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. 2021 Apr 15;11(4):1463-1479.
eCollection 2021.

A population-based study: how to identify high-risk T1 gastric cancer patients?

Xueer Zheng  1 , Kaibo Guo  1 , Harpreet S Wasan  2 , Shanming Ruan  3
Affiliations

A population-based study: how to identify high-risk T1 gastric cancer patients?

Xueer Zheng et al. Am J Cancer Res. .

Abstract

In T1 gastric cancer (GC), lymph nodes metastasis (LNM) is considered as a significant prognostic predictor and closely associated with following therapeutic approaches as well as distant metastasis (DM). This study aimed to not only seek risk factors of LNM and DM but also unpack the prognosis in T1 GC patients. We performed a retrospective study enrolling 5547 patients in T1 GC from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression models were produced to recognize independent risk factors of LNM and DM. Cox regression analyses were performed to identify important prognostic factors of overall survival (OS). Cancer-specific cumulative incidence was plotted by cumulative incidence function. Three nomograms of LNM, DM and OS were established and validated by receiver operating characteristic (ROC) and calibration curves to evaluate discrimination and accuracy. Decision curve analysis (DCA), clinical impact curves (CIC) and subgroups based on risk scores were constructed to measure nomograms clinical utility. The area under the curve (AUC) of LNM nomogram and DM nomogram were 0.735 and 0.896, respectively. OS nomogram was constructed and the corresponding C-index was 0.797. In conclusion, our user-friendly nomograms, which aimed to predict LNM, DM and OS in T1 gastric cancer patients, have shown high efficiency of discrimination and accuracy. These useful and visual tools may have advantageous clinical utility to identify high-risk T1 gastric patients and help clinicians to draw up an individual therapeutic strategy.

Keywords: SEER; T1 gastric cancer; distant metastasis; lymph nodes metastasis; nomogram; prognosis.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Research flowchart.
Figure 2
Figure 2
Nomogram (A), receiver operating characteristic curve (B), the calibration curve (C), decision curve analysis (D), and the clinical impact curve (E) for forecasting LNM in T1N0-3M0 gastric cancer patients.
Figure 3
Figure 3
Nomogram (A), receiver operating characteristic curve (B), the calibration curve (C), decision curve analysis (D), and the clinical impact curve (E) for forecasting DM in T1NXM0-1 gastric cancer patients.
Figure 4
Figure 4
Impact of lymph nodes metastasis on overall survival (A) and cancer-specific survival (C) in T1 gastric cancer. Effect of distant metastasis on overall survival (B) and cancer-specific survival (D) in T1 gastric cancer.
Figure 5
Figure 5
Forest plot depicting the significance of multivariate Cox proportional hazard regression prognostic factors of OS in T1 gastric cancer.
Figure 6
Figure 6
Nomogram (A), the calibration curve (B-D) and decision curve analysis (E-G) for forecasting overall survival in T1 gastric cancer patients.
Figure 7
Figure 7
Stacked bar charts of clinical effect on LNM nomogram (A) and DM nomogram (B). Kaplan-Meier curve of clinical effect on OS nomogram (C).
See this image and copyright information in PMC

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