Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China.
World J Surg Oncol. 2023 Sep 22;21(1):300. doi: 10.1186/s12957-023-03144-0.
The prognostic nutritional index (PNI), alkaline phosphatase (ALP), and lymph node ratio (LNR) are reportedly related to prognosis. The aim of this study was to elucidate the clinical importance of the LNR and hematological parameters in patients with high grade rectal neuroendocrine neoplasms (HG-RNENs) who were undergoing radical resection.
We reviewed the medical records of patients with HG-RNENs from 17 large-scale medical centers in China (January 1, 2010-April 30, 2022). A nomogram was constructed by using a proportional hazard model. Bootstrap method was used to draw calibration plots to validate the reproducibility of the model. Concordance index (C-Index), decision curve analysis (DCA), and time-dependent area under the receiver operating characteristic curve (TD-AUC) analysis were used to compare the prognostic predictive power of the new model with American Joint Committee on Cancer (AJCC) TNM staging and European Neuroendocrine Tumor Society (ENETS) TNM staging.
A total of 85 patients with HG-RNENs were enrolled in this study. In the 45 patients with HG-RNENs who underwent radical resection, PNI ≤ 49.13 (HR: 3.997, 95% CI: 1.379-11.581, P = 0.011), ALP > 100.0 U/L (HR: 3.051, 95% CI: 1.011-9.205, P = 0.048), and LNR > 0.40 (HR: 6.639, 95% CI: 2.224-19.817, P = 0.0007) were independent predictors of relapse-free survival. The calibration plots suggested that the nomogram constructed based on the three aforementioned factors had good reproducibility. The novel nomogram revealed a C-index superior to AJCC TNM staging (0.782 vs 0.712) and ENETS TNM staging (0.782 vs 0.657). Also, the new model performed better compared to AJCC TNM staging and ENETS TNM staging in DCA and TD-AUC analyses.
LNR, ALP, and PNI were independent prognostic factors in patients with HG-RNENs after radical resection, and the combined indicator had better predictive efficacy compared with AJCC TNM staging and ENETS TNM staging.
预后营养指数（PNI）、碱性磷酸酶（ALP）和淋巴结比值（LNR）与预后有关。本研究旨在阐明 LNR 和血液学参数在接受根治性切除术的高分级直肠神经内分泌肿瘤（HG-RNENs）患者中的临床重要性。
我们回顾了 2010 年 1 月 1 日至 2022 年 4 月 30 日期间来自中国 17 家大型医疗中心的 HG-RNENs 患者的病历。使用比例风险模型构建了一个列线图。Bootstrap 方法用于绘制校准图以验证模型的可重复性。通过一致性指数（C-指数）、决策曲线分析（DCA）和时间依赖性接受者操作特征曲线下面积（TD-AUC）分析比较了新模型与美国癌症联合委员会（AJCC）TNM 分期和欧洲神经内分泌肿瘤学会（ENETS）TNM 分期的预测预后能力。
本研究共纳入 85 例 HG-RNENs 患者。在 45 例接受根治性切除术的 HG-RNENs 患者中，PNI≤49.13（HR：3.997，95%CI：1.379-11.581，P=0.011）、ALP>100.0 U/L（HR：3.051，95%CI：1.011-9.205，P=0.048）和 LNR>0.40（HR：6.639，95%CI：2.224-19.817，P=0.0007）是无复发生存的独立预测因子。校准图表明，基于上述三个因素构建的列线图具有良好的可重复性。新型列线图显示 C-指数优于 AJCC TNM 分期（0.782 与 0.712）和 ENETS TNM 分期（0.782 与 0.657）。此外，在 DCA 和 TD-AUC 分析中，新模型的性能优于 AJCC TNM 分期和 ENETS TNM 分期。
LNR、ALP 和 PNI 是接受根治性切除术的 HG-RNENs 患者的独立预后因素，联合指标的预测效果优于 AJCC TNM 分期和 ENETS TNM 分期。
