MRI-based Nomogram to Preoperatively Predict Early Recurrence of Adenocarcinoma of the Esophagogastric Junction: a two-center study

Purpose: This study was to develop a predictive model based on preoperative MRI for early recurrence in patients with AEG. Methods: A retrospective analysis was performed on a cohort of consecutive patients from two medical centers who underwent preoperative contrast-enhanced MRI between March 2014 and October 2023, with AEG confirmed via surgical intervention. Cox regression analysis was used to explore risk factors for early postoperative recurrence, utilizing clinical data, laboratory results, and MRI characteristics. A nomogram was subsequently constructed and its performance was evaluated against the postoperative TNM staging system. Results: The study included 138 patients, divided into a training set (Center 1, n=81) and a validation set (Center 2, n=57). In the training set, three preoperative variables—tumor length, relative ADC value, and total number of regional lymph nodes—were found to be independently associated with early recurrence. The nomogram model constructed using these variables, demonstrated AUC values of 0.927 (95% CI, 0.854–0.928) and 0.896 (95% CI, 0.796–0.899) in the training and validation sets, respectively, with C-indices of 0.868 and 0.819. The model’s accuracy was significantly superior to that of the TNM staging system (P<0.05). Conclusion: The MRI-based nomogram demonstrates superior performance compared to the traditional TNM staging system in predicting early postoperative recurrence in AEG.