PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: The nomogram model is an effective support tool to predict OS in GC patients undergoing perioperative chemotherapy followed by radical surgery.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: The nomogram model is an effective support tool to predict OS in GC patients undergoing perioperative chemotherapy followed by radical surgery.
摘要：
■局部进展期胃癌(GC)患者的预后因素复杂多变。这项研究旨在为接受新辅助化疗和根治性手术的局部晚期GC患者提供一种新的生存预后模型。
■本研究纳入中山医院新辅助化疗的局部晚期GC患者，复旦大学。根据通过多变量Cox回归模型确定的独立预后因素建立列线图。在校准方面，在训练和独立的外部队列中评估了模型性能，歧视,和临床有用性。
■总共273名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和61.2个月，分别。列线图显示，劳伦型对预后的贡献最大，其次是ypN。预后列线图具有良好的辨别能力，C指数为0.689[95%置信区间（CI）：0.661-0.716]，受试者工作特征（ROC）曲线下面积（AUC）为0.778、0.746和0.725，3-5年和10年操作系统，分别。在外部验证队列中获得了类似的结果。根据列线图，整个队列分为高危组和低危组.风险组分类与临床特征显著相关，并产生3-的AUC值为0.781、0.748和0.727，5年和10年操作系统，分别。此外，与肿瘤淋巴结转移（TNM）分期系统（第8版）相比，日本标准,和德国标准，决策曲线分析(DCA)图形表明，新模型在预测3-，5-,和GC患者的10年OS。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接受根治性手术的GC患者OS的有效支持工具。
■本研究纳入中山医院新辅助化疗的局部晚期GC患者，复旦大学。根据通过多变量Cox回归模型确定的独立预后因素建立列线图。在校准方面，在训练和独立的外部队列中评估了模型性能，歧视,和临床有用性。
■总共273名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和61.2个月，分别。列线图显示，劳伦型对预后的贡献最大，其次是ypN。预后列线图具有良好的辨别能力，C指数为0.689[95%置信区间（CI）：0.661-0.716]，受试者工作特征（ROC）曲线下面积（AUC）为0.778、0.746和0.725，3-5年和10年操作系统，分别。在外部验证队列中获得了类似的结果。根据列线图，整个队列分为高危组和低危组.风险组分类与临床特征显著相关，并产生3-的AUC值为0.781、0.748和0.727，5年和10年操作系统，分别。此外，与肿瘤淋巴结转移（TNM）分期系统（第8版）相比，日本标准,和德国标准，决策曲线分析(DCA)图形表明，新模型在预测3-，5-,和GC患者的10年OS。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接受根治性手术的GC患者OS的有效支持工具。
