Development and Validation of a Prognostic Nomogram to Guide Decision-Making for High-Grade Digestive Neuroendocrine Neoplasms

The oncologist

article

Zhenyu Lin¹  Shengli Yang¹  Ying Zhu¹  Gang Wu¹  Jie Chen²  Tao Zhang¹  Haihong Wang¹  Yixuan Zhang²  Guiling Li¹  Guoliang Pi³  Xianjun Yu⁴  Yaobing Chen⁵  Kaizhou Jin⁴  Liangkai Chen⁶ 

[1] Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology;Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University;Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology;Fudan University Shanghai Cancer Center;Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology;Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology

关键词: Neuroendocrine neoplasm;    Digestive system;    High grade;    Development and validation;    Prognostic nomogram;   

DOI  :  10.1634/theoncologist.2019-0566

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background The objective of this study was to develop and validate a nomogram to predict 1-year overall survival (OS) and 2-year OS in patients with high-grade digestive neuroendocrine neoplasms (NENs) as well as to guide selection of subgroups that could benefit from systemic chemotherapy. Subjects, Materials, and Methods We performed a retrospective analysis of 223 patients with NENs of the gut and hepato-biliary-pancreatic system from four centers included in the development cohort. The nomogram was externally validated in a cohort of 90 patients from another one. Results The final model included lactate dehydrogenase, performance status, stage, Ki67, and site of primary tumor, all of which had a significant effect on OS. The uncorrected C-index was 0.761 for OS, and the bias-corrected C-index was 0.744. Predictions correlated well with observed 1-year and 2-year outcomes (judged by eye). The area under the time-dependent receiver operating characteristic curve at 12 months and 24 months was 0.876 and 0.838, respectively. The nomogram performed well in terms of both discrimination and calibration when applied to the validation cohort, and OS was significantly different between the two groups classified by nomogram score (log-rank p < .001). Conclusion The validated nomogram provided useful prediction of OS, which can be offered for clinicians to improve their abilities to assess patient prognosis, to create clinical risk groups for informing treatment or for patient stratification by disease severity in clinical trials. Implications for Practice The high-grade neuroendocrine neoplasms of the digestive system are rare malignancies with great heterogeneity. An overall survival nomogram was developed and externally validated in this study. Two subgroups were classified by the nomogram score, and platinum-based chemotherapy may not bring clinical benefit for the low-risk patients.

【 授权许可】

CC BY|CC BY-NC