Xie Jianwei, Zhao YaJun, Zhou Yanbing, He Qingliang, Hao Hankun, Qiu Xiantu, Zhao Gang, Xu Yanchang, Xue Fangqin, Chen Jinping, Su Guoqiang, Li Ping, Zheng Chao-Hui, Huang Chang-Ming
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
West District of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Anhui, China.
Front Oncol. 2021 Mar 2;11:533039. doi: 10.3389/fonc.2021.533039. eCollection 2021.
PRÉCIS: We present a valid and reproducible nomogram that combined the TNM stage as well as the Ki-67 index and carcinoembryonic antigen levels; the nomogram may be an indispensable tool to help predict individualized risks of death and help clinicians manage patients with gastric neuroendocrine carcinoma.
To analyze the long-term outcomes of patients with grade 3 GNEC who underwent curative surgery and investigated whether the combination of carcinoembryonic antigen (CEA) levels and Ki-67 index can predict the prognosis of patients with gastric neuroendocrine carcinoma (GNEC) and constructed a nomogram to predict patient survival.
In the training cohort, data were collected from 405 patients with GNEC after radical surgery at seven Chinese centers. A nomogram was constructed to predict long-term prognosis. Data for the validation cohort were collected from 305 patients.
The 5-year overall survival (OS) was worse in the high CEA group than in the normal CEA group (40.5% vs. 55.2%, p = 0.013). The 5-year OS was significantly worse in the high Ki-67 index group than in the low Ki-67 index group (47.9% vs. 57.2%, p = 0.012). Accordingly, we divided the whole cohort into a KC(-) group (low Ki-67 index and normal CEA) and KC(+) group (high Ki-67 index and/or high CEA). The KC(+) group had a worse prognosis than the KC(-) group (64.6% vs. 46.8%, p < 0.001). KC(+) and the AJCC 8 stage were independent factors for OS. Then, we combined KC status and the AJCC 8 stage to establish a nomogram; the C-index and area under the curve (AUC) were higher for the nomogram than for the AJCC 8 stage (C-index: 0.660 vs. 0.635, p = 0.005; AUC: 0.700 vs. 0.675, p = 0.020). The calibration curve verified that the nomogram had a good predictive value, with similar findings in the validation groups.
The nomogram based on KC status and the AJCC 8 stage predicted the prognosis of patients with GNEC well.
我们提出了一种有效且可重复的列线图，该列线图结合了TNM分期以及Ki-67指数和癌胚抗原水平；该列线图可能是帮助预测个体死亡风险以及帮助临床医生管理胃神经内分泌癌患者的不可或缺的工具。
分析接受根治性手术的3级胃神经内分泌癌（GNEC）患者的长期预后，并研究癌胚抗原（CEA）水平和Ki-67指数的组合是否可预测胃神经内分泌癌（GNEC）患者的预后，并构建列线图以预测患者生存情况。
在训练队列中，收集了来自中国七个中心的405例接受根治性手术后的GNEC患者的数据。构建列线图以预测长期预后。验证队列的数据来自305例患者。
高CEA组的5年总生存率（OS）低于正常CEA组（40.5%对55.2%，p = 0.013）。高Ki-67指数组的5年OS明显低于低Ki-67指数组（47.9%对57.2%，p = 0.012）。因此，我们将整个队列分为KC（-）组（低Ki-67指数和正常CEA）和KC（+）组（高Ki-67指数和/或高CEA）。KC（+）组的预后比KC（-）组差（64.6%对46.8%，p < 0.001）。KC（+）和美国癌症联合委员会（AJCC）第8版分期是OS的独立因素。然后，我们结合KC状态和AJCC第8版分期建立了列线图；列线图的C指数和曲线下面积（AUC）高于AJCC第8版分期（C指数：0.660对0.635，p = 0.005；AUC：0.700对0.675，p = 0.020）。校准曲线验证了列线图具有良好的预测价值，在验证组中也有类似发现。
基于KC状态和AJCC第8版分期的列线图能很好地预测GNEC患者的预后。
