School of Clinical Medicine, North China University of Science and Technology, Tangshan, China.
Department of Emergency Intensive Care Unit, Yangpu Hospital, Tongji University, Shanghai, China.
Pathol Oncol Res. 2023 Jun 2;29:1610897. doi: 10.3389/pore.2023.1610897. eCollection 2023.
This study aimed to develop a novel scoring system, named the integrated oxidative stress score (IOSS), based on oxidative stress indices to predict the prognosis in stage III gastric cancer. Retrospective analysis of stage III gastric cancer patients who were operated on between January 2014 and December 2016 were enrolled into this research. IOSS is a comprehensive index based on an achievable oxidative stress index, comprising albumin, blood urea nitrogen, and direct bilirubin. The patients were divided according to receiver operating characteristic curve into two groups of low IOSS (IOSS ≤ 2.00) and high IOSS (IOSS > 2.00). The grouping variable was performed by Chi-square test or Fisher's precision probability test. The continuous variables were evaluated by t-test. The disease free survival (DFS) and overall survival (OS) were performed by Kaplan-Meier and Log-Rank tests. Univariate Cox proportional hazards regression models and stepwise multivariate Cox proportional hazards regression analysis were determined to appraise the potential prognostic factors for DFS and OS. A nomogram of the potential prognostic factors by the multivariate analysis for DFS and OS was established with R software. In order to assess the accuracy of the nomogram in forecasting prognosis, the calibration curve and decision curve analysis were produced, contrasting the observed outcomes with the predicted outcomes. The IOSS was significantly correlated with the DFS and OS, and was a potential prognostic factor in patients with stage III gastric cancer. Patients with low IOSS had longer survival (DFS: χ = 6.632, = 0.010; OS: χ = 6.519, = 0.011), and higher survival rates. According to the univariate and multivariate analyses, the IOSS was a potential prognostic factor. The nomograms were conducted on the potential prognostic factors to improve the correctness of survival prediction and evaluate the prognosis in stage III gastric cancer patients. The calibration curve indicated a good agreement in 1-, 3-, 5-year lifetime rates. The decision curve analysis indicated that the nomogram's predictive clinical utility for clinical decision was better than IOSS. IOSS is a nonspecific tumor predictor based on available oxidative stress index, and low IOSS is found to be a vigorous factor of better prognosis in stage III gastric cancer.
本研究旨在建立一种新的评分系统，命名为综合氧化应激评分（IOSS），基于氧化应激指标预测 III 期胃癌的预后。本研究回顾性分析了 2014 年 1 月至 2016 年 12 月期间接受手术治疗的 III 期胃癌患者。IOSS 是一个基于可实现的氧化应激指数的综合指数，包括白蛋白、血尿素氮和直接胆红素。根据受试者工作特征曲线，患者被分为低 IOSS（IOSS≤2.00）和高 IOSS（IOSS>2.00）两组。分类变量采用卡方检验或 Fisher 精确概率检验。连续变量采用 t 检验评估。通过 Kaplan-Meier 和 Log-Rank 检验进行无病生存（DFS）和总生存（OS）分析。采用单因素 Cox 比例风险回归模型和逐步多因素 Cox 比例风险回归分析评估 DFS 和 OS 的潜在预后因素。通过 R 软件建立多因素分析 DFS 和 OS 的潜在预后因素的列线图。为了评估列线图预测预后的准确性，生成了校准曲线和决策曲线分析，将观察结果与预测结果进行对比。IOSS 与 DFS 和 OS 显著相关，是 III 期胃癌患者的潜在预后因素。低 IOSS 患者的生存时间更长（DFS：χ=6.632，P=0.010；OS：χ=6.519，P=0.011），生存率更高。根据单因素和多因素分析，IOSS 是一个潜在的预后因素。列线图是基于潜在的预后因素来提高生存预测的准确性，评估 III 期胃癌患者的预后。校准曲线表明，1、3、5 年的生存率有较好的一致性。决策曲线分析表明，列线图的预测临床实用性优于 IOSS。IOSS 是基于现有氧化应激指标的非特异性肿瘤预测因子，低 IOSS 被发现是 III 期胃癌患者更好预后的有力因素。
