Wang Lei, Ge Jingjing, Fang Yihua, Han Huiqiong, Qin Yanru
Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
BMC Gastroenterol. 2025 Apr 2;25(1):215. doi: 10.1186/s12876-025-03813-2.
We aimed to evaluate the efficacy of the log odds of positive lymph nodes (LODDS) in survival prediction of elderly patients with gastric adenocarcinoma (GAC) after gastrectomy, and to construct a relevant survival prediction model.
In this study, patient data was collected from both the Surveillance, Epidemiology, and End Results (SEER) database and a medical records database at a hospital in China. Least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox analysis were used to identify independent risk factors for cancer-specific survival (CSS) and a nomogram was constructed based on the results of multivariate Cox regression. Using consistency index (C-index), calibration curve, time-dependent receiver operating characteristic curve (tdROC) and decision curve analysis (DCA) to evaluate the predictive performance of nomogram. Generating Kaplan-Meier survival curves to show the difference in CSS between different groups.
Multivariate Cox analysis indicated that race, site, T stage, size, and LODDS were independently associated with the CSS. The C-index and AUC of the nomogram both exceed 0.71, while the calibration curve suggests that the nomogram accurately predicts CSS. Additionally, DCA curve results demonstrate superior clinical net benefits of the nomogram over TNM staging. High-risk patients identified by the predictive model exhibit inferior survival outcomes compared to low-risk patients. In addition, group comparison showed that only high-risk patients or high-LODDS group could benefit from chemotherapy and radiotherapy.
The LODDS is an independent prognostic factor for elderly GAC patients after gastrectomy. The nomogram based on LODDS has better predictive ability than the traditional TNM staging system, assisting clinical doctors in evaluating patient prognosis and guiding treatment.
我们旨在评估阳性淋巴结对数优势比（LODDS）在老年胃腺癌（GAC）患者胃切除术后生存预测中的疗效，并构建相关的生存预测模型。
在本研究中，收集了来自监测、流行病学和最终结果（SEER）数据库以及中国一家医院的病历数据库中的患者数据。使用最小绝对收缩和选择算子（LASSO）回归和多变量Cox分析来确定癌症特异性生存（CSS）的独立危险因素，并基于多变量Cox回归结果构建列线图。使用一致性指数（C指数）、校准曲线、时间依赖性受试者工作特征曲线（tdROC）和决策曲线分析（DCA）来评估列线图的预测性能。生成Kaplan-Meier生存曲线以显示不同组之间CSS的差异。
多变量Cox分析表明，种族、部位、T分期、肿瘤大小和LODDS与CSS独立相关。列线图的C指数和AUC均超过0.71，而校准曲线表明列线图能准确预测CSS。此外，DCA曲线结果表明列线图在临床净效益方面优于TNM分期。与低风险患者相比，预测模型识别出的高风险患者生存结局较差。此外，组间比较显示，只有高风险患者或高LODDS组能从化疗和放疗中获益。
LODDS是老年GAC患者胃切除术后的独立预后因素。基于LODDS的列线图比传统的TNM分期系统具有更好的预测能力，有助于临床医生评估患者预后并指导治疗。
