Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, #453, Tiyuchang Road, Xihu District, Hangzhou, 310000, Zhejiang Province, China.
Department of Respiratory and Critical Care Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, #453, Tiyuchang Road, Xihu District, Hangzhou, 310000, Zhejiang Province, China.
BMC Gastroenterol. 2023 Mar 6;23(1):54. doi: 10.1186/s12876-023-02706-6.
The purpose of this research was to construct a novel predictive nomogram to identify specific stage IB gastric adenocarcinoma (GAC) populations who could benefit from postoperative adjuvant chemotherapy (ACT).
Between 2004 and 2015, 1889 stage IB GAC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) program database. Then Kaplan-Meier survival analysis, univariate and multivariable Cox analyses, and univariate and multivariable logistic analyses were implemented. Finally, the predictive nomograms were constructed. The methods of area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were used to validate the clinical effectiveness of the models.
Of these patients, 708 cases underwent ACT, while the other 1181 patients didn't receive ACT. After PSM, the patients in the ACT group presented a longer median overall survival (133 vs. 85 months, p = 0.0087). Among the ACT group, 194 (36.0%) patients achieving more prolonged overall survival than 85 months were regarded as the beneficiary population. Then the logistic regression analyses were performed, and age, gender, marital status, primary site, tumor size, and regional nodes examined were included as predicting factors to construct the nomogram. The AUC value was 0.725 in the training cohort and 0.739 in the validation cohort, which demonstrated good discrimination. And calibration curves indicated ideal consistency between the predicted and observed probabilities. Decision curve analysis presented a clinically useful model. Furthermore, the prognostic nomogram predicting 1-, 3-, and 5-year cancer-specific survival presented good predictive ability.
The benefit nomogram could guide clinicians in decision-making and selecting optimal candidates for ACT among stage IB GAC patients. And the prognostic nomogram presented great prediction ability for these patients.
本研究旨在构建一种新的预测列线图，以确定特定的 IB 期胃腺癌（GAC）人群，这些人群可能从术后辅助化疗（ACT）中获益。
2004 年至 2015 年，从监测、流行病学和最终结果（SEER）计划数据库中提取 1889 例 IB 期 GAC 患者。然后进行 Kaplan-Meier 生存分析、单变量和多变量 Cox 分析、单变量和多变量逻辑分析。最后，构建预测列线图。使用曲线下面积（AUC）、校准曲线和决策曲线分析（DCA）方法验证模型的临床效果。
这些患者中，708 例接受了 ACT，而其余 1181 例未接受 ACT。经过 PSM 后，ACT 组患者的中位总生存期更长（133 个月 vs. 85 个月，p=0.0087）。在 ACT 组中，194 例（36.0%）患者的总生存期超过 85 个月，被认为是受益人群。然后进行逻辑回归分析，纳入年龄、性别、婚姻状况、原发部位、肿瘤大小和区域淋巴结检查作为预测因素构建列线图。训练队列的 AUC 值为 0.725，验证队列的 AUC 值为 0.739，表明具有良好的区分能力。校准曲线表明预测概率与观察概率之间存在理想的一致性。决策曲线分析呈现出一种具有临床意义的模型。此外，预测 1、3 和 5 年癌症特异性生存率的预后列线图具有良好的预测能力。
获益列线图可以为 IB 期 GAC 患者的 ACT 决策和选择最佳候选者提供指导。并且预后列线图对这些患者具有很好的预测能力。
