■由于生存率的提高,早期胃癌患者发生多原发恶性肿瘤(MPM)的风险增加。这项研究的目的是评估MPM的临床病理特征,并为预测早期胃癌后MPM的发展提供有用的工具。
■我们选择了1025例具有完整病历的早期胃癌患者进行回顾性分析。采用Cox比例风险回归模型分析早期胃癌发生MPM的独立危险因素。用RStudio软件比较有和无MPM的早期胃癌患者的OS,并建立了一个列线图来预测MPM1-的概率,2-,早期胃癌后3年。通过C指数和校准曲线评估列线图的预测有效性。决策曲线分析(DCA)测量了列线图对临床实践的适用性。
■在1025例早期胃癌患者中,66例患者(6.4%)有69例除早期胃癌以外的原发癌。他们的中位随访时间为41个月,他们的MPM累积发生率为4.9%,1-后5.4%和5.9%,2-,和3年,分别。食管癌是最常见的MPM,其次是肺癌和结肠直肠癌。男性(p=0.038),年龄≥65岁(p=0.003),吸烟史(p=0.036),淋巴结转移(p=0.013)是早期胃癌患者发生MPM的独立危险因素。合并MPM的早期胃癌患者的OS预后比没有MPM的早期胃癌患者差(p<0.001)。内部验证的列线图预测了早期胃癌后发生MPM的可能性(C指数=0.697)。校准图显示,早期胃癌中MPM的预测概率与观察结果相似,DCA具有较强的临床实用性。
■早期胃癌的诊断和治疗后,我们应该警惕MPM的可能性,并进行定期和仔细的监测。
UNASSIGNED: Patients with early gastric cancer have increased risk of developing multiple primary malignancies (MPM) due to improved survival rates. The purpose of this study was to evaluate the clinicopathological features of MPM and to generate a useful tool for predicting the development of MPM after early gastric cancer.
UNASSIGNED: We selected 1025 early gastric cancer patients with complete medical records for a retrospective analysis. The Cox proportional risk regression model was used to analyze the independent risk factors for the development of MPM in early gastric cancer. RStudio software was used to compare the OS of early gastric cancer patients with and without MPM, and a nomogram was established to predict the probability of MPM 1-, 2-, 3-year after early gastric cancer. The predictive effectiveness of the nomogram was evaluated by the C-index and calibration curve. Decision curve analysis (DCA) measured the applicability of the nomogram to clinical practice.
UNASSIGNED: Of the 1025 patients with early gastric cancer, 66 patients (6.4%) had 69 primary cancers other than early gastric cancer. They had a median follow-up of 41 months, and their cumulative incidence of MPM was 4.9%, 5.4% and 5.9% after 1-, 2-, and 3- year, respectively. Oesophageal cancer was the most frequently detected MPM, followed by lung and colorectal cancers. Male (p=0.038), age ≥65 years (p=0.003), smoking history (p=0.036), and lymph node metastasis (p=0.013) were independent risk factors for MPM in patients with early gastric cancer. Patients with early gastric cancer with MPM had a worse OS prognosis than patients with early gastric cancer without MPM (p<0.001). The internally validated nomogram predicted the probability of developing MPM after early gastric cancer (C index= 0.697). The calibration chart showed that the predicted probability of MPM in early gastric cancer was similar to the observed result, and the DCA showed strong clinical practicability.
UNASSIGNED: After the diagnosis and treatment of early gastric cancer, we should be alert to the possibility of MPM and perform regular and careful monitoring.