Department of General Surgery, The Yijishan Hospital of Wannan Medical College, Wuhu, China.
Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
PeerJ. 2024 Jul 10;12:e17751. doi: 10.7717/peerj.17751. eCollection 2024.
Tumor deposits (TD) was a significant risk factor impacting the prognosis of patients diagnosed with gastric cancer (GC), yet it was not currently incorporated into TNM staging systems. The objective of this research was to develop a predictive model for assessing the prognosis of patients with TD-positive GC.
Retrospective analysis was performed on the data of 4,972 patients treated for GC with D2 radical gastrectomy at Wannan Medical College's Yijishan Hospital between January 2012 and December 2021. The patients were categorized based on the number of TD (L1: 1, L2: 2-3, L3: ≥4) and the anatomical location of TD (Q1: single area, Q2: multiple areas). In a 3:1 ratio, patients were randomly assigned to one of two groups: training or validation.
The study included a total of 575 patients who were divided into the training group ( = 432) and validation group ( = 143). Survival analysis showed that the number and anatomical location of TD had a significant impact on the prognosis of patients with TD-positive GC. Univariate analysis of the training group data revealed that tumor size, T-stage, N-stage, histological grade, number and distribution of TD, neural invasion, and postoperative chemotherapy were associated with prognosis. Multivariate Cox regression analysis identified poor histological grade, T4 stage, N3 stage, number of TD, neural invasion, and postoperative chemotherapy as independent prognostic factors for GC patients with TD. A nomogram was developed using these variables, demonstrating well predictive ability for 1, 3, and 5-year overall survival (OS) in the validation set. The DCA curve shows that the constructed model shows a large positive net gain compared to the eighth edition Tumour, Node, Metastasis (TNM) staging system.
The prognostic model developed for patients with TD-positive GC has a higher clinical utility compared to the eighth edition of TNM staging.
肿瘤沉积物（TD）是影响胃癌（GC）患者预后的重要危险因素，但目前尚未纳入 TNM 分期系统。本研究旨在建立一种预测 TD 阳性 GC 患者预后的模型。
回顾性分析了 2012 年 1 月至 2021 年 12 月皖南医学院弋矶山医院行 D2 根治性胃切除术治疗的 4972 例 GC 患者的数据。根据 TD 数量（L1：1，L2：2-3，L3：≥4）和 TD 解剖位置（Q1：单个区域，Q2：多个区域）将患者进行分类。患者按 3:1 的比例随机分配到训练组或验证组。
本研究共纳入 575 例患者，分为训练组（n=432）和验证组（n=143）。生存分析显示，TD 的数量和解剖位置对 TD 阳性 GC 患者的预后有显著影响。训练组数据的单因素分析显示，肿瘤大小、T 分期、N 分期、组织学分级、TD 的数量和分布、神经侵犯和术后化疗与预后相关。多因素 Cox 回归分析确定组织学分级差、T4 期、N3 期、TD 数量、神经侵犯和术后化疗是 TD 阳性 GC 患者的独立预后因素。使用这些变量建立了一个列线图，在验证组中显示了对 1、3 和 5 年总生存率（OS）的良好预测能力。DCA 曲线显示，与第八版肿瘤、淋巴结、转移（TNM）分期系统相比，所构建的模型具有较大的阳性净收益。
与第八版 TNM 分期相比，TD 阳性 GC 患者的预后模型具有更高的临床实用性。
