Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Gastric Cancer. 2018 May;21(3):453-463. doi: 10.1007/s10120-017-0756-z. Epub 2017 Aug 21.
Some clinicopathological variables are known to influence the survival of patients with advanced gastric cancer. A comprehensive model based on these factors is needed for prediction of an individual's survival and appropriate patient counseling.
A nomogram for predicting 1-year survival in patients with advanced gastric cancer in the palliative chemotherapy setting was developed using clinicopathological data from 949 patients with unresectable or metastatic gastric cancer who had received first-line doublet cytotoxic chemotherapy from 2001 to 2006 at the National Cancer Center, Korea (Baseline Nomogram). For 836 patients whose initial response to chemotherapy is known, another nomogram (ChemoResponse-based Nomogram) was constructed using the response to chemotherapy as additional variable. Nomogram performance in terms of discrimination and calibration ability was evaluated using the C statistic and Hosmer-Lemeshow-type χ statistics.
Two different nomograms were developed and subjected to internal validation. The baseline nomogram incorporated 13 baseline clinicopathological variables, whereas the chemoresponse-based nomogram was composed of 11 variables including initial response to chemotherapy. Internal validation revealed good performance of the two nomograms in discrimination: C statistics = 0.656 (95% confidence interval, 0.628-0.673) for the baseline and 0.718 (95% confidence interval, 0.694-0.741) for the chemoresponse-based nomogram, which showed significantly better discrimination performance than the baseline nomogram (Z statistics = 3.74, p < 0.01).
This study suggests that individual 1-year survival probability of patients receiving first-line doublet cytotoxic chemotherapy for advanced gastric cancer can be reliably predicted by a nomogram-based method incorporating clinicopathological variables and initial response to chemotherapy.
一些临床病理变量已知会影响晚期胃癌患者的生存。需要建立一个基于这些因素的综合模型来预测个体的生存情况，并为患者提供适当的咨询。
使用来自 949 名 2001 年至 2006 年期间在韩国国家癌症中心接受一线双联细胞毒性化疗的不可切除或转移性胃癌患者的临床病理数据，开发了一个预测晚期胃癌患者姑息化疗 1 年生存率的列线图（基线列线图）。对于 836 名初始化疗反应已知的患者，使用化疗反应作为附加变量构建了另一个列线图（化疗反应列线图）。使用 C 统计量和 Hosmer-Lemeshow 型 χ 统计量评估列线图在区分能力和校准能力方面的性能。
开发了两个不同的列线图并进行了内部验证。基线列线图纳入了 13 个基线临床病理变量，而化疗反应列线图由包括初始化疗反应在内的 11 个变量组成。内部验证显示，两个列线图在区分方面表现良好：基线列线图的 C 统计量为 0.656（95%置信区间，0.628-0.673），化疗反应列线图为 0.718（95%置信区间，0.694-0.741），与基线列线图相比，显示出显著更好的区分性能（Z 统计量=3.74，p<0.01）。
本研究表明，通过纳入临床病理变量和初始化疗反应的列线图方法，可以可靠地预测接受一线双联细胞毒性化疗的晚期胃癌患者的 1 年生存率个体概率。
