577141Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.
West Branch of the First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
Technol Cancer Res Treat. 2022 Jan-Dec;21:15330338221112741. doi: 10.1177/15330338221112741.
No effective peripheral blood predictors have been establoshed for first-line chemotherapy in patients with advanced gastric cancer. In this study, a nomogram combining the neutrophil-to-lymphocyte ratio/D-dimer with gender, number of metastases, and histological grade was established to predict progression-free survival in patients with unresectable advanced gastric cancer. We retrospectively collected baseline clinical characteristics and blood parameters from 153 patients diagnosed with advanced gastric cancer that underwent oxaliplatin-based first-line chemotherapy. Kaplan-Meier analysis and Cox regression analysis were used to determine the factors associated with progression-free survival. The concordance index (C-index) and calibration curve were used to determine the prediction accuracy and discriminative ability of the nomogram as a visual complement to the prognostic score system. Determined by the X-tile software, the optimal cut-off points for the neutrophil-to-lymphocyte ratio and D-dimer were 3.18 and 0.56 mg/L, respectively. Multivariate analysis identified four independent prognostic factors: two or more metastatic organs (HR: 1.562, 95% CI: 1.009-2.418, = .046), poor differentiation (HR: 0.308, 95% CI: 0.194-0.487, < .001), neutrophil-to-lymphocyte ratio >3.18 (HR: 1.427, 95% CI: 1.024-1.989, = .036), and D-dimer >0.56 mg/L (HR: 1.811, 95% CI: 1.183-2.773, = .006). Receiver operating characteristic curves showed that the combination of the neutrophil-to-lymphocyte ratio and D-dimer in the prediction model exhibited the highest predictive performance (area under the curve, 0.800). The prognostic nomogram yielded a C-index of 0.800. Decision curve analysis demonstrated that the prognostic nomogram was clinically useful. A nomogram-based risk classification system was also constructed to facilitate risk stratification of advanced gastric cancer for optimal clinical management. We identified the neutrophil-to-lymphocyte ratio and D-dimer level as independent prognostic factors for advanced gastric cancer. The prognostic nomogram combining the neutrophil-to-lymphocyte ratio and D-dimer level can be applied in the individualized prediction of treatment outcome in patients with advanced gastric cancer.
尚未建立有效的外周血预测指标来预测晚期胃癌患者的一线化疗效果。本研究建立了一个联合中性粒细胞与淋巴细胞比值/ D-二聚体、性别、转移数量和组织学分级的列线图，用于预测不可切除的晚期胃癌患者的无进展生存期。我们回顾性收集了 153 例接受奥沙利铂为基础的一线化疗的晚期胃癌患者的基线临床特征和血液参数。采用 Kaplan-Meier 分析和 Cox 回归分析确定与无进展生存期相关的因素。一致性指数（C-index）和校准曲线用于确定列线图的预测准确性和判别能力，作为预后评分系统的直观补充。通过 X-tile 软件确定中性粒细胞与淋巴细胞比值和 D-二聚体的最佳截断值分别为 3.18 和 0.56mg/L。多因素分析确定了四个独立的预后因素：两个或更多转移器官（HR：1.562，95%CI：1.009-2.418，=0.046）、低分化（HR：0.308，95%CI：0.194-0.487，<0.001）、中性粒细胞与淋巴细胞比值>3.18（HR：1.427，95%CI：1.024-1.989，=0.036）和 D-二聚体>0.56mg/L（HR：1.811，95%CI：1.183-2.773，=0.006）。受试者工作特征曲线显示，预测模型中中性粒细胞与淋巴细胞比值和 D-二聚体的组合具有最高的预测性能（曲线下面积，0.800）。预后列线图的 C-index 为 0.800。决策曲线分析表明，预后列线图具有临床实用性。还构建了基于列线图的风险分类系统，以方便晚期胃癌的风险分层，从而进行最佳临床管理。我们确定中性粒细胞与淋巴细胞比值和 D-二聚体水平是晚期胃癌的独立预后因素。联合中性粒细胞与淋巴细胞比值和 D-二聚体水平的预后列线图可用于预测晚期胃癌患者的治疗效果。
