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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Nomograms for pre- and postoperative prediction of long-term survival among proximal gastric cancer patients: A large-scale, single-center retrospective study
Qi-Yue Chen, Zhi-Liang Hong, Qing Zhong, Zhi-Yu Liu, Xiao-Bo Huang, Si-Jin Que, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chao-Hui Zheng, Chang-Ming Huang
Qi-Yue Chen, Zhi-Liang Hong, Qing Zhong, Zhi-Yu Liu, Xiao-Bo Huang, Si-Jin Que, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chao-Hui Zheng, Chang-Ming Huang, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Qi-Yue Chen, Zhi-Liang Hong, Qing Zhong, Zhi-Yu Liu, Xiao-Bo Huang, Si-Jin Que, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chao-Hui Zheng, Chang-Ming Huang, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Qi-Yue Chen, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chao-Hui Zheng, Chang-Ming Huang, Key Laboratory of the Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Qi-Yue Chen, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chao-Hui Zheng, Chang-Ming Huang, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province, No. 2016Y9031; the General Project of Miaopu Scientific Research Fund of Fujian Medical University, No. 2015MP021; Youth Project of Fujian Provincial Health and Family Planning Commission, No. 2016-1-41; Fujian Province Medical Innovation Project, Chinese Physicians Association Young Physician Respiratory Research Fund, No. 2015-CXB-16; and Fujian Science and Technology Innovation Joint Fund Project, No. 2017Y9004.
Author contributions: Chen QY and Hong ZL conceived the study, analyzed the data, and drafted the manuscript; Huang CM, Lin JX, Zhong Q, and Zheng CH helped critically revise the manuscript for important intellectual content; and Liu ZY, Li P, Xie JW, Wang JB, Lu J, Cao LL, and Lin M helped collect the data and design the study.
Institutional review board statement: This study received local ethical approval from the Ethics Committee of Fujian Medical University Union Hospital. The ethical approval number is 2019KY059.
Informed consent statement: This study used administrative data that were unidentifiable. Informed consent was not applicable.
Conflict-of-interest statement: All authors have no conflicts of interest related to this article to declare.
Open-Access: 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/
Corresponding author: Chang-Ming Huang, MD, Professor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China.
hcmlr2002@163.com
Telephone: +86-591-83363366 Fax: +86-591-83320319
Received: March 17, 2019
Peer-review started: March 18, 2019
First decision: May 24, 2019
Revised: June 29, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: November 6, 2019
Processing time: 236 Days and 16.9 Hours
ARTICLE HIGHLIGHTS
Research background
Gastric cancer (GC) is the fourth most common malignant tumor worldwide and currently ranks second among the causes of cancer-related deaths. The biological behaviors of proximal GC and cancer in the lower portion of the stomach exhibit certain differences. Currently, although there has been great progress in the early diagnosis of and radical surgery and chemotherapy for proximal GC, the postoperative prognosis of patients with this type of cancer is still not ideal. Determining how to individualize treatment according to the characteristics of cancer patients and the features of the tumor is still a main problem in the treatment of proximal GC.
Research motivation
Searching for indicators that can effectively predict a poor prognosis in patients with GC may facilitate the formulation of an individualized treatment plan and thereby improve the prognosis of patients.
Research objectives
This study aimed to explore the postoperative prognosis of proximal GC patients and the related preoperative and postoperative factors and establish preoperative and postoperative nomogram prediction models based on the results.
Research methods
Between January 2007 and June 2013, we prospectively collected and retrospectively analyzed the medical records of 746 patients with proximal GC, who were divided into a training set (n = 560, 75%) and a validation set (n = 186, 25%). A Cox regression analysis was used to identify the preoperative and postoperative risk factors for overall survival (OS).
Research results
Among the 746 patients examined, the 3- and 5-year OS rates were 66.1% and 58.4%, respectively. In the training set, preoperative T stage (cT), N stage (cN), CA19-9, tumor size, ASA core, and 3- to 6-mo weight loss were incorporated into the preoperative nomogram for the prediction of OS. In addition to these variables, LVI, postoperative tumor size, T stage, N stage, blood transfusions, and complications were incorporated into the postoperative nomogram. All calibration curves for the OS probability fit well. In the training set, the preoperative nomogram achieved a C-index of 0.751 [95% confidence interval (CI): 0.732-0.770] in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 86.8%, 73.0%, 43.72%, and 20.9%, P < 0.001). The postoperative nomogram had a C-index of 0.758 in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 82.6%, 74.3%, 45.9%, and 18.9%, P < 0.001).
Research conclusions
The nomograms accurately predict the pre- and postoperative long-term survival of proximal GC patients.
Research perspectives
This is a retrospective study only involving participants from Eastern countries. Compared with Western countries, the incidence of GC in Eastern countries is high, and there are more advanced GC patients. The biological characteristics of GC may differ between Eastern and Western countries. Therefore, we hope that the predictive model will be further validated and improved through a single-center RCT trial or even a multi-center prospective trial.
