Clinical and Translational Research
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1384-1420
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1384
Risk factors, prognostic factors, and nomograms for distant metastasis in patients with diagnosed duodenal cancer: A population-based study
Jia-Rong Shang, Chen-Yi Xu, Xiao-Xue Zhai, Zhe Xu, Jun Qian
Jia-Rong Shang, Chen-Yi Xu, Xiao-Xue Zhai, Jun Qian, Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
Chen-Yi Xu, Department of Proctology, Nanjing Hospital of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
Zhe Xu, Department of Digestive Cancer Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
Co-first authors: Jia-Rong Shang and Chen-Yi Xu.
Co-corresponding authors: Zhe Xu and Jun Qian.
Author contributions: Shang JR and Xu CY made equal contributions to this work. They both played significant roles in the research, including study design, data collection, data analysis and interpretation, and manuscript drafting. Zhai XX collected data; Xu Z and Qian J provided guidance and support throughout the research, assisted in data collection and analysis, and actively participated in manuscript revision and editing. All authors have read and approved the final manuscript. The reason for listing them as co-first authors is based on their equal and significant contributions to the research project. This is evident in the following aspects: Research design and planning: co-first authors Shang JR and Xu CY played equally important roles in the design and planning of the research project. They jointly formulated the research framework, defined the main objectives, and determined the research methods. Data collection and analysis: Both co-first authors actively participated in data collection, organization, and analysis. They collaborated in handling a substantial amount of experimental data and conducted statistical analyses to ensure the scientific reliability of the study. Data interpretation and presentation: Shang JR and Xu CY worked together to interpret the experimental results and jointly wrote sections of the research report related to data presentation. They ensured that the data was presented to the readers in a clear and accurate manner. Manuscript drafting: Both authors contributed equally to drafting the research manuscript. They shared responsibilities in writing different sections of the research, including the introduction, methodology, results, and discussion. In summary, Shang JR and Xu CY demonstrated equal intellectual contributions throughout the entire research project, including research design, data processing, result interpretation, and manuscript writing. Therefore, they are considered qualified co-first authors. This arrangement reflects their collaborative and equal contributions to the project, ensuring fair and just authorship recognition. Xu Z and Qian J are designated as co-corresponding authors based on their equal contributions to the conception, design, and execution of the research project, illustrating their shared responsibility in the development and implementation of the study. They collaborated closely in the acquisition, analysis, and interpretation of data, ensuring a comprehensive and rigorous evaluation of the results. Both authors actively participated in drafting and critically revising the manuscript, providing intellectual input, and approving the final version for submission. They jointly supervised the research, overseeing various aspects of the project to guarantee its integrity and accuracy. Their collaborative efforts and equal contributions underscore the significance of designating them as co-corresponding authors.
Supported by State Administration of Traditional Chinese Medicine Base Construction Stomach Cancer Special Fund, No. Y2020CX57; Jiangsu Provincial Graduate Research and Practical Innovation Program Project, No. SJCX23-0799.
Institutional review board statement: This study complied with the principles of the Declaration of Helsinki. Because all data were derived from a public database and individual information was anonymous, it was permitted to obtain the data from the SEER database. Ethical review and approval were waived for this study, due to the data being publicly available and anonymous.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhe Xu, MD, PhD, Chief Physician, Doctor, Surgeon, Surgical Oncologist, Department of Digestive Cancer Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Avenue, Qinhuai District, Nanjing 210000, Jiangsu Province, China. xi.88@163.com
Received: October 16, 2023
Peer-review started: October 16, 2023
First decision: December 19, 2023
Revised: December 24, 2023
Accepted: February 4, 2024
Article in press: February 4, 2024
Published online: April 15, 2024
Processing time: 177 Days and 11.7 Hours
Abstract
BACKGROUND

Duodenal cancer is one of the most common subtypes of small intestinal cancer, and distant metastasis (DM) in this type of cancer still leads to poor prognosis. Although nomograms have recently been used in tumor areas, no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.

AIM

To develop and evaluate nomograms for predicting the risk of DM and personalized prognosis in patients with duodenal cancer.

METHODS

Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer, and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM. Two novel nomograms were established, and the results were evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

RESULTS

A total of 2603 patients with duodenal cancer were included, of whom 457 cases (17.56%) had DM at the time of diagnosis. Logistic analysis revealed independent risk factors for DM in duodenal cancer patients, including gender, grade, tumor size, T stage, and N stage (P < 0.05). Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM, including age, histological type, T stage, tumor grade, tumor size, bone metastasis, chemotherapy, and surgery (P < 0.05). The accuracy of the nomograms was validated in the training set, validation set, and expanded testing set using ROC curves, calibration curves, and DCA curves. The results of Kaplan-Meier survival curves (P < 0.001) indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer.

CONCLUSION

The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM, potentially enhancing clinical decision-making.

Keywords: Duodenal cancer; Distant metastasis; Nomogram; Risk factors; Prognostic factors

Core Tip: Developed and evaluated were two new nomograms for predicting the risk of distant metastasis (DM) and providing personalized prognosis for patients with primary duodenal cancer. The study involved a total of 2603 duodenal cancer patients, among whom 457 (17.56%) had DM at the time of diagnosis. Independent risk factors for DM in duodenal cancer patients were identified. Additionally, independent prognostic factors for duodenal cancer patients with DM were determined. The results indicated that the nomograms accurately predicted the occurrence and prognosis of DM in duodenal cancer patients.