Qian Hao, Lv Xiaohui, Song Qiying, Su Rujuan, Xie Tianyu, Wu Di, Chang Rongyan, Chen Lubin, Yang Yanling, Chen Yong, Wang Xinxin, Ru Yi, Shang Lei, Guo Xin
Department of Health Statistics, School of Public Health, Fourth Military Medical University.
Department of Endoscopic Surgery, Xijing Hospital, Fourth Military Medical University.
J Cancer. 2021 Sep 21;12(22):6740-6748. doi: 10.7150/jca.60576. eCollection 2021.
The current model for predicting prognosis and chemotherapy response of patients with gastric adenocarcinoma is the TNM staging system, which may lack adequate accuracy and evaluations of molecular features at the individual level. We aimed to develop a prediction model to assess the individualized prognosis and responsiveness to fluorouracil-based adjuvant chemotherapy. This retrospective study concluded 2 independent cohorts of patients with GAC. The expression of dysbindin was quantified and evaluated the association with the overall survival for GAC patients. A prediction model for postoperative overall survival was generated and internally and externally validated. The interaction between dysbindin expression and PACT was detected in advanced GAC patients. Of the 637 patients enrolled in the study, 425 were men (66.7%) with a mean (SD) age of 59.79 (9.81) years. High levels of dysbindin expression predicted a poor prognosis in patients with GAC. Multivariate analysis demonstrated dysbindin expression was an independent prognostic predictor of overall survival in the test, validation and combined cohorts. A prognostic predictive model incorporating age, dysbindin expression, pathological differentiation, Lauren's classification and the TNM staging system was established. This model had better predictive accuracy for overall survival than the traditional TNM staging system and was internally and externally validated. More importantly, advanced GAC patients with low dysbindin expression were likely to benefit from fluorouracil-based PACT. The risk stratification model incorporating dysbindin expression and TNM staging system showed better predictive accuracy. Advanced GAC patients with low dysbindin expression revealed better response of fluorouracil-based adjuvant chemotherapy.
目前用于预测胃腺癌患者预后和化疗反应的模型是TNM分期系统，该系统可能在个体水平上缺乏足够的准确性和对分子特征的评估。我们旨在开发一种预测模型，以评估个体化预后以及对基于氟尿嘧啶的辅助化疗的反应性。这项回顾性研究纳入了2个独立的胃腺癌患者队列。对dysbindin的表达进行定量，并评估其与胃腺癌患者总生存期的关联。生成了术后总生存期的预测模型，并进行了内部和外部验证。在晚期胃腺癌患者中检测到dysbindin表达与基于铂类辅助化疗（PACT）之间的相互作用。在该研究纳入的637例患者中，425例为男性（66.7%），平均（标准差）年龄为59.79（9.81）岁。dysbindin高表达预示胃腺癌患者预后不良。多变量分析表明，在测试、验证和合并队列中，dysbindin表达是总生存期的独立预后预测因素。建立了一个包含年龄、dysbindin表达、病理分化、Lauren分类和TNM分期系统的预后预测模型。该模型对总生存期的预测准确性优于传统的TNM分期系统，并经过了内部和外部验证。更重要的是，dysbindin低表达的晚期胃腺癌患者可能从基于氟尿嘧啶的PACT中获益。结合dysbindin表达和TNM分期系统的风险分层模型显示出更好的预测准确性。dysbindin低表达的晚期胃腺癌患者对基于氟尿嘧啶的辅助化疗反应更好。
