■构建有效的预后指标,以预测接受铂类和氟尿嘧啶类化疗的晚期胃癌(AGC)患者的总生存期(OS)和三联方案疗效。
■在2011年至2021年之间,纳入了来自两项随机III期试验和一项II期试验的679名患者。
■我们收集了11个基线临床病理参数和14个血液学参数以建立预后指标。
■单变量和多变量Cox分析用于筛选预后因素,并进行了预后指标列线图。
■确定了七个预后因素:非近端胃区域的原发肿瘤部位,印戒细胞癌(SRCC)/粘液性癌,腹膜转移,中性粒细胞计数高于正常值上限(ULN),淋巴细胞计数低于正常值的下限,乳酸脱氢酶水平高于ULN,碱性磷酸酶水平高于ULN对预后有重要意义。构建预后列线图,命名为复旦晚期胃癌预后风险评分(FARS)指数,高危组患者的OS明显短于低危组患者(中位OS,15.5与8.0个月,p<0.001)。FARS指数曲线下的面积为1-,2-,3年OS分别为0.70、0.72和0.77。验证和外部队列验证了FARS指数的预后价值。此外,确定了三个三联方案的疗效参数:SRCC/黏液腺癌,原发肿瘤位于非近端胃区,和外周中性粒细胞计数高于ULN;随后进行了TRIS指数。在具有三个参数中的任何两个的患者中,三联方案的OS明显长于双联方案(p=0.018).
■构建的预测AGC患者OS的FARS指数和筛选三联疗法优势人群的TRIS指数可用于辅助临床决策和个体风险分层。
局部晚期和转移性胃癌的预后指标迄今为止,尚未建立晚期胃癌(AGC)公认的系统预后评分.我们的研究旨在构建一个有效的预后指标来预测AGC患者的总生存期(OS),以帮助临床决策和个人风险分层。在我们的研究中,确定了七个预后因素:非近端胃区域的原发肿瘤部位,印戒细胞癌(SRCC)/粘液性癌,腹膜转移,中性粒细胞计数高于正常值上限(ULN),淋巴细胞计数低于正常值的下限,乳酸脱氢酶水平高于ULN,碱性磷酸酶水平高于ULN对预后有重要意义。构建了一个名为复旦晚期胃癌预后风险评分(FARS)指数的预后指标,高危组患者的OS明显短于低危组患者(中位OS,15.5个月vs.8.0个月,P<0.001)。此外,确定了三个三联方案的疗效参数:SRCC/黏液腺癌,原发肿瘤位于非近端胃区,和外周中性粒细胞计数高于ULN;随后进行了TRIS指数。在具有三个参数中的任何两个的患者中,三联方案的OS明显长于双联方案(P=0.018).
UNASSIGNED: To construct an effective prognostic index to predict overall survival (OS) and triplet regimen efficacy for advanced gastric cancer (AGC) patients treated with platinum-based and fluorouracil-based chemotherapy.
UNASSIGNED: Between 2011 and 2021, 679 patients from two randomized phase III trials and one phase II trial were enrolled.
UNASSIGNED: We collected 11 baseline clinicopathological and 14 hematological parameters to establish a prognostic index.
UNASSIGNED: Univariate and multivariate Cox analyses were used to screen prognostic factors, and a prognostic index nomogram was conducted.
UNASSIGNED: Seven prognostic factors were identified: primary tumor site in the non-proximal gastric area, signet-ring cell carcinoma (SRCC)/mucinous carcinoma, peritoneal metastasis, neutrophil count higher than the upper limit of normal value (ULN), lymphocyte count lower than the lower limit of normal value, lactate dehydrogenase level higher than the ULN, and alkaline phosphatase level higher than the ULN as significant for prognosis. A prognostic nomogram named the Fudan advanced gastric cancer prognostic risk score (FARS) index was constructed, and patients in the high-risk group had significantly shorter OS than those in the low-risk group (median OS, 15.5 versus 8.0 months, p < 0.001). The areas under the curve of the FARS index for 1-, 2-, and 3-year OS were 0.70, 0.72, and 0.77, respectively. A validation and external cohort verified the prognostic value of the FARS index. Moreover, three triplet regimen efficacy parameters were identified: SRCC/mucinous adenocarcinoma, primary tumor location in the non-proximal gastric area, and peripheral neutrophil count higher than the ULN; a TRIS index was subsequently conducted. In patients with any two of the three parameters, the triplet regimen showed significantly longer OS than the doublet regimen (p = 0.018).
UNASSIGNED: The constructed FARS index to predict the OS of AGC patients and the TRIS index to screen out the dominant population for triplet regimens can be used to aid clinical decision-making and individual risk stratification.
A prognostic index in locally advanced and metastatic gastric cancer To date, no recognized systematic prognostic score has been established for advanced gastric cancer (AGC). Our research aims to construct an effective prognostic index to predict overall survival (OS) for AGC patients to aid clinical decision-making and individual risk stratification. In our research, seven prognostic factors were identified: primary tumor site in the non-proximal gastric area, signet-ring cell carcinoma (SRCC)/mucinous carcinoma, peritoneal metastasis, neutrophil count higher than the upper limit of normal value (ULN), lymphocyte count lower than the lower limit of normal value, lactate dehydrogenase level higher than the ULN, and alkaline phosphatase level higher than the ULN as significant for prognosis. A prognostic index named the Fudan advanced gastric cancer prognostic risk score (FARS) index was constructed, and patients in the high-risk group had significantly shorter OS than those in low-risk group (median OS, 15.5 months vs. 8.0 months, P < 0.001). Moreover, three triplet regimen efficacy parameters were identified: SRCC/mucinous adenocarcinoma, primary tumor location in the non-proximal gastric area, and peripheral neutrophil count higher than the ULN; a TRIS index was subsequently conducted. In patients with any two of the three parameters, the triplet regimen showed significantly longer OS than the doublet regimen (P = 0.018).