Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 396-408
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.396
Development of a clinical nomogram for prediction of response to neoadjuvant chemotherapy in patients with advanced gastric cancer
Bing Liu, Yu-Jie Xu, Feng-Ran Chu, Guang Sun, Guo-Dong Zhao, Sheng-Zhong Wang
Bing Liu, Yu-Jie Xu, Guang Sun, Guo-Dong Zhao, Sheng-Zhong Wang, Department of Gastrointestinal Surgery, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, Hainan Province, China
Feng-Ran Chu, Clinical College, Hainan Medical University, Haikou 571199, Hainan Province, China
Co-first authors: Bing Liu and Yu-Jie Xu.
Co-corresponding authors: Sheng-Zhong Wang and Guo-Dong Zhao.
Author contributions: Liu B and Xu YJ contributed to paper writing and data analysis; Chu FR revised the manuscript; Sun G contributed to data collection; Wang SZ and Zhao GD contributed to supervision and paper revision; Liu B was in charge of proposing the research ideas, setting the overall research objectives, preparing, creating, and describing the works to be published, and writing the first draft; Xu YJ was responsible for verifying the paper data, writing computer code and supporting algorithms, testing the existing code components, creating models, and proposing improvements of the paper design and for statistical analysis; Wang SZ supervised and led the planning and execution of research activities, the revision of manuscript content, especially the critical commentary and revision, and the polishing of manuscript language; Zhao GD improved the design of the paper, checked the authenticity of the data, verified the overall reusability of the conclusions, experiments, and other contents of the research results, and provided financial support for the publication project. Considering the significant contributions made by Liu B, Xu YJ, Wang SZ, and Zhao GD to this paper, all authors unanimously agreed to designate Liu B and Xu YJ as the co-first authors and Wang SZ and Zhao GD as the co-corresponding authors.
Supported by Natural Science Foundation of Hainan Province, No. 823RC609.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Central South University Xiangya School of Medicine Affiliated Haikou Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Data sharing statement: The data that support the results of this research is available on request from the corresponding author. Considering privacy or ethical restrictions, the data is not publicly 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: Sheng-Zhong Wang, Doctor, Additional Professor, Department of Gastrointestinal Surgery, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No. 43 Renmin Avenue, Meilan District, Haikou 570208, Hainan Province, China. shengzhong323@163.com
Received: August 25, 2023
Peer-review started: August 25, 2023
First decision: September 29, 2023
Revised: November 5, 2023
Accepted: January 19, 2024
Article in press: January 19, 2024
Published online: February 27, 2024
Processing time: 184 Days and 12.1 Hours
ARTICLE HIGHLIGHTS
Research background

Neoadjuvant chemotherapy (NAC) has an unclear therapeutic effect on advanced gastric cancer (GC).

Research motivation

This work focused on identifying factors related to chemosensitivity to NAC treatment to be able to offer the best treatments for GC patients receiving NAC.

Research objectives

To find factors associated with chemosensitivity to NAC treatment and to provide the optimal therapeutic strategies for GC patients receiving NAC.

Research methods

Predicting factors were identified by least absolute shrinkage and selection operator logistic regression. Additionally, a nomogram model was employed to predict the response to NAC.

Research results

We enrolled 230 patients, consisting of 154 males (67.0%) and 76 females (33.0%). These patients were aged 24-80 years (average, 59.37 ± 10.60). According to the TRG standard, 95 patients were assigned into the obvious response group (grades 0-1) and 135 into the poor response group (grades 2-3), yielding an obvious response rate of 41.3%. As revealed by the least absolute shrinkage and selection operator regression, tumor location (P < 0.001), histological differentiation (P = 0.001), clinical T stage (P = 0.008), and carbohydrate antigen 724 (P = 0.008) were significant risk factors for NAC efficacy. The C-index of the prediction nomogram was 0.806. According to calibration curve analysis, the predicted value was highly consistent with real measurement. Moreover, decision curve analysis revealed the high application value of this nomogram clinically.

Research conclusions

Our nomogram combining tumor location, histological differentiation, clinical T stage, and carbohydrate antigen 724 showed a high performance in predicting NAC response, which can be applied in identifying the best therapeutic strategies for advanced GC patients by gastrointestinal surgeons.

Research perspectives

Candidate predictive factors were identified by the least absolute shrinkage and selection operator logistic regression. The response to NAC was predicted by a nomogram model.