基于新辅助化疗前CT影像组学的列线图预测进展期胃腺癌远期疗效

目的：开发和验证一种新型列线图模型预测进展期胃腺癌患者远期预后。方法：回顾性分析2010年1月至2018年12月在福建医科大学附属协和医院132例及青海大学附属医院45例接受新辅助化疗后行根治性切除术的胃腺癌患者临床资料。基于新辅助化疗前CT影像组学评分（CT-RS）构建列线图模型（RS-CN），并通过ROC曲线下面积（AUC）,Time-ROC曲线，Cindex评估RS-CN的预测能力。结果：训练队列中，RS-CN预测胃腺癌患者总体生存率的C-Index为0.72,AUC显著优于TRG分级（P=0.019），且与ypTNM分期相当（P=0.786）。Time-ROC曲线显示在各个时间段RS-CN预测总体生存能力始终优于TRG分级及ypTNM分期。外部验证队列中得到相同的结果。进一步分析，低风险组（RS-CN<288.4）患者3年总生存（overall survival,OS）及无病生存（disease-free survival,DFS）均显著优于高风险组（RS-CN≥288.4），但高风险组进行术后辅助化疗3年DFS显著提高（P<0.05）,3年OS (P=0.099)...

Computed tomography radiomics-based nomogram before neoadjuvant chemotherapy predicts long-term efficacy in advanced gastric cancer

  Objective  Development and validation of a novel nomogram model to predict the long-term prognosis of patients with advanced gastric cancer.   Methods  We conducted a retrospective analysis of clinical and follow-up data taken from patients at Fujian Medical University Union Hospital (132 cases) and the Affiliated Hospital of Qinghai University (45 cases) who underwent NAC followed by radical gastrectomy from January 2010 to December 2018. A radiomic signatures clinical nomogram (RS-CN) was established based on CT-RS. The prediction performance of the RS-CN was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC values), time-dependent ROC, and C-index.  Results  In the training cohort, RS-CN yielded good predictive performance for OS in AGC patients as evaluated using C-Index (0.72); the AUC of RS-CN was significantly better than that of TRG classification (P=0.019) and was comparative to ypTNM stage (P=0.786). The validation cohort yielded similar outcomes. In both the training and validation cohorts, time-dependent ROC curves showed that RS-CN consistently outperformed TRG classification and ypTNMstage. The 3-year overall survival (OS) and disease-free survival (DFS) of patients in the low-risk group (RS-CN score ≤288.4) was significantly better than that of patients in the high-risk group (RS-CN score >288.4). Adjuvant chemotherapy (AC) significantly improved 3-year DFS in only the high-risk group (both P<0.05) but did not cause significant differences in 3-year OS (P=0.099).  Conclusions  Compared with traditional ypTNM staging, our study developed nomogram based on CT-RS before NAC can help identify patients who may benefit from NAC and AC, providing a guide to facilitate precise NAC for AGC.