基于术前循环肿瘤细胞的可切除胃癌预测新列线图
A Novel Nomogram to Predict Resectable Gastric Cancer Based on Preoperative Circulating Tumor Cell.
机构信息
Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
Zhongshan People's Hospital Affiliated to Guangdong Medical University, Guangdong, China.
出版信息
Clin Transl Gastroenterol. 2024 Feb 1;15(2):e00561. doi: 10.14309/ctg.0000000000000561.
INTRODUCTION
Circulating tumor cells (CTCs) have been suggested to have an important prognostic role in gastrointestinal tumors. We developed a preoperative CTC-based nomogram to predict the prognosis of patients with resectable gastric cancer after surgery and established a risk stratification system based on the nomogram.
METHODS
From January 2012 to June 2017, we screened 258 patients with gastric cancer treated with surgery from one center as the training cohort and 133 patients with gastric cancer treated with surgery from another as the validation cohort, screened prognostic factors for the training cohort using univariate and multivariate Cox risk proportional models, created predictive overall survival (OS) and a recurrence-free survival (RFS) nomogram, and plotted the receiver operating characteristic curve and calibration curve for this nomogram in the training and validation cohorts. Risk score stratification was performed according to the nomogram, and OS curves were plotted for the low, medium, and high-risk groups using the Kaplan-Meier method.
RESULTS
The CTC positivity rate was 78.5% in all patients. CTC, TNM stage, and Ki-67 were the prognostic factors affecting OS and RFS after gastric cancer surgery. The nomogram consisted of these 3 variables. In the training group, the area under the curve of the nomogram for OS at 1, 3, and 5 years was 0.918, 0.829, and 0.813, respectively, and the area under the curve for RFS was 0.900, 0884, and 0.839, respectively. There was a statistically significant difference in OS among the low, medium, and high-risk groups according to the risk stratification system constructed from nomogram scores ( P < 0.001).
DISCUSSION
Two nomograms based on preoperative CTC were established to predict OS and RFS after resectable gastric cancer. The 2 nomograms had good discrimination and calibration and significant stratification ability of the risk stratification system established according to them.
简介
循环肿瘤细胞（CTC）被认为在胃肠道肿瘤中有重要的预后作用。我们开发了一种基于术前 CTC 的列线图，以预测可切除胃癌患者手术后的预后，并基于该列线图建立了风险分层系统。
方法
从 2012 年 1 月至 2017 年 6 月，我们筛选了 258 名接受手术治疗的胃癌患者作为训练队列，另筛选了 133 名接受手术治疗的胃癌患者作为验证队列，使用单因素和多因素 Cox 风险比例模型筛选训练队列的预后因素，创建预测总生存期（OS）和无复发生存期（RFS）的列线图，并在训练和验证队列中绘制该列线图的接收者操作特征曲线和校准曲线。根据列线图进行风险评分分层，并使用 Kaplan-Meier 方法绘制低、中、高危组的 OS 曲线。
结果
所有患者的 CTC 阳性率为 78.5%。CTC、TNM 分期和 Ki-67 是影响胃癌手术后 OS 和 RFS 的预后因素。该列线图由这 3 个变量组成。在训练组中，OS 列线图在 1、3 和 5 年的曲线下面积分别为 0.918、0.829 和 0.813，RFS 的曲线下面积为 0.900、0.884 和 0.839。根据基于列线图评分构建的风险分层系统，低、中、高危组之间的 OS 存在统计学差异（P<0.001）。
讨论
建立了两个基于术前 CTC 的列线图，以预测可切除胃癌患者的 OS 和 RFS。这两个列线图具有良好的区分度和校准度，以及根据它们建立的风险分层系统具有显著的分层能力。
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