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Meng X, Hao F, Wang N, Qin P, Ju Z, Sun D. Log odds of positive lymph nodes (LODDS)-based novel nomogram for survival estimation in patients with invasive micropapillary carcinoma of the breast. BMC Med Res Methodol 2024; 24:90. [PMID: 38637725 PMCID: PMC11025266 DOI: 10.1186/s12874-024-02218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Invasive micropapillary carcinoma (IMPC) of the breast is known for its high propensity for lymph node (LN) invasion. Inadequate LN dissection may compromise the precision of prognostic assessments. This study introduces a log odds of positive lymph nodes (LODDS) method to address this issue and develops a novel LODDS-based nomogram to provide accurate prognostic information. METHODS The study analyzed data from 1,901 patients with breast IMPC from the Surveillance, Epidemiology, and End Results database. It assessed the relationships between LODDS and the number of excised LN (eLN), positive LN (pLN), and the pLN ratio (pLNR), identifying an optimal threshold value using a restricted cubic spline method. Predictive factors were identified by the Cox least absolute shrinkage and selection operator (Cox-LASSO) regression and validated through multivariate Cox regression to construct a nomogram. The model's accuracy, discrimination, and utility were assessed. The study also explored the consequences of excluding LODDS from the nomogram and compared its effectiveness with the tumor-node-metastasis (TNM) staging system. RESULTS LODDS improved N status classification by identifying heterogeneity in patients with pLN ratios of 0% (pLN =0) or 100% (pLN =eLN) and setting -1.08 as the ideal cutoff. Five independent prognostic factors for breast cancer-specific survival (BCSS) were identified: tumor size, N status, LODDS, progesterone receptor status, and histological grade. The LODDS-based nomogram achieved a strong concordance index of 0.802 (95% CI: 0.741-0.863), surpassing both the version without LODDS and the conventional TNM staging in all tests. CONCLUSIONS For breast IMPC, LODDS served as an independent prognostic factor, its effectiveness unaffected by the anatomical LN count, enhancing the accuracy of N staging. The LODDS-based nomogram showed promise in offering more personalized prognostic information.
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Affiliation(s)
- Xiangdi Meng
- Department of Radiation Oncology, Weifang People's Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang, 261041, Shandong, China
- Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Furong Hao
- Department of Radiation Oncology, Weifang People's Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang, 261041, Shandong, China
| | - Nan Wang
- Department of Radiation Oncology, Weifang People's Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang, 261041, Shandong, China
| | - Peiyan Qin
- Department of Radiation Oncology, Weifang People's Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang, 261041, Shandong, China
| | - Zhuojun Ju
- Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Daqing Sun
- Department of Radiation Oncology, Weifang People's Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang, 261041, Shandong, China.
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Liu CY, Yang YS, Ye K, He HF. Development of nomograms for predicting the survival of intestinal-type gastric adenocarcinoma patients after surgery. Sci Rep 2023; 13:17430. [PMID: 37833383 PMCID: PMC10576064 DOI: 10.1038/s41598-023-44671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/11/2023] [Indexed: 10/15/2023] Open
Abstract
Intestinal-type gastric adenocarcinoma (IGA) is a common phenotype of gastric cancer. Currently, few studies have constructed nomograms that may predict overall (OS) and cancer-specific survival (CSS) probability after surgery. This study is to establish novel nomograms for predicting the survival of IGA patients who received surgery. A total of 1814 IGA patients who received surgery between 2000 and 2018 were selected from Surveillance, Epidemiology, and End Results database and randomly assigned to the training and validating sets at a ratio of 7:3. Then univariate and multivariate cox regression analyses were performed to screen significant indictors for the construction of nomograms. The calibration curve, the area under the receiver operating characteristic (receiver operating characteristic, ROC) curve (the area under curve, AUC), C-index, net reclassification index (NRI), integrated discrimination improvement (IDI) and decision curve analysis (DCA) curves were applied to assess the performance of the model. The significant outcomes of multivariate analysis revealed that ten variables (age, sex, race, surgery type, summary stage, grade, AJCC TNM stage, radiotherapy, number of regional nodes examined, number of regional nodes positive) were demonstrated to construct the nomogram for OS and ten variables (age, sex, race, surgery type, summary stage, grade, AJCC TNM stage, chemotherapy, number of regional nodes examined, number of regional nodes positive) for CSS. The calibration and AUC uncovered their favorable predictive performance. Subsequently, C-index, NRI, IDI and DCA curves further validated the predicative superiority of nomograms over 7th AJCC Stage System. The validated nomogram provides more reliable OS and CSS predictions for postoperative IGA patients with good accuracy, which can help surgeons in treatment decision-making and prognosis evaluation.
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Affiliation(s)
- Chu-Yun Liu
- Department of Anaesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China
| | - Yu-Shen Yang
- Department of Anaesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China
- Department of General Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China
| | - Kai Ye
- Department of General Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China.
| | - He-Fan He
- Department of Anaesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China.
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Zhuo X, Xia L, Tang W, He W. A practical nomogram and risk stratification system for predicting survival outcomes in neuroblastoma patients: a SEER population-based study. J Cancer Res Clin Oncol 2023; 149:12285-12296. [PMID: 37430162 PMCID: PMC10465685 DOI: 10.1007/s00432-023-05110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Neuroblastoma (NB) is a childhood malignancy with marked heterogeneity, resulting in highly variable outcomes among patients. This study aims to establish a novel nomogram and risk stratification system to predict the overall survival (OS) for patients with NB. METHODS We analyzed neuroblastoma patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The nomogram was constructed using independent risk factors for OS, identified through univariate and multivariate Cox regression analyses. The accuracy of this nomogram was evaluated with the concordance index, receiver operating characteristic curve, calibration curve, and decision curve analysis. In addition, we developed a risk stratification system based on the total score of each patient in the nomogram. RESULTS A total of 2185 patients were randomly assigned to the training group and the testing group. Six risk factors, including age, chemotherapy, brain metastases, primary site, tumor stage, and tumor size, were identified in the training group. Using these factors, a nomogram was constructed to predict 1-, 3-, and 5-year OS of NB patients. This model exhibited superior accuracy in the training and testing groups, exceeding traditional tumor stage prediction. Subgroup analysis suggested worse prognosis for retroperitoneal origin in the intermediate-risk group and adrenal gland origin in the high-risk group compared to other sites. Additionally, the prognosis for high-risk patients significantly improved after surgery. We also developed a web application to make the nomogram more user-friendly in clinical practices. CONCLUSION This nomogram demonstrates excellent accuracy and reliability, offering more precise personalized prognostic predictions to clinical patients.
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Affiliation(s)
- Xiaoyu Zhuo
- Department of Pediatric Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Liangfeng Xia
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Wenjing Tang
- Department of Pediatric Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Wenqi He
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Zheng W, Jiang W, Wu Q, Chen J, Zhang Z, Yu S, Guo C. Comparisons of different lymph node staging systems for predicting overall survival of node-positive patients with renal cell carcinoma: a retrospective cohort study using the Surveillance, Epidemiology and End Results database. BMJ Open 2023; 13:e068044. [PMID: 37185648 PMCID: PMC10151935 DOI: 10.1136/bmjopen-2022-068044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To compare the prognostic values of three lymph node staging systems in renal cell carcinoma (RCC), including the number of positive lymph nodes (NPLN), lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS). DESIGN A retrospective cohort study using data from the Surveillance, Epidemiology and End Results (SEER) database. SETTING AND PARTICIPANTS 1904 patients with pathological N1 RCC, diagnosed from 2004 to 2015 and underwent nephrectomy combined with lymph node dissection, were identified from the SEER database. PRIMARY OUTCOME MEASURE The primary outcome of this study was overall survival (OS). Restricted cubic spline functions and multivariable Cox regression analyses were employed to characterise the associations of OS with NPLN, LNR and LODDS, respectively. RESULTS Data of 1904 eligible RCC patients were extracted from the SEER database. The mortality risks of RCC patients increased with the increasing of NPLN, LNR and LODDS. NPLN (NPLN3 vs NPLN1, HR 1.22, 95% CI 1.05 to 1.43, p=0.001), LNR (LNR3 vs LNR1, HR 1.46, 95% CI 1.28 to 1.67, p<0.001; LNR2 vs LNR1, HR 1.28, 95% CI 1.09 to 1.50, p=0.002) and LODDS (LODDS3 vs LODDS1, HR 1.48, 95% CI 1.28 to 1.72, p<0.001; LODDS2 vs LODDS1, HR 1.34, 95% CI 1.17 to 1.53, p<0.001) were all independent prognostic factors of OS. The predictive abilities of LNR (Akaike information criterion, AIC: 19576.3, optimism-corrected C-index: 0.677) and LODDS (AIC: 19579.2, optimism-corrected C-index: 0.676) were comparable, superior to NPLN (AIC: 19603.7, optimism-corrected C-index: 0.673). In subgroup analyses, the LODDS classification could better stratify survival of RCC patients, in particular for those with the number of dissected lymph nodes <13 or NPLN≤2. CONCLUSIONS NPLN, LNR and LODDS were all independent predictors of OS in RCC. When compared with NPLN and LNR, LODDS had a better performance in survival prediction and risk stratification. The three metrics all had the potential to be integrated into future versions of the American Joint Committee on Cancer staging manual.
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Affiliation(s)
- Wenwen Zheng
- Department of Pharmacy, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
- Department of Education, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Wei Jiang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, People's Republic of China
- Department of Radiotherapy, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Qingna Wu
- Department of Pharmacy, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Jiaojiao Chen
- Department of Pharmacy, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Zhiyu Zhang
- Department of Urology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Shengqiang Yu
- Department of Organ Transplantation, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Chenyu Guo
- Department of Pharmacy, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
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Salari A, Ghahari M, Nowroozi A, Ghahari P, Haddad M, Sahebi L, Ayati M, Momeni SA, Nowroozi MR, Amini E. Log Odds of Positive Lymph Nodes (LODDS) as an Independent Predictor of Overall Survival Following Radical Cystectomy in Urothelial Bladder Cancer: Time to Rethink Conventional Node Staging. Clin Genitourin Cancer 2022; 21:e175-e181. [PMID: 36567241 DOI: 10.1016/j.clgc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radical cystectomy (RC) with lymph node dissection is the mainstay of treatment for patients with muscle-invasive bladder cancer (MIBC) and high risk non-MIBC. The American Joint Committee on Cancer's (AJCC) node staging and lymph node ratio (LNR) systems are used in estimating prognosis; however, they do not directly factor in negative dissected nodes. In this study, we evaluated the log odds of positive lymph nodes (LODDS), a novel measure of nodal involvement, as a predictor of survival. PATIENTS AND METHODS Eighty-three patients who underwent RC were retrospectively included and their demographic and clinical data were collected. Kaplan-Meier curve and Cox regression were used for survival analyses. RESULTS Median number of dissected lymph nodes was 13 (range 3-45). ROC curve analysis indicated -0.92 as the optimal LODDS cutoff. LODDS > -0.92 was associated with higher T stage, lymphovascular invasion, and significantly worse overall survival (OS) (mean OS 18.6 vs. 45.1 months, P-value < .001). Furthermore, we evaluated AJCC node staging, LNR, and LODDS in three separate multivariable Cox regression models. Among 3 different measures of nodal disease burden, only LODDS was an independent predictor of OS (HR 2.71, 95% CI 1.28-5.73, P = .009). CONCLUSIONS Our results show that LODDS is an independent predictor of OS and outperforms AJCC node staging and LNR in forecasting prognosis among patients with urothelial bladder cancer who undergo RC.
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Affiliation(s)
- Abolfazl Salari
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ghahari
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nowroozi
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parichehr Ghahari
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Haddad
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leyla Sahebi
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ayati
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Momeni
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Erfan Amini
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Yang J, Huang H, Li W, Ran S, Hu J, Zhang Y, Li W, Chen C, He W. A Prognostic Nomogram Based on Log Odds of Positive Lymph Nodes to Predict Overall Survival for Non-Metastatic Bladder Cancer Patients after Radical Cystectomy. Curr Oncol 2022; 29:6834-6846. [PMID: 36290816 PMCID: PMC9601192 DOI: 10.3390/curroncol29100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023] Open
Abstract
(1) Purpose: The purpose of this study was to evaluate the prognostic capacity of the pathological N status (pN), lymph node ratio (LNR), and the log odds of positive lymph nodes (LODDS), and to build a prognostic nomogram to predict overall survival (OS) for bladder cancer patients treated by radical cystectomy. (2) Methods: The clinical and pathological characteristics of 10,938 patients with bladder cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2017. The predictive capacity was assessed by univariate and multivariate Cox regression analyses, the area under the receiver operating characteristic curve (AUC), and C-index. Calibration curves, decision curve analysis (DCA), and risk-grouping were utilized to evaluate the predictive accuracy and discriminative ability of the nomogram. (3) Results: LODDS was an independent risk factor for bladder cancer (all p < 0.001) and demonstrated the highest values of C-index and AUC. The values of AUCs in the training cohort were 0.747, 0.743, and 0.735 for predicting 1-, 3-, and 5-year OS, respectively. Calibration curves and DCA curves suggested the excellent clinical application value of our nomogram. (4) Conclusions: LODDS is a better predictive indicator for bladder cancer patients compared to pN and LNR. The LODDS-incorporated nomogram has excellent accuracy and promising clinical application value for non-metastatic bladder cancer after radical cystectomy.
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Affiliation(s)
- Jingtian Yang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Huasheng Huang
- Department of Urology, Houjie Hospital of Dongguan, Dongguan 523945, China;
| | - Wenshuang Li
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Shengming Ran
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Jintao Hu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Yishan Zhang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Wenjie Li
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Changhao Chen
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
- Correspondence: (C.C.); (W.H.)
| | - Wang He
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (J.Y.); (W.L.); (S.R.); (J.H.); (Y.Z.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
- Correspondence: (C.C.); (W.H.)
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Li C, Xu F, Huang Q, Han D, Zheng S, Wu W, Zhao F, Feng X, Lyu J. Nomograms for Differentiated Thyroid Carcinoma Patients Based on the Eighth AJCC Staging and Competing Risks Model. JNCI Cancer Spectr 2021; 5:pkab038. [PMID: 34159295 PMCID: PMC8211639 DOI: 10.1093/jncics/pkab038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Differentiated thyroid carcinoma (DTC) patients have a long survival period and good prognosis, so they are easily affected by competing risk events. The purpose of this study was to use the competing risks model to identify prognostic factors for cause-specific death (CSD) and death due to other causes (DOC) in patients with DTC. Methods Our screening process identified 34 585 DTC patients in the Surveillance, Epidemiology, and End Results database and randomly divided them into a training cohort and a validation cohort. We used the Fine and Gray subdistribution hazards model to establish the CSD and DOC nomograms. The distinguishing ability and consistency of the nomograms were evaluated using the consistency indexes and calibration plots. Results Our analysis of a competing risks model revealed that pathological grade, tumor size, histological type, American Joint Committee on Cancer (AJCC)-8 stage, surgery status, adjuvant radiotherapy status, adjuvant chemotherapy status, and log odds of positive lymph nodes are prognostic factors for CSD, and age at diagnosis, year of diagnosis, sex, pathological grade, tumor size, AJCC-8 stage, surgery status, adjuvant radiotherapy status, and lymph node ratio are prognostic factors for DOC. The 1-year, 3-year, and 5-year concordance indexes in the validation cohorts were 0.942, 0.931, and 0.913 for the CSD nomogram and 0.813, 0.746, and 0.776 for the DOC nomogram. The calibration plots showed good consistency in both nomograms. Conclusions Our nomograms can be used as a tool to help clinicians individually predict the probability of CSD and DOC in DTC patients at 1 year, 3 years, and 5 years, which has certain guiding value in clinical applications.
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Affiliation(s)
- Chengzhuo Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Shaanxi Province, China
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Shaanxi Province, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Hubei Province, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Shaanxi Province, China
| | - Shuai Zheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province, China
- School of Public Health, Shaanxi University of Chinese Medicine, Shaanxi Province, China
| | - Wentao Wu
- School of Public Health, Xi’an Jiaotong University Health Science Center, Shaanxi Province, China
| | - Fanfan Zhao
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Shaanxi Province, China
| | - Xiaojie Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Shaanxi Province, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangdong Province, China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Shaanxi Province, China
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Cao S, Li J, Yang K, Zhang J, Xu J, Feng C, Li H. Development and validation of a novel prognostic model for long-term overall survival in liposarcoma patients: a population-based study. J Int Med Res 2021; 48:300060520975882. [PMID: 33296604 PMCID: PMC7731721 DOI: 10.1177/0300060520975882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To construct and validate a clinically accurate and histology-specific nomogram to predict overall survival (OS) among liposarcoma (LPS) patients. Methods We retrospectively screened eligible patients with LPS diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results database. We screened independent predictors for the nomogram using univariate and multivariate analyses. We then evaluated the prognostic accuracy of the nomogram by receiver operating characteristic (ROC) curve analysis and Harrell’s concordance index. The prognostic performances of the nomogram and the American Joint Committee on Cancer (AJCC) seventh edition staging system were compared using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analyses (DCA). Results A novel nomogram was developed using independent prognostic variables, which exhibited excellent predictive performances for 3- and 5-year OS according to ROC curves. The C-index proved that the proposed nomogram had better prognostic accuracy for LPS than the traditional AJCC system, while the NRI, IDI, and DCA of the nomogram indicated better clinical net benefit. Conclusions The proposed nomogram can predict 3- and 5-year OS of LPS patients with reliable accuracy and may thus help clinicians to develop appropriate clinical therapies and counseling strategies to prolong the life expectancy of these patients.
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Affiliation(s)
- Shuai Cao
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jie Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Kai Yang
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jun Zhang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jiawei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chaoshuai Feng
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Haopeng Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Haopeng Li, Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China.
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Sheng X, Lu X, Wu J, Chen L, Cao H. A Nomogram Predicting the Prognosis of Renal Cell Carcinoma Patients with Lung Metastases. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6627562. [PMID: 33791367 PMCID: PMC7997741 DOI: 10.1155/2021/6627562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The optimal tool for predicting the survival of renal cell carcinoma (RCC) patients with lung metastases remains controversial. METHODS We selected patients diagnosed with RCC and lung metastases, from 2010 to 2015, from the Surveillance, Epidemiology, and End Results (SEER) database. After the selection of inclusion criteria and exclusion criterion, the rest of the patients were incorporated into model analysis. Least absolute shrinkage and selection operator (LASSO) regression was used to select the most important features for construction of a nomogram predicting cancer-specific survival. A calibration plot and the concordance index (C-index) were used to estimate nomogram efficacy in a validation cohort. The association between important factors selected by LASSO regression, and prognosis was assessed by the Kaplan-Meier (KM) survival curve. The receiver operating characteristic (ROC) curves were drawn to compare sensitivity and specificity between the nomogram we built and the TNM stage-based model. RESULTS A total of 1,369 patients met the inclusion criteria, but not the exclusion criteria. The LASSO regression model reduced 15 features to seven potential predictors of survival, including tumor grade, the extent of surgery, N and T status, histological profile, and brain and bone metastasis status. Such features had good discrimination in the KM survival curves. The nomogram showed excellent discriminatory power (C-index, 0.71; 95% confidence interval: 0.70 to 0.72) and good calibration in terms of both 1- and 2-year cancer-specific survival. The nomogram showed great discriminatory power (C-index 0.68) and adequate calibration when applied to the validation cohort. The areas under the curve (AUCs) of nomogram were 0.767 and 0.780, respectively, and the AUCs of TNM stage were 0.617 and 0.618 at 1 and 2 years, respectively. CONCLUSIONS Our nomogram might play a major role in predicting the cancer-specific survival of RCC patients with lung metastases.
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Affiliation(s)
- Xinyu Sheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City 310003, China
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd, Hangzhou City 310003, China
| | - Xuan Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City 310003, China
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd, Hangzhou City 310003, China
| | - Jian Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City 310003, China
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd, Hangzhou City 310003, China
| | - Lu Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City 310003, China
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd, Hangzhou City 310003, China
| | - Hongcui Cao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City 310003, China
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd, Hangzhou City 310003, China
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, 79 Qingchun Rd, Hangzhou City 310003, China
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Bruni D, Angell HK, Galon J. The immune contexture and Immunoscore in cancer prognosis and therapeutic efficacy. Nat Rev Cancer 2020; 20:662-680. [PMID: 32753728 DOI: 10.1038/s41568-020-0285-7] [Citation(s) in RCA: 835] [Impact Index Per Article: 208.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
The international American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumour-node-metastasis (TNM) staging system provides the current guidelines for the classification of cancer. However, among patients within the same stage, the clinical outcome can be very different. More recently, a novel definition of cancer has emerged, implicating at all stages a complex and dynamic interaction between tumour cells and the immune system. This has enabled the definition of the immune contexture, representing the pre-existing immune parameters associated with patient survival. Even so, the role of distinct immune cell types in modulating cancer progression is increasingly emerging. An immune-based assay named the 'Immunoscore' was defined to quantify the in situ T cell infiltrate and was demonstrated to be superior to the AJCC/UICC TNM classification for patients with colorectal cancer. This Review provides a broad overview of the main immune parameters positively or negatively shaping cancer development, including the Immunoscore, and their prognostic and predictive value. The importance of the immune system in cancer control is demonstrated by the requirement for a pre-existing intratumour adaptive immune response for effective immunotherapies, such as checkpoint inhibitors. Finally, we discuss how the combination of multiple immune parameters, rather than individual ones, might increase prognostic and/or predictive power.
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Affiliation(s)
- Daniela Bruni
- INSERM, Laboratory of Integrative Cancer Immunology; Équipe Labellisée Ligue Contre le Cancer; Sorbonne Université; Sorbonne Paris Cité; Université de Paris; Centre de Recherche des Cordeliers, Paris, France
| | - Helen K Angell
- Translational Medicine, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Jérôme Galon
- INSERM, Laboratory of Integrative Cancer Immunology; Équipe Labellisée Ligue Contre le Cancer; Sorbonne Université; Sorbonne Paris Cité; Université de Paris; Centre de Recherche des Cordeliers, Paris, France.
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Zheng W, Li K, Zhu W, Ding Y, Wu Q, Tang Q, Lu C, Zhao Q, Yu S, Guo C. Nomogram prediction of overall survival based on log odds of positive lymph nodes for patients with penile squamous cell carcinoma. Cancer Med 2020; 9:5425-5435. [PMID: 32519819 PMCID: PMC7402844 DOI: 10.1002/cam4.3232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to establish a nomogram to predict the long‐term overall survival (OS) for patients with penile squamous cell carcinoma (PSCC). Method The PSCC patients receiving regional lymph node dissection (RLND) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The dataset of all eligible patients were used to develop the predictive model. The significant independent predictors were identified through Cox regression modeling based on the Bayesian information criterion and then incorporated into a nomogram to predicted 1‐, 3‐, and 5‐year OS. Internal validation was performed using the bootstrap resampling method. The model performance was evaluated using Harrell's concordance index (C‐index), calibration plots, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results Totally, 384 eligible PSCC patients were enrolled from the SEER database. A nomogram for OS prediction was developed, in which three clinical variables significantly associated with OS were integrated, including age, N classification, and log odds of positive lymph nodes (LODDS). The C‐index of the nomogram (0.746, 95% CI: 0.702‐0.790) was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system (0.692, 95% CI: 0.646‐0.738, P = .020). The bootstrap optimism‐corrected C‐index for the nomogram was 0.739 (95% CI: 0.690‐0.784). The bias‐corrected calibration plots showed the predicted risks were in good accordance with the actual risks. The results of NRI, IDI, and DCA exhibited superior predictive capability and higher clinical use of the nomogram compared with the AJCC staging system. Conclusion We successfully constructed a simple and reliable nomogram for OS prediction among PSCC patients receiving RLND, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.
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Affiliation(s)
- Wenwen Zheng
- Department of Education, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Kangqi Li
- Drug Clinical Trial Agency, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Weiwei Zhu
- Drug Clinical Trial Agency, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuexia Ding
- Department of Pharmacy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Qingna Wu
- Department of Pharmacy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Qiling Tang
- Department of Pharmacy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Congxiao Lu
- Drug Clinical Trial Agency, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Quan Zhao
- Department of Pharmacy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Shengqiang Yu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Chenyu Guo
- Drug Clinical Trial Agency, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
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Nomogram Based on microRNA Signature Contributes to Improve Survival Prediction of Clear Cell Renal Cell Carcinoma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7434737. [PMID: 32280701 PMCID: PMC7128070 DOI: 10.1155/2020/7434737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
Objective Numerous microRNAs (miRNAs) have been identified in ccRCC and recommended to be used for predicting clear cell renal cell carcinoma (ccRCC) prognosis. However, it is not clear whether a miRNA-based nomogram results in improved survival prediction in patients with ccRCC. Methods miRNA profiles from tumors and normal tissues were downloaded from The Cancer Genome Atlas (TCGA) database and analyzed using the "limma" package. The association between differentially expressed miRNAs and patient prognosis was identified using univariate, least absolute shrinkage and selection operator (LASSO), and multivariate Cox regression analyses. Next, all patients were randomly divided into development and validation cohorts at a ratio of 1 : 1. A nomogram was established based on independent prognostic factors in the development cohort. The prognostic performance of the nomogram was validated in both cohorts using the concordance index (C-index) and calibration plots. Results Multivariate Cox analysis identified the 13-miRNA signature, as well as AJCC stage and age, as independent prognostic factors after adjusting for other clinical covariates. The nomogram was built based on the independent variables. In the development cohort, the C-index for the constructed nomogram to predict overall survival (OS) was 0.792, which was higher than the C-index (0.731) of the AJCC staging system and C-index (0.778) of the miRNA signature. The nomogram demonstrated good discriminative ability in the validation cohort in predicting OS, with a C-index of 0.762. The calibration plots indicated an excellent agreement between the nomogram predicted survival probability and the actual observed outcomes. Furthermore, decision curve analysis (DCA) indicated that the nomogram was superior to the AJCC staging system in increasing the net clinical benefit. Conclusions The novel proposed nomogram based on a miRNA signature is a more reliable and robust tool for predicting the OS of patients with ccRCC compared to AJCC staging system, thus, improving clinical decision-making.
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Wang CY, Yang J, Zi H, Zheng ZL, Li BH, Wang Y, Ge Z, Jian GX, Lyu J, Li XD, Ren XQ. Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy. BMC Cancer 2020; 20:10. [PMID: 31906882 PMCID: PMC6943892 DOI: 10.1186/s12885-019-6495-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background Surgery is the only way to cure gastric adenocarcinoma (GAC), and chemotherapy is the basic adjuvant management for GAC. A significant prognostic nomogram for predicting the respective disease-specific survival (DSS) rates of GAC patients who receive surgery and chemotherapy has not been established. Objective We were planning to establish a survival nomogram model for GAC patients who receive surgery and chemotherapy. Methods We identified 5764 GAC patients who had received surgery and chemotherapy from the record of Surveillance, Epidemiology, and End Results (SEER) database. About 70% (n = 4034) of the chosen GAC patients were randomly assigned to the training set, and the rest of the included ones (n = 1729) were assigned to the external validation set. A prognostic nomogram was constructed by the training set and the predictive accuracy of it was validated by the validation set. Results Based on the outcome of a multivariate analysis of candidate factors, a nomogram was developed that encompassed age at diagnosis, number of regional lymph nodes examined after surgery, number of positive regional lymph nodes, sex, race, grade, derived AJCC stage, summary stage, and radiotherapy status. The C-index (Harrell’s concordance index) of the nomogram model was some larger than that of the traditional seventh AJCC staging system (0.707 vs 0.661). Calibration plots of the constructed nomogram displayed that the probability of DSS commendably accord with the survival rate. Integrated discrimination improvement (IDI) revealed obvious increase and categorical net reclassification improvement (NRI) showed visible enhancement. IDI for 3-, 5- and 10- year DSS were 0.058, 0.059 and 0.058, respectively (P > 0.05), and NRI for 3-, 5- and 10- year DSS were 0.380 (95% CI = 0.316–0.470), 0.407 (95% CI = 0.350–0.505), and 0.413 (95% CI = 0.336–0.519), respectively. Decision curve analysis (DCA) proved that the constructed nomogram was preferable to the AJCC staging system. Conclusion The constructed nomogram supplies more credible DSS predictions for GAC patients who receive surgery and chemotherapy in the general population. According to validation, the new nomogram will be beneficial in facilitating individualized survival predictions and useful when performing clinical decision-making for GAC patients who receive surgery and chemotherapy.
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Affiliation(s)
- Chao-Yang Wang
- Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China.,Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China
| | - Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Hao Zi
- Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China
| | - Zhong-Li Zheng
- Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China
| | - Bing-Hui Li
- Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China.,Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China
| | - Yang Wang
- Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China.,Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China
| | - Zheng Ge
- Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China.,Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China
| | - Guang-Xu Jian
- Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China.,Department of ICU, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xiao-Dong Li
- Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China.,Department of Urology, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Xue-Qun Ren
- Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China. .,Institute of Evidence-Based Medicine and knowledge translation, Henan University, Kaifeng, Henan, China.
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Zhao E, Zhou C, Chen S. Prognostic nomogram based on log odds of positive lymph nodes for gastric carcinoma patients after surgical resection. Future Oncol 2019; 15:4207-4222. [PMID: 31789059 DOI: 10.2217/fon-2019-0473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To build a prognostic nomogram based on log odds of positive lymph nodes for patients with gastric carcinoma (GC) after resection, and to compare the predictive performance with the American Joint Committee on Cancer (AJCC) staging system and lymph node ratio (LNR). Methods: Multivariate analyses were performed to identify the independent variables for cancer-specific survival (CSS). A nomogram was constructed based on independent clinicopathological factors. Results: The C-indices for predicting CSS were 0.674 in development cohort and 0.647 in validation cohort, which were higher than that of the AJCC staging system and LNR. Conclusion: The nomogram was more accurate than the AJCC staging system and LNR for predicting CSS in patients undergoing resection for GC.
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Affiliation(s)
- Enfa Zhao
- Department of Structural Heart Disease, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Changli Zhou
- Department of Gastroenterology, the First Affiliated Hospital of Jilin University, Changchun 130000, PR China
| | - Shimin Chen
- Department of Gastroenterology, the First Clinical Medical School of Shaanxi University of Chinese Medicine, Xianyang, 712000, PR China
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Xia A, Chen Y, Chen J, Pan Y, Bao L, Gao X. Prognostic value of the albumin-to-alkaline phosphatase ratio on urologic outcomes in patients with non-metastatic renal cell carcinoma following curative nephrectomy. J Cancer 2019; 10:5494-5503. [PMID: 31632493 PMCID: PMC6775680 DOI: 10.7150/jca.34029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Few studies focused on the relationship between the albumin-to-alkaline phosphatase ratio (AAPR) and the urologic outcomes in patients with non-metastatic renal cell carcinoma (RCC) following curative surgery. The aim of this study was to evaluate the prognostic value of preoperative AAPR in non-metastatic RCC patients. Methods: The prognostic value of AAPR was evaluated in a primary cohort with 419 non-metastatic RCC patients following curative radical or partial nephrectomy and then further validated in an independent cohort consisting of 204 patients. A nomogram was developed based on the independent predictors, and its predictive value was assessed. Results: Kaplan-Meier survival analysis demonstrated that patients with low AAPR levels were significantly associated with worse overall survival (OS) and cancer-specific survival (CSS) compared with patients with high AAPR levels both in two cohorts. Univariate and multivariate analyses revealed that low AAPR was an independent risk factor for OS (HR = 2.745; 95%CI, 1.266-5.953; P = 0.011) and CSS (HR = 3.042; 95%CI, 1.278-7.243; P = 0.012). Moreover, subgroup analysis (Fuhrman grade G1+G2 and Fuhrman grade G3+G4; T1+T2 stage and T3+T4 stage) revealed that low AAPR was also related to worse urological outcomes. Although no significant differences between patients with low AAPR and patients with high AAPR can be observed with regard to CSS under Fuhrman grade G1+G2 (P=0.058) and T1+T2 stage (P=0.318), there was a worse CSS trend in low AAPR patients. The established nomograms for OS and CSS were well calibrated and had moderate discriminative ability (concordance index: 0.821 and 0.839, respectively) Conclusions: Preoperative AAPR might be an independent prognostic factor in patients with non-metastatic RCC. The ratio should be applied in RCC patients for risk stratification and clinical decision-making.
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Affiliation(s)
- Aidan Xia
- Department of Hematology, The Third Clinical Institute Affiliated to Wenzhou Medical University, People's Hospital of Wenzhou, Wenzhou, Zhejiang province, 325006, P.R. China
| | - Yuming Chen
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu province, 225001, P.R. China
| | - Jingfeng Chen
- Department of Anorectal surgery, sixth affiliated hospital of Wenzhou medical university (Lishui People's Hospital), Lishui, Zhejiang province, 323000, P.R. China
| | - Yue Pan
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang province,325006, P.R. China
| | - Lianmin Bao
- Department of Respiratory, Rui'an People's Hospital, The Third Affiliated Hospital of the Wenzhou Medical University, Wenzhou, Zhejiang province, 325200, P.R. China
| | - Xiaomin Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, P.R. China
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Liao X, Qiu S, Zheng X, Ai J, Jin X, Gong L, Bao Y, Jin K, Li H, Yang L, Wei Q. Lymph Node Density as an Independent Prognostic Factor in Node-Positive Renal-Cell Carcinoma: Results From the Surveillance, Epidemiology, and End Results Program. Clin Genitourin Cancer 2019; 17:e968-e980. [PMID: 31229458 DOI: 10.1016/j.clgc.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous studies have revealed lymph node density (LND) to be an independent prognostic factor in cancer. However, data from 20 years ago failed to demonstrate the prognostic value of LND in node-positive renal-cell carcinoma (RCC). This study was undertaken to comprehensively investigate the prognostic value of LND in node-positive RCC. PATIENTS AND METHODS Within the Surveillance, Epidemiology and End Results database, we accessed data on patients diagnosed with histologically confirmed node-positive RCC from 2004 to 2014. The cubic spline smoothing technique and Cox regression were used to evaluate the correlation between LND and cancer-specific mortality (CSM). The X-Tile program was used to identify the optimal cut point of LND in node-positive RCC. Robustness of the results in various subgroups was also explored. Univariable and multivariable analyses were performed to determine predictors of CSM. Sensitivity analyses were performed. RESULTS A total of 1750 node-positive RCCs were identified. We found a nonlinear positive correlation between the likelihood of CSM and LND. X-Tile analysis identified best cut point of LND as 35% with a maximum chi-square of 18.58. Every 10% increase in LND increased CSM by 5% (hazard ratio = 1.05; 95% confidence interval, 1.02-1.07; P < .0001), and LND ≥ 35% was associated with 41% increase in CSM (hazard ratio = 1.41; 95% confidence interval, 1.20-1.65; P < .0001) in fully adjusted Cox regression. Results of sensitivity analyses were consistent with those of the primary analysis. CONCLUSION LND is an independent prognostic factor in node-positive RCC and should be incorporated into the cancer staging system.
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Affiliation(s)
- Xinyang Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China; Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaonan Zheng
- West China Medical School, Sichuan University, Chengdu, Sichuan, PR China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xi Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lina Gong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Kun Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Huifang Li
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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