Zhang BL, Peng F, Li L, Gao YH, Wang ZJ, Lu YX, Chen L, Zhang KC. Construction and validation of a novel prognostic nomogram for patients with poorly differentiated gastric neuroendocrine neoplasms. World J Clin Oncol 2025; 16(4): 102565 [DOI: 10.5306/wjco.v16.i4.102565]
Corresponding Author of This Article
Ke-Cheng Zhang, PhD, Professor, Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. zhangkecheng@301hospital.com.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Apr 24, 2025; 16(4): 102565 Published online Apr 24, 2025. doi: 10.5306/wjco.v16.i4.102565
Construction and validation of a novel prognostic nomogram for patients with poorly differentiated gastric neuroendocrine neoplasms
Ben-Long Zhang, Fei Peng, Li Li, Yun-He Gao, Zi-Jian Wang, Yi-Xun Lu, Lin Chen, Ke-Cheng Zhang
Ben-Long Zhang, Department of Breast and Thyroid Surgery, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou 570208, Hainan Province, China
Fei Peng, Department of Gastrointestinal Surgery, Zhongxian People’s Hospital of Chongqing, Chongqing 400000, China
Li Li, Yun-He Gao, Zi-Jian Wang, Lin Chen, Ke-Cheng Zhang, Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Yi-Xun Lu, Department of Anesthesiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Co-first authors: Ben-Long Zhang and Fei Peng.
Author contributions: Zhang BL, Peng F, and Li L reviewed the literature, collected data, analyzed data, and drafted the manuscript; Zhang BL and Peng F they contributed equally to this article, they are the co-first authors of this manuscript; Zhang KC and Chen L conceived and designed the study and finalized manuscript; Gao YH, Wang ZJ, and Lu YX revised the manuscript; and all authors made significant contributions to this paper and approved the submitted version.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Chinese PLA General Hospital, approval No. S2022-137-01.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data involved in this study can be obtained from the corresponding author.
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: Ke-Cheng Zhang, PhD, Professor, Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. zhangkecheng@301hospital.com.cn
Received: October 22, 2024 Revised: January 3, 2025 Accepted: January 17, 2025 Published online: April 24, 2025 Processing time: 155 Days and 10 Hours
Abstract
BACKGROUND
The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms (PDGNENs) is dismal and related research is limited.
AIM
To investigate the prognostic factors, and validate a novel prognostic nomogram for PDGNEN patients.
METHODS
We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023. Overall survival (OS) differences were assessed with the Log-rank test and Kaplan-Meier survival curves. Cox regression analysis identified independent risk factors for prognosis. Model performance was evaluated using Harrell’s concordance index, receiver operating characteristic analysis, area under the curve, calibration curves, and decision curve analysis (UDC), including the area under the UDC.
RESULTS
The study included 336 patients (227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma). The average age was 62.7 years. The cohort comprised 80 (24.7%) patients in stage I, 146 (42.9%) in stage II, 62 (18.1%) in stage III, and 48 (14.3%) in stage IV. Significant differences in OS were observed across tumor-node-metastasis stages (P < 0.001). Multivariate analysis showed age, Ki-67 index, invasion depth, lymph node metastasis, distant metastasis, and platelet-to-lymphocyte ratio as independent risk factors. We developed a nomogram with a concordance index of 0.779 (95% confidence interval: 0.743-0.858). Receiver operating characteristic analysis showed area under the curves for 1-year, 3-year, and 5-year OS predictions of 0.865, 0.850, and 0.890, respectively. The calibration curve demonstrated good agreement with actual outcomes. The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027, 0.291 vs 0.179, and 0.376 vs 0.216 for 1-year, 3-year, and 5-year OS, respectively.
CONCLUSION
PDGNENs are predominantly found in older men, often in advanced stages at diagnosis, resulting in poor prognosis. The established nomogram demonstrates strong predictive capability and clinical utility.
Core Tip: This single-center retrospective study investigates the clinicopathological characteristics of patients with poorly differentiated gastric neuroendocrine neoplasms and develops a prognostic prediction model. A total of 336 patients were included, making it the largest single-center cohort globally. Key findings indicate that platelet-to-lymphocyte ratio, age, Ki-67 index, invasion depth, lymph node metastasis, and distant metastasis are independent risk factors for survival. The nomogram prediction model demonstrated superior predictive accuracy and clinical usefulness compared to the tumor-node-metastasis staging system.
