Kattan Michael W, Karpeh Martin S, Mazumdar Madhu, Brennan Murray F
Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, C1275 New York, NY 10021, USA.
J Clin Oncol. 2003 Oct 1;21(19):3647-50. doi: 10.1200/JCO.2003.01.240.
Few published studies have addressed individual patient risk after R0 resection for gastric cancer. We developed and internally validated a nomogram that combines these factors to predict the probability of 5-year gastric cancer-specific survival on the basis of 1,039 patients treated at a single institution.
Nomogram predictor variables included age, sex, primary site (distal one-third, middle one-third, gastroesophageal junction, and proximal one-third), Lauren histotype (diffuse, intestinal, mixed), number of positive lymph nodes resected, number of negative lymph nodes resected, and depth of invasion. Death as a result of gastric cancer was the predicted end point. The concordance index was used as an accuracy measure, with bootstrapping to correct for optimistic bias. Calibration plots were constructed.
Gastric cancer-specific survival at 5 years was 50%. A nomogram was constructed on the basis of a Cox regression model. The bootstrap-corrected concordance index was 0.80. When compared with the predictive ability of American Joint Committee on Cancer stage, the nomogram discrimination was superior (P <.001). Nomogram calibration appeared to be excellent.
A nomogram was developed to predict 5-year disease-specific survival after R0 resection for gastric cancer. This tool should be useful for patient counseling, follow-up scheduling, and clinical trial eligibility determination.
很少有已发表的研究探讨胃癌R0切除术后个体患者的风险。我们开发并在内部验证了一种列线图，该列线图结合了这些因素，以预测在单一机构接受治疗的1039例患者的5年胃癌特异性生存概率。
列线图预测变量包括年龄、性别、原发部位（远端三分之一、中间三分之一、胃食管交界和近端三分之一）、劳伦组织学类型（弥漫型、肠型、混合型）、切除的阳性淋巴结数量、切除的阴性淋巴结数量以及浸润深度。胃癌导致的死亡是预测的终点。一致性指数用作准确性度量，并采用自抽样法校正乐观偏差。构建校准图。
5年胃癌特异性生存率为50%。基于Cox回归模型构建了列线图。自抽样法校正后的一致性指数为0.80。与美国癌症联合委员会分期的预测能力相比，列线图的区分度更高（P <.001）。列线图校准似乎非常出色。
开发了一种列线图来预测胃癌R0切除术后5年的疾病特异性生存。该工具应有助于患者咨询、随访安排和临床试验资格判定。
