Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 396-408
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.396
Development of a clinical nomogram for prediction of response to neoadjuvant chemotherapy in patients with advanced gastric cancer
Bing Liu, Yu-Jie Xu, Feng-Ran Chu, Guang Sun, Guo-Dong Zhao, Sheng-Zhong Wang
Bing Liu, Yu-Jie Xu, Guang Sun, Guo-Dong Zhao, Sheng-Zhong Wang, Department of Gastrointestinal Surgery, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, Hainan Province, China
Feng-Ran Chu, Clinical College, Hainan Medical University, Haikou 571199, Hainan Province, China
Co-first authors: Bing Liu and Yu-Jie Xu.
Co-corresponding authors: Sheng-Zhong Wang and Guo-Dong Zhao.
Author contributions: Liu B and Xu YJ contributed to paper writing and data analysis; Chu FR revised the manuscript; Sun G contributed to data collection; Wang SZ and Zhao GD contributed to supervision and paper revision; Liu B was in charge of proposing the research ideas, setting the overall research objectives, preparing, creating, and describing the works to be published, and writing the first draft; Xu YJ was responsible for verifying the paper data, writing computer code and supporting algorithms, testing the existing code components, creating models, and proposing improvements of the paper design and for statistical analysis; Wang SZ supervised and led the planning and execution of research activities, the revision of manuscript content, especially the critical commentary and revision, and the polishing of manuscript language; Zhao GD improved the design of the paper, checked the authenticity of the data, verified the overall reusability of the conclusions, experiments, and other contents of the research results, and provided financial support for the publication project. Considering the significant contributions made by Liu B, Xu YJ, Wang SZ, and Zhao GD to this paper, all authors unanimously agreed to designate Liu B and Xu YJ as the co-first authors and Wang SZ and Zhao GD as the co-corresponding authors.
Supported by Natural Science Foundation of Hainan Province, No. 823RC609.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Central South University Xiangya School of Medicine Affiliated Haikou Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Data sharing statement: The data that support the results of this research is available on request from the corresponding author. Considering privacy or ethical restrictions, the data is not publicly available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Zhong Wang, Doctor, Additional Professor, Department of Gastrointestinal Surgery, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, No. 43 Renmin Avenue, Meilan District, Haikou 570208, Hainan Province, China. shengzhong323@163.com
Received: August 25, 2023
Peer-review started: August 25, 2023
First decision: September 29, 2023
Revised: November 5, 2023
Accepted: January 19, 2024
Article in press: January 19, 2024
Published online: February 27, 2024
Abstract
BACKGROUND

The efficacy of neoadjuvant chemotherapy (NAC) in advanced gastric cancer (GC) is still a controversial issue.

AIM

To find factors associated with chemosensitivity to NAC treatment and to provide the optimal therapeutic strategies for GC patients receiving NAC.

METHODS

The clinical information was collected from 230 GC patients who received NAC treatment at the Central South University Xiangya School of Medicine Affiliated Haikou Hospital from January 2016 to December 2020. Least absolute shrinkage and selection operator logistic regression analysis was used to find the possible predictors. A nomogram model was employed to predict the response to NAC.

RESULTS

In total 230 patients were finally included in this study, including 154 males (67.0%) and 76 females (33.0%). The mean age was (59.37 ± 10.60) years, ranging from 24 years to 80 years. According to the tumor regression grade standard, there were 95 cases in the obvious response group (grade 0 or grade 1) and 135 cases in the poor response group (grade 2 or grade 3). The obvious response rate was 41.3%. Least absolute shrinkage and selection operator analysis showed that four risk factors significantly related to the efficacy of NAC were tumor location (P < 0.001), histological differentiation (P = 0.001), clinical T stage (P = 0.008), and carbohydrate antigen 724 (P = 0.008). The C-index for the prediction nomogram was 0.806. The calibration curve revealed that the predicted value exhibited good agreement with the actual value. Decision curve analysis showed that the nomogram had a good value in clinical application.

CONCLUSION

A nomogram combining tumor location, histological differentiation, clinical T stage, and carbohydrate antigen 724 showed satisfactory predictive power to the response of NAC and can be used by gastrointestinal surgeons to determine the optimal treatment strategies for advanced GC patients.

Keywords: Advanced gastric cancer, Predictor, Neoadjuvant chemotherapy, Nomogram, Tumor regression grade

Core Tip: Clinical information was collected from 230 gastric cancer patients who received neoadjuvant chemotherapy (NAC) from January 2016 to December 2020. Least absolute shrinkage and selection operator logistic regression analysis was performed to find the possible predictors for a nomogram model for prediction of response to NAC. The nomogram combining tumor location, histological differentiation, clinical T stage, and carbohydrate antigen 724 showed satisfactory predictive power to response of NAC and could be used by gastrointestinal surgeons to identify an optimal treatment strategy for advanced gastric cancer patients.