G. (2024). Defining benchmarks for total and distal gastrectomy: Global multicentre analysis. Br. J. Surg., 111.","DOI":"10.1093\/bjs\/znae118.071"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1016\/j.ejso.2021.05.034","article-title":"Postoperative outcomes after laparoscopic or open gastrectomy: A national cohort study of 10,343 patients","volume":"47","author":"Challine","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1097\/SLA.0000000000004341","article-title":"Incidence and Grading of Complications After Gastrectomy for Cancer Using the GASTRODATA Registry: A European Retrospective Observational Study","volume":"272","author":"Baiocchi","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1097\/SLA.0000000000005116","article-title":"Outcomes of esophagogastric cancer surgery during eight years of surgical auditing by the Dutch Upper Gastrointestinal Cancer Audit (DUCA)","volume":"274","author":"Voeten","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3008","DOI":"10.1245\/s10434-014-3664-z","article-title":"Morbidity and mortality associated with gastrectomy for gastric cancer","volume":"21","author":"Papenfuss","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"van den Boorn, H.G., Engelhardt, E.G., van Kleef, J., Sprangers, M.A.G., van Oijen, M.G.H., Abu-Hanna, A., Zwinderman, A.H., Coup\u00e9, V.M.H., and van Laarhoven, H.W.M. (2018). Prediction models for patients with esophageal or gastric cancer: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0192310"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1007\/s11605-012-2010-7","article-title":"A preoperative nomogram to predict the risk of perioperative mortality following gastric resections for malignancy","volume":"16","author":"Dhir","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/bjs.9968","article-title":"Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer","volume":"103","author":"Fischer","year":"2016","journal-title":"Br. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/SLA.0000000000001127","article-title":"Risk Model for Distal Gastrectomy When Treating Gastric Cancer on the Basis of Data From 33,917 Japanese Patients Collected Using a Nationwide Web-based Data Entry System","volume":"262","author":"Kurita","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1002\/bjs.4414","article-title":"Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM","volume":"91","author":"Tekkis","year":"2004","journal-title":"Br. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1097\/SLA.0000000000000781","article-title":"Total gastrectomy risk model: Data from 20,011 Japanese patients in a nationwide internet-based database","volume":"260","author":"Watanabe","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/ckj\/sfaa188","article-title":"External validation of prognostic models: What, why, how, when and where?","volume":"14","author":"Ramspek","year":"2021","journal-title":"Clin. Kidney J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1080\/17453674.2021.1910448","article-title":"Availability and reporting quality of external validations of machine-learning prediction models with orthopedic surgical outcomes: A systematic review","volume":"92","author":"Groot","year":"2021","journal-title":"Acta Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1097\/SLA.0000000000005616","article-title":"Machine learning risk prediction model of 90-day mortality after gastrectomy for cancer","volume":"276","author":"Pera","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jclinepi.2014.06.018","article-title":"A new framework to enhance the interpretation of external validation studies of clinical prediction models","volume":"68","author":"Debray","year":"2015","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/SLA.0000000000005853","article-title":"Artificial Intelligence-enabled decision support in surgery: State-of-the-art and future directions","volume":"278","author":"Loftus","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Collins, G.S., Reitsma, J.B., Altman, D.G., and Moons, K.G. (2015). Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): The TRIPOD statement. BMJ, 350.","DOI":"10.1136\/bmj.g7594"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3081","DOI":"10.1016\/j.ejso.2021.04.025","article-title":"Evaluation of data quality in the Spanish EURECCA Esophagogastric Cancer Registry","volume":"47","author":"Castro","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1007\/s10120-018-0839-5","article-title":"International consensus on a complications list after gastrectomy for cancer","volume":"22","author":"Baiocchi","year":"2019","journal-title":"Gastric Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hancock, J.T., and Khoshgoftaar, T.M. (2020). CatBoost for big data: An interdisciplinary review. J. Big Data, 7.","DOI":"10.1186\/s40537-020-00369-8"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v033.i01","article-title":"Regularization paths for generalized linear models vi coordinate descent","volume":"33","author":"Friedman","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1023\/A:1010933404324","article-title":"Random forest","volume":"45","author":"Breiman","year":"2001","journal-title":"Mach. Learn."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1198\/016214503000125","article-title":"Boosting with the L2 loss: Regression and classification","volume":"98","author":"Yu","year":"2003","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/BF00116037","article-title":"The strength of weak learnability","volume":"5","author":"Schapire","year":"1990","journal-title":"Mach. Learn."},{"key":"ref_27","first-page":"131","article-title":"An Investigation of missing data methods for classification trees applied to binary response data","volume":"11","author":"Ding","year":"2010","journal-title":"J. Mach. Learn. Res."},{"key":"ref_28","first-page":"1","article-title":"DALEX: Explainers for complex predictive models in R","volume":"19","author":"Biecek","year":"2018","journal-title":"J. Mach. Learn. Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lang, M., Binder, M., Richter, J., Schratz, P., Pfisterer, F., Coors, S., Au, Q., Casalicchio, G., Kotthoff, L., and Bischi, B. (2019). mlr3: A modern object-oriented machine learning framework in R. J. Open Source Softw., 4.","DOI":"10.21105\/joss.01903"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jclinepi.2014.09.007","article-title":"External validation of new risk prediction models is infrequent and reveals worse prognostic discrimination","volume":"68","author":"Siontis","year":"2015","journal-title":"J. Clin. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Saito, T., and Rehmsmeier, M. (2015). The precision-recall plot is more informative than the ROC plot when evaluating binary classifiers on imbalanced datasets. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0118432"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Pinker, E. (2018). Reporting accuracy of rare event classifiers. NPJ Digit. Med., 1.","DOI":"10.1038\/s41746-018-0062-0"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/13\/2463\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:10:33Z","timestamp":1760109033000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/13\/2463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,5]]},"references-count":32,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["cancers16132463"],"URL":"https:\/\/doi.org\/10.3390\/cancers16132463","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,5]]}}}