Predictive Value of Combined Preoperative Carcinoembryonic Antigen Level and Ki-67 Index in Patients With Gastric Neuroendocrine Carcinoma After Radical Surgery.

Jianwei Xie,Jianwei Xie,Guoqiang Su,Ping Li,Ping Li,Gang Zhao,Yajun Zhao,Qingliang He,Qingliang He,Xiantu Qiu,Yanchang Xu,Chang-Ming Huang,Chang-Ming Huang,Hankun Hao,Hankun Hao,Fangqin Xue,Fangqin Xue,Yanbing Zhou,Yanbing Zhou,Chao-Hui Zheng,Chao-Hui Zheng,Jinping Chen

doi:10.3389/fonc.2021.533039

Abstract

PrécisWe present a valid and reproducible nomogram that combined the TNM stage as well as the Ki-67 index and carcinoembryonic antigen levels; the nomogram may be an indispensable tool to help predict individualized risks of death and help clinicians manage patients with gastric neuroendocrine carcinoma.BackgroundTo analyze the long-term outcomes of patients with grade 3 GNEC who underwent curative surgery and investigated whether the combination of carcinoembryonic antigen (CEA) levels and Ki-67 index can predict the prognosis of patients with gastric neuroendocrine carcinoma (GNEC) and constructed a nomogram to predict patient survival.MethodsIn the training cohort, data were collected from 405 patients with GNEC after radical surgery at seven Chinese centers. A nomogram was constructed to predict long-term prognosis. Data for the validation cohort were collected from 305 patients.ResultsThe 5-year overall survival (OS) was worse in the high CEA group than in the normal CEA group (40.5% vs. 55.2%, p = 0.013). The 5-year OS was significantly worse in the high Ki-67 index group than in the low Ki-67 index group (47.9% vs. 57.2%, p = 0.012). Accordingly, we divided the whole cohort into a KC(-) group (low Ki-67 index and normal CEA) and KC(+) group (high Ki-67 index and/or high CEA). The KC(+) group had a worse prognosis than the KC(-) group (64.6% vs. 46.8%, p < 0.001). KC(+) and the AJCC 8th stage were independent factors for OS. Then, we combined KC status and the AJCC 8th stage to establish a nomogram; the C-index and area under the curve (AUC) were higher for the nomogram than for the AJCC 8th stage (C-index: 0.660 vs. 0.635, p = 0.005; AUC: 0.700 vs. 0.675, p = 0.020). The calibration curve verified that the nomogram had a good predictive value, with similar findings in the validation groups.ConclusionsThe nomogram based on KC status and the AJCC 8th stage predicted the prognosis of patients with GNEC well.

Highlights

Gastric neuroendocrine carcinomas (GNECs) are rare and account for 0.2% to 1.5% of all gastric cancers, with increasing incidence in recent years [1,2,3]
To the best of our knowledge, this study is currently the largest study on GNEC and is the first in which a nomogram was prepared for GNEC prognosis
Our study provided an important tool that can be used to evaluate the risk of death of patients with GNEC

Summary

Introduction

Gastric neuroendocrine carcinomas (GNECs) are rare and account for 0.2% to 1.5% of all gastric cancers, with increasing incidence in recent years [1,2,3]. GNECs have a worse survival, with 5-year overall survival (OS) rates ranging from 31% to 38%, even after radical gastrectomy and adjuvant chemotherapy [3, 4]. Ki-67 index is an important factor to evaluate the grade of GNECs, but its prognostic value in GNECs is still controversial [6, 7]. To analyze the long-term outcomes of patients with grade 3 GNEC who underwent curative surgery and investigated whether the combination of carcinoembryonic antigen (CEA) levels and Ki-67 index can predict the prognosis of patients with gastric neuroendocrine carcinoma (GNEC) and constructed a nomogram to predict patient survival

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Conclusion