背景:肝转移(LM)是导致胃癌(GC)患者预后不良的主要因素。这项研究的目的是分析GCLM患者的重要预后风险因素,并建立可靠的列线图模型,可以准确预测个体化预后。从而增强评估患者预后的能力。
目的:分析GCLM的预后危险因素,建立可靠的列线图模型,准确预测个体化预后,从而增强患者预后评估。
方法:对与GCLM(III型)有关的临床数据进行回顾性分析,2010年1月至2018年1月入住解放军总医院多个中心的普外科。数据集以2:1的比例分为开发队列和验证队列。在发展队列中,我们利用单变量和多变量Cox回归分析来确定与GCLM患者总生存期相关的独立危险因素.随后,我们基于这些发现建立了预测模型,并使用接收器操作员特征曲线分析评估了其性能,校正曲线,和临床决策曲线。创建了一个列线图来直观地表示预测模型,然后使用验证队列进行外部验证。
结果:本研究共纳入372例患者,包括发展队列中的248名个体和验证队列中的124名个体。根据Cox分析结果,我们的最终预测模型包含五个独立的危险因素,包括白蛋白水平,原发肿瘤大小,肝外转移的存在,手术治疗现状,和化疗。1-,3-,和5年的“曲线下面积”值在发展队列中分别为0.753、0.859和0.909;而在验证队列中,它们分别为0.772、0.848和0.923。此外,校正曲线显示观测值与实际值之间具有优异的一致性.最后,决策曲线分析曲线显示临床净获益显著.
结论:我们的研究确定了GCLM的重要预后风险因素,并建立了可靠的列线图模型,在评估患者预后时显示出有希望的预测准确性和潜在的临床益处。
BACKGROUND: Liver metastases (LM) is the primary factor contributing to unfavorable outcomes in patients diagnosed with gastric cancer (GC). The objective of this study is to analyze significant prognostic risk factors for patients with GCLM and develop a reliable nomogram model that can accurately predict individualized prognosis, thereby enhancing the ability to evaluate patient outcomes.
OBJECTIVE: To analyze prognostic risk factors for GCLM and develop a reliable nomogram model to accurately predict individualized prognosis, thereby enhancing patient outcome assessment.
METHODS: Retrospective analysis was conducted on clinical data pertaining to GCLM (type III), admitted to the Department of General Surgery across multiple centers of the Chinese PLA General Hospital from January 2010 to January 2018. The dataset was divided into a development cohort and validation cohort in a ratio of 2:1. In the development cohort, we utilized univariate and multivariate Cox regression analyses to identify independent risk factors associated with overall survival in GCLM patients. Subsequently, we established a prediction model based on these findings and evaluated its performance using receiver operator characteristic curve analysis, calibration curves, and clinical decision curves. A nomogram was created to visually represent the prediction model, which was then externally validated using the validation cohort.
RESULTS: A total of 372 patients were included in this study, comprising 248 individuals in the development cohort and 124 individuals in the validation cohort. Based on Cox analysis results, our final prediction model incorporated five independent risk factors including albumin levels, primary tumor size, presence of extrahepatic metastases, surgical treatment status, and chemotherapy administration. The 1-, 3-, and 5-years Area Under the Curve values in the development cohort are 0.753, 0.859, and 0.909, respectively; whereas in the validation cohort, they are observed to be 0.772, 0.848, and 0.923. Furthermore, the calibration curves demonstrated excellent consistency between observed values and actual values. Finally, the decision curve analysis curve indicated substantial net clinical benefit.
CONCLUSIONS: Our study identified significant prognostic risk factors for GCLM and developed a reliable nomogram model, demonstrating promising predictive accuracy and potential clinical benefit in evaluating patient outcomes.