Wang Yan, Zhang Shilong, Ding Bowen, Tang Zhaoqing, Ji Yuan, Yu Yiyi, Cui Yuehong, Wang Xuefei, Sun Yihong, Liu Tianshu
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Medical College and Zhongshan Hospital Immunotherapy Translational Research Center, Fudan University, Shanghai, China.
Transl Gastroenterol Hepatol. 2024 Jun 17;9:39. doi: 10.21037/tgh-23-75. eCollection 2024.
Prognostic factors are complicated and changeable for locally advanced gastric cancer (GC) patients. This study aimed to perform a novel prognostic model on survival for locally advanced GC patients who have received neoadjuvant chemotherapy and radical surgery.
The locally advanced GC patients with neoadjuvant chemotherapy were included in this study from Zhongshan Hospital, Fudan University. A nomogram was developed based on independent prognostic factors identified through a multivariable Cox regression model. Model performance was evaluated in training and independent external cohorts in terms of calibration, discrimination, and clinical usefulness.
A total of 273 patients received radical resections. The median progression-free survival (PFS) and overall survival (OS) for all patients were 43.8 and 61.2 months, respectively. Nomogram showed that Lauren type made the greatest contribution to prognosis, followed by ypN. The prognostic nomogram had excellent discriminative ability, with a C-index of 0.689 [95% confidence interval (CI): 0.661-0.716], and an area under the receiver operating characteristic (ROC) curve (AUC) of 0.778, 0.746, and 0.725 for 3-, 5- and 10-year OS, respectively. Similar results were obtained in the external validation cohort. Based on the nomogram, the whole cohort was divided into high-risk and low-risk groups. And risk group classification was significantly associated with clinical characteristics, and produced an AUC value of 0.781, 0.748, and 0.727 for 3-, 5- and 10-year OS, respectively. Furthermore, compared with the tumor-node-metastasis (TNM) staging system (8th edition), Japanese criteria, and German criteria, the decision curve analysis (DCA) graphically demonstrated that the new model had more optimal net benefits in predicting the 3-, 5-, and 10-year OS for GC patients. Both C-index and time-dependent ROC curve demonstrated that the nomogram had a stronger capability for accurately predicting prognosis compared with the other staging system.
The nomogram model is an effective support tool to predict OS in GC patients undergoing perioperative chemotherapy followed by radical surgery.
局部进展期胃癌（GC）患者的预后因素复杂多变。本研究旨在为接受新辅助化疗和根治性手术的局部进展期GC患者建立一种新的生存预后模型。
本研究纳入了复旦大学附属中山医院接受新辅助化疗的局部进展期GC患者。基于通过多变量Cox回归模型确定的独立预后因素建立了列线图。在训练队列和独立外部队列中，从校准、区分度和临床实用性方面评估模型性能。
共有273例患者接受了根治性切除术。所有患者的中位无进展生存期（PFS）和总生存期（OS）分别为43.8个月和61.2个月。列线图显示，劳伦分型对预后的贡献最大，其次是ypN。预后列线图具有出色的区分能力，C指数为0.689[95%置信区间（CI）：0.661-0.716]，3年、5年和10年总生存期的受试者操作特征（ROC）曲线下面积（AUC）分别为0.778、0.746和0.725。在外部验证队列中也获得了类似结果。基于列线图，将整个队列分为高风险和低风险组。风险组分类与临床特征显著相关，3年、5年和10年总生存期的AUC值分别为0.781、0.748和0.727。此外，与肿瘤-淋巴结-转移（TNM）分期系统（第8版）、日本标准和德国标准相比，决策曲线分析（DCA）以图形方式表明，新模型在预测GC患者3年、5年和10年总生存期方面具有更优的净效益。C指数和时间依赖性ROC曲线均表明，与其他分期系统相比，列线图具有更强的准确预测预后的能力。
列线图模型是预测接受围手术期化疗后行根治性手术的GC患者总生存期的有效支持工具。
