基于SII和TSP的Ⅱ、Ⅲ期胃腺癌术后患者预后相关列线图模型的构建与验证

Construction and validation of a prognostic Nomogram based on SII and TSP for patients with stageⅡandⅢgastric adenocarcinoma after surgery

目的:探索术前系统性免疫炎症指标(systemic immune-inflammation index,SII)、病理特征肿瘤间质百分比(tumor stroma percentage,TSP)对Ⅱ、Ⅲ期胃腺癌术后患者预后的评估价值,构建并验证基于SII及TSP的预后相关列线图模型。方法:回顾性分析我院行胃癌根治术的Ⅱ、Ⅲ期胃腺癌术后患者380例临床病理资料,并对SII和病理特征TSP分组,比较不同分组下临床病理资料与生化指标的差异。生存分析采用乘积极限法(Kaplan-Meier),并进行对数秩检验(Log-rank test)。Cox比例风险回归模型进行单因素和多因素分析,以确定对预后有影响的因素。分别绘制术前SII、TSP、pTNM分期及联合预测患者预后的受试者工作特征曲线(receiver operating characteristic curve,ROC),并计算曲线下面积(area under the curve,AUC)以比较预测效能。采用R软件(版本4.0.5)构建预后列线图,并进行内部验证。结果:共入组380例Ⅱ、Ⅲ期胃腺癌患者。男女比例为2.8∶1。发病年龄≥60岁(80.26%)、低分化(61.58%)占比较高。Ⅱ、Ⅲ期占比分别为36.32%、63.68%。大部分患者(82.37%)伴淋巴结转移。神经侵犯达61.58%,脉管癌栓达64.74%。将入组患者的SII高、低分组与其他临床病理资料比较分析,发现高、低SII两组间各临床病理特征差异无统计学意义(均P>0.05)。高TSP组200例(52.63%),低TSP组180例(47.37%)。与低TSP组相比,高TSP组中pTNM分期较晚,近端胃、淋巴结转移、神经侵犯、脉管癌栓比例较高,差异具有统计学意义(均P<0.05);而年龄、性别、肿瘤最大径、肿瘤分化程度、T分期、外周血肿瘤指标、SII方面两组间差异均无统计学意义(均P>0.05)。低SII组总体生存率显著高于高SII组(P=0.0297),低TSP组总体生存率显著高于高TSP组(P<0.001)。pTNM分期、神经侵犯、TSP、SII是影响入组患者总体生存的独立预后因素(均P<0.05)。ROC曲线结果显示,联合SII、TSP、pTNM分期较单一因素可更为有效预测Ⅱ、Ⅲ期胃腺癌患者的预后。列线图模型C指数为0.6867(95%CI:0.6445~0.7290),AIC为1832,校准预测曲线与理想曲线贴合良好。结论:高SII、高TSP是Ⅱ、Ⅲ期胃腺癌术后患者预后不良的独立危险因素。基于SII和TSP的列线图模型预测准确性较好,有助于对Ⅱ、Ⅲ期胃腺癌术后患者的预后评估。

Objective:To explore the value of preoperative SII and pathological characteristics TSP in evaluating the prognosis of patients with stageⅡandⅢgastric adenocarcinoma after surgery,and to construct and validation the prognostic correlation Nomogram model based on SII and TSP.Methods:380 postoperative patients with stageⅡandⅢgastric adenocarcinoma who underwent radical gastric cancer were collected and followed up.Their clinicopathological data were retrospectively analysed and grouped into SII and pathological features TSP to compare the differences in clinicopathological features and biochemical indicators under different groupings.Survival analysis was performed by the product limit method(Kaplan-Meier)with Log-rank test.Cox proportional risk regression models were used for univariate and multifactorial analysis to identify factors that had an impact on prognosis.ROCs for preoperative SII,TSP,pTNM staging and combined prediction of patients'prognosis were plotted separately and the area under the curve(AUC)was calculated to compare predictive efficacy.Nomogram was constructed using R software(version 4.0.5)and validated internally.Results:A total of 380 patients with stageⅡandⅢgastric adenocarcinoma were enrolled.The male to female ratio was 2.8∶1.Age at presentation≥60 years(80.26%)and poor differentiation(61.58%)accounted for a higher proportion.The proportion of stageⅡandⅢwas 36.32%and 63.68%respectively.The majority of patients had lymph node metastases(82.37%).Nerve invasion amounted to 61.58%and vascular invasion to 64.74%.Analysis of the high and low SII groups of the enrolled patients compared with other clinicopathological data revealed that SII and clinicopathological features did not show statistical significance(all P>0.05).There were 200 cases(52.63%)in the high TSP group and 180 cases(47.37%)in the low TSP group.Compared with the low TSP group,the high TSP group had a later pTNM stage and a higher proportion of proximal gastric cancer,lymph node metastases,nerve invasion and vascular invasion,with statistically significant differences(all P<0.05).There was no statistically significant difference with age,gender,tumor size,degree of differentiation,T stage,tumour index and SII(all P>0.05).Overall survival was significantly higher in the low SII group than in the high SII group(P=0.0297)and significantly better in the low TSP group than in the high TSP group(P<0.001).pTNM stage,nerve invasion,TSP and SII were independent prognostic factors affecting the overall survival of the enrolled patients(all P<0.05).ROC curve the results showed that the combination of SII,TSP,and pTNM stage was more effective in predicting the prognosis of patients with stageⅡandⅢgastric adenocarcinoma than single factors.The C-index of Nomogram model was 0.6867(95%CI:0.6445~0.7290)and the AIC was 1832,with the calibrated prediction curve fitting well with the ideal curve.Conclusion:High SII and high TSP were independent risk factors for poor prognosis in patients with stageⅡandⅢgastric adenocarcinoma.The Nomogram based on SII and TSP has good prediction accuracy and is helpful to evaluate the prognosis of patients with stageⅡandⅢgastric adenocarcinoma after surgery.