Zhang Ben-Long, Peng Fei, Li Li, Gao Yun-He, Wang Zi-Jian, Lu Yi-Xun, Chen Lin, Zhang Ke-Cheng
Department of Breast and Thyroid Surgery, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou 570208, Hainan Province, China.
Department of Gastrointestinal Surgery, Zhongxian People's Hospital of Chongqing, Chongqing 400000, China.
World J Clin Oncol. 2025 Apr 24;16(4):102565. doi: 10.5306/wjco.v16.i4.102565.
The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms (PDGNENs) is dismal and related research is limited.
To investigate the prognostic factors, and validate a novel prognostic nomogram for PDGNEN patients.
We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023. Overall survival (OS) differences were assessed with the Log-rank test and Kaplan-Meier survival curves. Cox regression analysis identified independent risk factors for prognosis. Model performance was evaluated using Harrell's concordance index, receiver operating characteristic analysis, area under the curve, calibration curves, and decision curve analysis (UDC), including the area under the UDC.
The study included 336 patients (227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma). The average age was 62.7 years. The cohort comprised 80 (24.7%) patients in stage I, 146 (42.9%) in stage II, 62 (18.1%) in stage III, and 48 (14.3%) in stage IV. Significant differences in OS were observed across tumor-node-metastasis stages ( < 0.001). Multivariate analysis showed age, Ki-67 index, invasion depth, lymph node metastasis, distant metastasis, and platelet-to-lymphocyte ratio as independent risk factors. We developed a nomogram with a concordance index of 0.779 (95% confidence interval: 0.743-0.858). Receiver operating characteristic analysis showed area under the curves for 1-year, 3-year, and 5-year OS predictions of 0.865, 0.850, and 0.890, respectively. The calibration curve demonstrated good agreement with actual outcomes. The area under the UDC for the nomogram the 8 American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 0.027, 0.291 0.179, and 0.376 0.216 for 1-year, 3-year, and 5-year OS, respectively.
PDGNENs are predominantly found in older men, often in advanced stages at diagnosis, resulting in poor prognosis. The established nomogram demonstrates strong predictive capability and clinical utility.
低分化胃神经内分泌肿瘤（PDGNENs）患者的预后较差，相关研究有限。
探讨PDGNEN患者的预后因素，并验证一种新的预后列线图。
我们进行了一项回顾性研究，使用2000年1月至2023年6月在中国人民解放军总医院第一医学中心接受治疗的PDGNEN患者的临床和病理数据。采用对数秩检验和Kaplan-Meier生存曲线评估总生存期（OS）差异。Cox回归分析确定预后的独立危险因素。使用Harrell一致性指数、受试者工作特征分析、曲线下面积、校准曲线和决策曲线分析（UDC）评估模型性能，包括UDC曲线下面积。
该研究纳入336例患者（227例神经内分泌癌和109例混合性腺神经内分泌癌）。平均年龄为62.7岁。该队列包括80例（24.7%）I期患者、146例（42.9%）II期患者、62例（18.1%）III期患者和48例（14.3%）IV期患者。在肿瘤-淋巴结-转移分期中观察到OS有显著差异（<0.001）。多因素分析显示年龄、Ki-67指数、浸润深度、淋巴结转移、远处转移和血小板与淋巴细胞比值为独立危险因素。我们开发了一个一致性指数为0.779（95%置信区间：0.743-0.858）的列线图。受试者工作特征分析显示，1年、3年和5年OS预测的曲线下面积分别为0.865、0.850和0.890。校准曲线显示与实际结果具有良好的一致性。该列线图、美国癌症联合委员会第8版肿瘤-淋巴结-转移分期系统在1年、3年和5年OS时的UDC曲线下面积分别为0.047±0.027、0.291±0.179和0.376±0.216。
PDGNENs主要见于老年男性，诊断时多为晚期，预后较差。所建立的列线图显示出强大的预测能力和临床实用性。
