用于预测接受原发性肿瘤切除的伴有肝转移的胃癌患者生存率及评估手术获益的列线图的开发与验证
Development and validation of a nomogram to predict the survival and estimate surgical benefits for gastric cancer with liver metastasis receiving primary tumor resection.
作者信息
Su Rishun, Sun Xuezeng, Chen Songyao, Deng Guofei, Yin Songcheng, He Yulong, Hao Tengfei, Gu Liang, Zhang Changhua
机构信息
Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
出版信息
Front Oncol. 2024 Nov 8;14:1418548. doi: 10.3389/fonc.2024.1418548. eCollection 2024.
BACKGROUND
Surgical treatment has been widely controversial for gastric cancer accompanied by liver metastasis (GCLM). This paper aims to develop and validate a nomogram to predict the survival and estimate surgical benefits for GCLM patients.
METHODS
A total of 616 GCLM patients from the Surveillance, Epidemiology, and End Results Program (SEER) database and 74 GCLM patients receiving primary tumor resection (PTR) from the Chinese center were included in this study. Patients from the SEER database were divided into training set (with PTR) (n=493) and non-operative set (without PTR) (n=123). Patients undergoing PTR from China were included as external validation set. Independent risk factors associated with the overall survival of GCLM patients undergoing PTR were identified in the training set via log-rank test and Cox regression analysis. Afterwards, a comprehensive model and corresponding nomogram were constructed and validated by validation set.
RESULTS
The survival of patients undergoing PTR (n=493) was longer than that without PTR (n=123) (log-rank test, <0.0001) in SEER cohort. T stage (HR=1.40, 95% CI=1.14, 1.73), differentiation grade (HR=1.47, 95% CI=1.17, 1.85), non-hepatic metastases (HR=1.69, 95% CI=1.29, 2.21), and adjuvant therapy (HR=0.34, 95% CI= 0.28, 0.42) were closely related with the survival of GCLM with PTR, and thus, a four-factor nomogram was established. However, GCLM patients receiving PTR in the high-risk subgroup (n=255) screened out by the nomogram did not have better survival outcomes compared with patients without PTR (n=123) (log-rank test, =0.25).
CONCLUSIONS
The nomogram could predict survival of GCLM patients receiving PTR with acceptable accuracy. In addition, although PTR did improve the survival of whole GCLM patients, patients in the high-risk subgroup were unable to benefit from PTR, which could assist clinicians to make decisions for the treatment of GCLM.
背景
对于伴有肝转移的胃癌（GCLM），手术治疗一直存在广泛争议。本文旨在开发并验证一种列线图，以预测GCLM患者的生存率并评估手术获益。
方法
本研究纳入了来自监测、流行病学和最终结果计划（SEER）数据库的616例GCLM患者以及来自中国中心的74例接受原发性肿瘤切除术（PTR）的GCLM患者。来自SEER数据库的患者被分为训练集（接受PTR）（n = 493）和非手术组（未接受PTR）（n = 123）。来自中国接受PTR的患者作为外部验证集。通过对数秩检验和Cox回归分析在训练集中确定与接受PTR的GCLM患者总生存相关的独立危险因素。之后，构建综合模型及相应列线图，并通过验证集进行验证。
结果
在SEER队列中，接受PTR的患者（n = 493）的生存期长于未接受PTR的患者（n = 123）（对数秩检验，<0.0001）。T分期（HR = 1.40，95%CI = 1.14，1.73）、分化程度（HR = 1.47，95%CI = 1.17，1.85）、非肝转移（HR = 1.69，95%CI = 1.29，2.21）和辅助治疗（HR = 0.34，95%CI = 0.28，0.42）与接受PTR的GCLM患者的生存密切相关，因此，建立了一个四因素列线图。然而，通过列线图筛选出的高危亚组中接受PTR的GCLM患者与未接受PTR的患者（n = 123）相比，并未有更好 的生存结局（对数秩检验，= 0.25）。
结论
该列线图能够以可接受的准确性预测接受PTR的GCLM患者的生存情况。此外，尽管PTR确实改善了整个GCLM患者的生存，但高危亚组患者无法从PTR中获益，这有助于临床医生对GCLM的治疗做出决策。
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