Analysis and external validation of a nomogram to predict peritoneal dissemination in gastric cancer.

Xijie Chen,Runcong Nie,Shi Chen,Yijia Lin,Junsheng Peng,Xinyou Wang,Dongwen Chen,Jun Xiang,Yingbo Chen

doi:10.21147/j.issn.1000-9604.2020.02.07

Abstract

ObjectivePeritoneal dissemination is difficult to diagnose by conventional imaging technologies. We aimed to construct a nomogram to predict peritoneal dissemination in gastric cancer (GC) patients.MethodsWe retrospectively analyzed 1,112 GC patients in Sun Yat-sen University Cancer Center between 2001 and 2010 as the development set and 474 patients from The Sixth Affiliated Hospital, Sun Yat-sen University between 2010 and 2016 as the validation set. The clinicopathological variables associated with gastric cancer with peritoneal dissemination (GCPD) were analyzed. We used logistic regression analysis to identify independent risk factors for peritoneal dissemination. Then, we constructed a nomogram for the prediction of GCPD and defined its predictive value with a receiver operating characteristic (ROC) curve. External validation was performed to validate the applicability of the nomogram.ResultsIn total, 250 patients were histologically identified as having peritoneal dissemination. Logistic regression analysis demonstrated that age, sex, tumor location, tumor size, signet-ring cell carcinoma (SRCC), T stage, N stage and Borrmann classification IV (Borrmann IV) were independent risk factors for peritoneal dissemination. We constructed a nomogram consisting of these eight factors to predict GCPD and found an optimistic predictive capability, with a C-index of 0.791, an area under the curve (AUC) of 0.791, and a 95% confidence interval (95% CI) of 0.762−0.820. The results found in the external validation set were also promising.ConclusionsWe constructed a highly sensitive nomogram that can assist clinicians in the early diagnosis of GCPD and serve as a reference for optimizing clinical management strategies.

Highlights

Despite decreasing incidence and improvements in treatment in recent years, gastric cancer (GC) remains the fifth most common malignant tumor and the third leading cause of cancer-related deaths worldwide [1]
There were 1,377 patients in the development set from the original database, 265 of whom were excluded because of missing data, among whom 24 patients lacked information on tumor size and signet-ring cell carcinoma (SRCC), 45 lacked information on Borrmann classification IV (Borrmann IV), 119 lacked information on T stage and N stage, and the remaining 77 lacked carcinoembryonic antigen (CEA) data
After we excluded some patients with missing data, a total of 474 patients were included in the validation set, with 409 (86.3%) of the patients identified as not having peritoneal metastasis and 65 (13.7%) of the patients identified as having one or more peritoneal metastases in the postoperative pathological examination

Summary

Introduction

Despite decreasing incidence and improvements in treatment in recent years, gastric cancer (GC) remains the fifth most common malignant tumor and the third leading cause of cancer-related deaths worldwide [1]. Data have shown that the incidence of newly diagnosed GC in China is up to 30 per 100,000, accounting for approximately 40% of all cases in the world and leading to 294,000 cancerrelated deaths, accounting for approximately 50% of the www.cjcrcn.org. Chen et al Nomogram for gastric cancer with peritoneal dissemination world’s GC deaths [2,3,4]. Surgery is the only possible way to curatively treat GC; it does not benefit gastric cancer with peritoneal dissemination (GCPD) [8]. To avoid unnecessary invasive harm from “open-and-close” surgery, the accurate staging of GC patients, especially the accurate diagnosis of peritoneal dissemination, is an essential component of precise personal therapy

Methods

Results

Conclusion