Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Division of Acute and Critical care Surgery, Ajou University School of Medicine, Suwon, Korea.
Ann Surg Oncol. 2021 Nov;28(12):7027-7037. doi: 10.1245/s10434-021-09754-w. Epub 2021 Apr 6.
Few current preoperative risk assessment tools provide essential, optimized treatment for gastric cancer. The purpose of this study was to develop and validate a nomogram that uses preoperative data to predict survival and risk assessments.
A survival prediction model was constructed using data from a developmental cohort of 1251 patients with stage I to III gastric cancer who underwent curative resection between January 2005 and December 2008 at Ajou University Hospital, Korea. The model was internally validated for discrimination and calibrated using bootstrap resampling. To externally validate the model, data from a validation cohort of 2012 patients with stage I to III gastric cancer who underwent surgery at multiple centers in Korea between January 2001 and June 2006 were analyzed. Analyses included the model's discrimination index (C-index), calibration plots, and decision curve that predict overall survival.
Eight independent predictors, including age, sex, clinical tumor size, macroscopic features, body mass index, histology, clinical stages, and tumor location, were considered for developing the nomogram. The discrimination index was 0.816 (adjusted C-index) in the developmental cohort and 0.781 (adjusted C-index) in the external validation cohort. Additionally, in both the developmental and validation datasets, age and tumor size were significantly correlated with each other and were independent indicators for survival (P < 0.05).
We developed a new nomogram by using the most common and significant preoperative parameters that can help to identify high-risk patients before treatment and help clinicians to make appropriate decisions for patients with stage I to III gastric cancer.
目前很少有术前风险评估工具能为胃癌提供必要的优化治疗。本研究旨在开发和验证一种列线图，该列线图使用术前数据来预测生存和风险评估。
使用韩国 Ajou 大学医院于 2005 年 1 月至 2008 年 12 月期间接受根治性切除术的 I 期至 III 期胃癌患者的 1251 例患者的发展队列数据构建生存预测模型。使用 bootstrap 重采样对内部分辨度和校准进行验证。为了外部验证模型，分析了韩国多家中心于 2001 年 1 月至 2006 年 6 月期间接受手术治疗的 I 期至 III 期胃癌患者的 2012 例验证队列数据。分析包括模型的判别指数（C 指数）、校准图和预测总生存的决策曲线。
纳入了 8 个独立的预测因子，包括年龄、性别、临床肿瘤大小、大体特征、体重指数、组织学、临床分期和肿瘤位置，用于开发列线图。在发展队列中的判别指数为 0.816（校正 C 指数），在外部验证队列中的判别指数为 0.781（校正 C 指数）。此外，在发展和验证数据集均中，年龄和肿瘤大小彼此显著相关，是生存的独立指标（P < 0.05）。
我们使用最常见和最重要的术前参数开发了一种新的列线图，该列线图可以帮助在治疗前识别高危患者，并帮助临床医生为 I 期至 III 期胃癌患者做出适当的决策。
