Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2020; 26(19): 2427-2439
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2427
Nomogram for predicting pathological complete response to neoadjuvant chemotherapy in patients with advanced gastric cancer
Yong-He Chen, Jian Xiao, Xi-Jie Chen, Hua-She Wang, Dan Liu, Jun Xiang, Jun-Sheng Peng
Yong-He Chen, Xi-Jie Chen, Hua-She Wang, Jun Xiang, Jun-Sheng Peng, Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Yong-He Chen, Xi-Jie Chen, Hua-She Wang, Jun Xiang, Jun-Sheng Peng, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, Guangdong Province, China
Jian Xiao, Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Dan Liu, Department of Laboratory Science, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510655, Guangdong Province, China
Author contributions: Peng JS and Chen YH designed the study; Chen YH, Xiao J and Chen XJ contributed equally in acquiring, analyzing and interpreting the data and drafted the initial manuscript; Wang HS, Liu D and Xiang J revised the article critically for important intellectual content; Chen YH, Xiao J and Chen XJ contributed equally to this work.
Supported by the Guangzhou Science and Technology Project, No. 201803010040; Natural Science Foundation of Guangdong Province, No. 2016A030310187; and Nation Key Clinical Discipline.
Institutional review board statement: The study was reviewed and approved by The Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou).
Informed consent statement: All study participants, or their legal guardian, were provided with informed consent prior to study by the follow-up office.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun-Sheng Peng, MD, Doctor, Professor, Chief, Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong Province, China. pengjsh@mail.sysu.edu.cn
Received: January 21, 2020
Peer-review started: January 21, 2020
First decision: March 6, 2020
Revised: April 23, 2020
Accepted: April 28, 2020
Article in press: April 28, 2020
Published online: May 21, 2020
Abstract
BACKGROUND

Survival benefit of neoadjuvant chemotherapy (NAC) for advanced gastric cancer (AGC) is a debatable issue. Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs. For those who achieve pathological complete response (pCR), NAC significantly prolonged prolapsed-free survival and overall survival. For those with poor response, NAC yielded no survival benefit, only toxicity and increased risk for tumor progression during chemotherapy, which may hinder surgical resection. Thus, predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.

AIM

To establish a nomogram for predicting pCR to NAC for AGC patients.

METHODS

Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study. Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR. Based on these predictors, a nomogram model was developed and internally validated using the bootstrap method.

RESULTS

pCR was confirmed in 27 patients (27/208, 13.0%). Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level, lymphocyte ratio, lower monocyte count and tumor differentiation grade were associated with higher pCR. Concordance statistic of the established nomogram was 0.767.

CONCLUSION

A nomogram predicting pCR to NAC was established. Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters, it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.

Keywords: Advanced gastric cancer, Neoadjuvant chemotherapy, Nomogram, Pathological complete response

Core tip: Pathological complete response is an important prognosis factor for advanced gastric cancer patients who underwent neoadjuvant chemotherapy and tumor resection. In our study, we built a nomogram that predicted pathological complete response to neoadjuvant chemotherapy utilizing only easily available pretreatment parameters such as carcinoembryonic antigen level, lymphocyte ratio, monocyte count and tumor differentiation grade. It showed satisfactory predictive power with an area under the receiver operating characteristic curve of 0.823 and a concordance statistic of 0.767. It can be inferred that this nomogram is practical for the development of personalized treatment strategy for advanced gastric cancer patients.