I 期-Ⅱ期胃神经内分泌癌降阶梯化疗？真实世界的竞争风险分析。

De-escalating chemotherapy for stage I-II gastric neuroendocrine carcinoma? A real-world competing risk analysis.

机构信息

Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310000, China.

出版信息

World J Surg Oncol. 2023 May 6;21(1):142. doi: 10.1186/s12957-023-03029-2.

DOI:10.1186/s12957-023-03029-2

PMID:37149679

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10163728/

Abstract

BACKGROUND

The role of adjuvant chemotherapy in gastric neuroendocrine neoplasms (GNEC) has not been well clarified yet. The study was designed to investigate the potential effect of adjuvant chemotherapy in stage I-II GNEC patients and construct a predictive nomogram.

METHOD

Stage I-II GNEC patients were included in the Surveillance, Epidemiology, and End Results (SEER) database and divided into chemotherapy and no-chemotherapy groups. We used Kaplan-Meier survival analyses, propensity score matching (PSM), and competing risk analyses. The predictive nomogram was then built and validated.

RESULTS

Four hundred four patients with stage I-II GNEC were enrolled from the SEER database while 28 patients from Hangzhou TCM Hospital were identified as the external validation cohort. After PSM, similar 5-year cancer-specific survival was observed in two groups. The outcomes of competing risk analysis indicated a similar 5-year cumulative incidence of cancer-specific death (CSD) between the two cohorts (35.4% vs. 31.4%, p = 0.731). And there was no significant relation between chemotherapy and CSD in the multivariate competing risks regression analysis (HR, 0.79; 95% CI, 0.48-1.31; p = 0.36). Furthermore, based on the variables from the multivariate analysis, a competing event nomogram was created to assess the 1-, 3-, and 5-year risks of CSD. The 1-, 3-, and 5-year area under the receiver operating characteristic curve (AUC) values were 0.770, 0.759, and 0.671 in the training cohort, 0.809, 0.782, and 0.735 in the internal validation cohort, 0.786, 0.856, and 0.770 in the external validation cohort. Furthermore, calibration curves revealed that the expected and actual probabilities of CSD were relatively consistent.

CONCLUSION

Stage I-II GNEC patients could not benefit from adjuvant chemotherapy after surgery. De-escalation of chemotherapy should be considered for stage I-II GNEC patients. The proposed nomogram exhibited excellent prediction ability.

摘要

背景

辅助化疗在胃神经内分泌肿瘤（GNEC）中的作用尚未得到充分阐明。本研究旨在探讨辅助化疗对 I 期- II 期 GNEC 患者的潜在疗效，并构建预测列线图。

方法

本研究纳入了来自 Surveillance, Epidemiology, and End Results（SEER）数据库的 I 期- II 期 GNEC 患者，并分为化疗组和非化疗组。我们采用 Kaplan-Meier 生存分析、倾向评分匹配（PSM）和竞争风险分析。然后构建并验证了预测列线图。

结果

本研究从 SEER 数据库中纳入了 404 例 I 期- II 期 GNEC 患者，同时纳入了杭州市中医院的 28 例患者作为外部验证队列。经过 PSM 后，两组患者的 5 年癌症特异性生存率相似。竞争风险分析的结果表明，两组患者的 5 年累积癌症特异性死亡率（CSD）相似（35.4%比 31.4%，p=0.731）。多变量竞争风险回归分析也未发现化疗与 CSD 之间存在显著关系（HR，0.79；95%CI，0.48-1.31；p=0.36）。此外，基于多变量分析的变量，我们创建了一个竞争事件列线图来评估 1 年、3 年和 5 年 CSD 的风险。在训练队列中，1 年、3 年和 5 年的接收器操作特征曲线（AUC）值分别为 0.770、0.759 和 0.671，内部验证队列分别为 0.809、0.782 和 0.735，外部验证队列分别为 0.786、0.856 和 0.770。此外，校准曲线表明，CSD 的预期概率与实际概率较为一致。