Background:Few studies have shown nomograms that may predict disease-specific survival(DSS)probability after curative D2 gastrectomy for advanced gastric cancer(AGC),particularly among Chinese patients.This study soug...Background:Few studies have shown nomograms that may predict disease-specific survival(DSS)probability after curative D2 gastrectomy for advanced gastric cancer(AGC),particularly among Chinese patients.This study sought to develop an elaborative nomogram that predicts long-term DSS for AGC in Chinese patients.Methods:A retrospective study was conducted on 6753 AGC patients undergoing D2 gastrectomy between January 1,2000 and December 31,2012 from three large medical hospitals in China.We assigned patients from Sun Yat-sen University Cancer Center to the training set,and patients from the First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital to two separate external validation sets.A multivariate survival analysis was performed using Cox proportional hazards regression model in a training set,and a nomogram was constructed.Harrell’s C-index was used to evaluate discrimination and calibration plots were used to validate similarities between survival probabilities predicted by the nomogram model and actual survival rates in two validation sets.Results:The multivariate Cox regression model identified age,tumor size,location,Lauren classification,lymphatic/venous invasion,depth of invasion,and metastatic lymph node ratio as covariates associated with survival.In the training set,the nomogram exhibited superior discrimination power compared with the 8th American Joint Com-mittee on Cancer TNM classification(Harrell’s C-index,0.82 vs.0.74;P<0.001).In two validation sets,the nomogram’s discrimination power was also excellent relative to TNM classification(C-index,0.83 vs.0.75 and 0.81 vs.0.74,respec-tively;P<0.001 for both).After calibration,the nomogram produced survival predictions that corresponded closely with actual survival rate.Conclusions:The established nomogram was able to predict 3-,5-,and 10-year DSS probabilities for AGC patients.Validation revealed that this nomogram exhibited excellent discrimination and calibration capacity,suggesting its clinical utility.展开更多
文摘背景与目的目前鲜有文献报道接受D2根治性切除术的进展期胃癌(advanced gastric cancer,AGC)患者的疾病特异性生存(disease?specific survival,DSS)预测系统,尤其针对中国胃癌患者。本研究拟构建一种精准预测中国进展期胃癌患者预后的列线图(Nomogram)模型。方法回顾性纳入2000年1月1日至2012年12月31日间在中国三家大型医院接受D2胃切除术的6753例AGC患者。中山大学肿瘤防治中心患者作为训练集,中国医科大学附属第一医院和天津医科大学肿瘤医院患者作为两个独立的外部验证集。在训练集中采用Cox比例风险回归模型进行多因素生存分析,并构建Nomogram模型,在验证集中通过Harrell’s C-index和校准曲线评价该模型的准确性、实际生存情况和模型预测的一致性。结果 Cox回归模型显示年龄、肿瘤大小、部位、Lauren分型、淋巴管/血管浸润、肿瘤浸润深度和淋巴结转移率为患者预后相关因素。在训练集中,Nomogram模型的预测准确度较美国癌症研究联合会(American Joint Committee on Cancer,AJCC)TNM癌症分期系统(第8版)更高(C-index,0.82 vs. 0.74,P <0.001)。在两个验证集中,亦出现类似的结果(C-index分别为0.83 vs. 0.75和0.81 vs. 0.74;两者均P <0.001)。校准曲线显示Nomogram模型预测的患者生存与和实际生存高度接近。结论本研究构建的Nomogram模型能够预测AGC患者的3年、 5年和10年疾病特异性生存,经外部验证显示其具有较高的准确性和区分效能,预示潜在的临床应用前景。
基金supported by the Natural Science Foundation of Guangdong Province(No.2015A030313089)the Major Program of Collaborative Innovation of Guangzhou(No.201508030042).
文摘Background:Few studies have shown nomograms that may predict disease-specific survival(DSS)probability after curative D2 gastrectomy for advanced gastric cancer(AGC),particularly among Chinese patients.This study sought to develop an elaborative nomogram that predicts long-term DSS for AGC in Chinese patients.Methods:A retrospective study was conducted on 6753 AGC patients undergoing D2 gastrectomy between January 1,2000 and December 31,2012 from three large medical hospitals in China.We assigned patients from Sun Yat-sen University Cancer Center to the training set,and patients from the First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital to two separate external validation sets.A multivariate survival analysis was performed using Cox proportional hazards regression model in a training set,and a nomogram was constructed.Harrell’s C-index was used to evaluate discrimination and calibration plots were used to validate similarities between survival probabilities predicted by the nomogram model and actual survival rates in two validation sets.Results:The multivariate Cox regression model identified age,tumor size,location,Lauren classification,lymphatic/venous invasion,depth of invasion,and metastatic lymph node ratio as covariates associated with survival.In the training set,the nomogram exhibited superior discrimination power compared with the 8th American Joint Com-mittee on Cancer TNM classification(Harrell’s C-index,0.82 vs.0.74;P<0.001).In two validation sets,the nomogram’s discrimination power was also excellent relative to TNM classification(C-index,0.83 vs.0.75 and 0.81 vs.0.74,respec-tively;P<0.001 for both).After calibration,the nomogram produced survival predictions that corresponded closely with actual survival rate.Conclusions:The established nomogram was able to predict 3-,5-,and 10-year DSS probabilities for AGC patients.Validation revealed that this nomogram exhibited excellent discrimination and calibration capacity,suggesting its clinical utility.
