Nomogram established using risk factors of early gastric cancer for predicting the lymph node metastasis

BACKGROUND For the prognosis of patients with early gastric cancer(EGC),lymph node metastasis(LNM)plays a crucial role.A thorough and precise evaluation of the patient for LNM is now required.AIM To determine the factors influencing LNM and to construct a prediction model of LNM for EGC patients.METHODS Clinical information and pathology data of 2217 EGC patients downloaded from the Surveillance,Epidemiology,and End Results database were collected and analyzed.Based on a 7:3 ratio,1550 people were categorized into training sets and 667 people were assigned to testing sets,randomly.Based on the factors influencing LNM determined by the training sets,the nomogram was drawn and verified.RESULTS Based on multivariate analysis,age at diagnosis,histology type,grade,T-stage,and size were risk factors of LNM for EGC.Besides,nomogram was drawn to predict the risk of LNM for EGC patients.Among the categorical variables,the effect of grade(well,moderate,and poor)was the most significant prognosis factor.For training sets and testing sets,respectively,area under the receiver-operating characteristic curve of nomograms were 0.751[95%confidence interval(CI):0.721-0.782]and 0.786(95%CI:0.742-0.830).In addition,the calibration curves showed that the prediction model of LNM had good consistency.CONCLUSION Age at diagnosis,histology type,grade,T-stage,and tumor size were independent variables for LNM in EGC.Based on the above risk factors,prediction model may offer some guiding implications for the choice of subsequent therapeutic approaches for EGC.

Prognostic factors for disease-free survival in postoperative patients with hepatocellular carcinoma and construction of a nomogram model

BACKGROUND Hepatocellular carcinoma(HCC)is the most common type of liver cancer and has a high risk of invasion and metastasis along with a poor prognosis.AIM To investigate the independent predictive markers for disease-free survival(DFS)in patients with HCC and establish a trustworthy nomogram.METHODS In this study,445 patients who were hospitalized in The First Affiliated Hospital of Anhui Medical College between December 2009 and December 2014 were retrospectively examined.The survival curve was plotted using the Kaplan–Meier method and survival was determined using the log-rank test.To identify the prognostic variables,multivariate Cox regression analyses were carried out.To predict the DFS in patients with HCC,a nomogram was created.C-indices and receiver operator characteristic curves were used to evaluate the nomogram’s performance.Decision curve analysis(DCA)was used to evaluate the clinical application value of the nomogram.RESULTS Longer DFS was observed in patients with the following characteristics:elderly,I–II stage,and no history of hepatitis B.The calibration curve showed that this nomogram was reliable and had a higher area under the curve value than the tumor node metastasis(TNM)stage.Moreover,the DCA curve revealed that the nomogram had good clinical applicability in predicting 3-and 5-year DFS in HCC patients after surgery.CONCLUSION Age,TNM stage,and history of hepatitis B infection were independent factors for DFS in HCC patients,and a novel nomogram for DFS of HCC patients was created and validated.

Efficacy and outcome of extensive intraoperative peritoneal lavage plus surgery vs surgery alone with advanced gastric cancer patients

BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.In addition,the surgery itself may lead to the dissemination of tumor cells.Therefore,it is necessary to remove residual tumor cells.Recently,some researchers found that extensive intraoperative peritoneal lavage(EIPL)plus intraperitoneal chemotherapy can improve the prognosis of patients and eradicate peritoneal free cancer for GC patients.However,few studies explored the safety and long-term outcome of EIPL after curative gastrectomy.AIM To evaluate the efficacy and long-term outcome of advanced GC patients treated with EIPL.METHODS According to the inclusion and exclusion criteria,a total of 150 patients with advanced GC were enrolled in this study.The patients were randomly allocated to two groups.All patients received laparotomy.For the non-EIPL group,peritoneal lavage was washed using no more than 3 L of warm saline.In the EIPL group,patients received 10 L or more of saline(1 L at a time)before the closure of the abdomen.The surviving rate analysis was compared by the Kaplan-Meier method.The prognostic factors were carried out using the Cox appropriate hazard pattern.RESULTS The basic information in the EIPL group and the non-EIPL group had no significant difference.The median follow-up time was 30 mo(range:0-45 mo).The 1-and 3-year overall survival(OS)rates were 71.0%and 26.5%,respectively.The symptoms of ileus and abdominal abscess appeared more frequently in the non-EIPL group(P<0.05).For the OS of patients,the EIPL,Borrmann classification,tumor size,N stage,T stage and vascular invasion were significant indicators.Then multivariate analysis revealed that EIPL,tumor size,vascular invasion,N stage and T stage were independent prognostic factors.The prognosis of the EIPL group was better than the non-EIPL group(P<0.001).The 3-year survival rate of the EIPL group(38.4%)was higher than the non-EIPL group(21.7%).For the recurrence-free survival(RFS)of patients,the risk factor of RFS included EIPL,N stage,vascular invasion,type of surgery,tumor location,Borrmann classification,and tumor size.EIPL and tumor size were independent risk factors.The RFS curve of the EIPL group was better than the non-EIPL group(P=0.004),and the recurrence rate of the EIPL group(24.7%)was lower than the non-EIPL group(46.4%).The overall recurrence rate and peritoneum recurrence rate in the EIPL group was lower than the non-EIPL group(P<0.05).CONCLUSION EIPL can reduce the possibility of perioperative complications including ileus and abdominal abscess.In addition,the overall survival curve and RFS curve were better in the EIPL group.

Development and validation of a novel nomogram for predicting overall survival in gastric cancer based on inflammatory markers

BACKGROUND Nearly 66%of occurrences of gastric cancer(GC),which has the second-highest death rate of all cancers,arise in developing countries.In several cancers,the predictive significance of inflammatory markers has been established.AIM To identify clinical characteristics and develop a specific nomogram to determine overall survival for GC patients.METHODS Nine hundred and four GC patients treated at the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2013 were recruited.Prognostic risk variables were screened for Cox analysis.The C index,receiver operator characteristic(ROC)curve,and decision curve analysis were used to evaluate the nomogram.RESULTS Tumor node metastasis stage,carcinoembryonic antigen,systemic immuneinflammation index,and age were identified as independent predictive variables by multivariate analysis.Systemic immune-inflammation index value was superior to that of other inflammatory indicators.The ROC indicated the nomogram had a higher area under the curve than other factors,and its C-index for assessing the validation and training groups of GC patients was extremely reliable.CONCLUSIONWe created a novel nomogram to forecast the prognosis of GC patients following curativegastrectomy based on blood markers and other characteristics. Both surgeons and patients canbenefit significantly from this new scoring system.