Analysis of risk factors for liver metastasis in gastric cancer and construction of prediction model

doi:10.3877/cma.j.issn.1674-3946.2023.04.008

Abstract

Abstract:

Objective

By retrospective analysis of clinical data of patients with single-center gastric cancer，independent risk factors for liver metastasis of gastric cancer were obtained，and a Nomogram prediction model was established.

Methods

Eighty-five patients with gastric cancer with liver metastasis（GCLM）from January 1，2010 to December 31，2020，and 536 patients without liver metastasis who underwent radical gastrectomy from January 1，2015 to December 31，2015 were included in the study. Statistical software SPSS 22.0 and R 3.6.3 were used for data analysis. Univariate and multifactor Logistic regression and ROC curve were applied，and the results of multifactor analysis were visualized by Nomogram. P<0.1 was considered statistically significant.

Results

Tumor location，N stage，age，sex，degree of tumor differentiation，neutrophil-lymphocyte ratio（NLR），CEA，CA125，CA242 were independent risk factors for liver metastasis of gastric cancer，and a Nomogram was established（C=0.911，95%CI：0.880-0.958）.

Conclusions

By introducing tumor location classification，neutrophil-lymphocyte ratio（NLR），platelet-lymphocyte ratio（PLR）and other systemic inflammatory response indicators，and nutritional indicators prognostic nutrition index（OPNI），we determined the risk factors for liver metastasis of gastric cancer and established a predictive Nomogram model to provide a reference for clinical prediction of liver metastasis of gastric cancer.

Key words: Stomach Neoplasms, Neoplasm Metastasis, Logistic Models, Nomograms, Risk Factors

Heng Yu, Xiaofeng Lu, Peng Song, Yonghuan Mao, Feng Sun, Shichao Ai, Feng Wang, Liang Tao, Qiongyuan Hu, Meng Wang, Song Liu, Qiong Wang, Xiaofei Shen, Wenxian Guan. Analysis of risk factors for liver metastasis in gastric cancer and construction of prediction model[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 375-379.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2023.04.008

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References 16

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临床资料	无肝转移（n=536）	伴肝转移(n=85）	P值
年龄	62.8(55.6,69.5)	66(60,7)	<0.010
≤65	303(56.6)	13(15.3)
>65	233(43.5)	72(84.7)
性别			0.010
女	138(25.7)	37(43.5)
男	398(74.3)	48(56.5)
肿瘤位置			<0.010
胃底贲门与胃体小弯	265(49.4)	57(67.1)
胃体大弯	88(16.4)	7(8.2)
胃窦大小弯及幽门	183(34.2)	21(24.7)
T分期			<0.010
T₁	132(24.6)	0(0.0)
T₂	67(12.5)	2(2.4)
T₃	231(43.1)	59(69.4)
T₄	106(19.8)	24(28.2)
N分期			<0.010
N₀	201(37.5)	5(5.9)
N₁	96(17.9)	13(15.3)
N₂	79(14.7)	26(30.6)
N₃	160(29.9)	41(48.2)
分化程度			<0.010
低分化	390(72.8)	50(58.8)
中分化	99(18.5)	35(41.2)
高分化	47(8.7)	0(0.0)
CEA	2.3(1.3,3.5)	3.3(1.91,11.2)	<0.010
≤10 ng/ml	516(96.3)	63(74.1)
>10 ng/ml	20(3.7)	22(25.9)
AFP	1.7(0.9,3.0)	4.9(2.0,20.2)	<0.010
≤10 ng/ml	495(92.4)	52(61.2)
>10 ng/ml	41(7.6)	33(38.8)
CA125	8(5.3,11.6)	13.2(8.3,21.8)	<0.010
≤30.2 U/ml	516(96.3)	68(80.0)
>30.2 U/ml	20(3.7)	17(20.0)
CA242	4.2(2.8,7.6)	9.62(3.74,41)	<0.010
≤10 U/ml	444(82.8)	43(50.6)
>10 U/ml	92(17.2)	42(49.4)
CA199	10.4(6.7,17.6)	19.2(9.1,151.8)	<0.010
≤27 U/ml	447(83.4)	48(56.5)
>27 U/ml	89(16.6)	37(43.5)
CA724	1.8(1.1,3.8)	3.3(1.4,10.2)	<0.010
≤6.9 U/ml	464(86.6)	57(67.1)
>6.9 U/ml	72(13.4)	28(32.9)
OPNI	46.9(43.8,49.7)	44.7(41.1,47.7)	<0.010
PLR	116.5(89.4,153.0)	140.9(105.6,201.4)	<0.010
NLR	2(1.5,2.6)	2.7(2.1,3.6)	<0.010

临床资料	无肝转移（n=536）	伴肝转移(n=85）	P值
年龄	62.8(55.6,69.5)	66(60,7)	<0.010
≤65	303(56.6)	13(15.3)
>65	233(43.5)	72(84.7)
性别			0.010
女	138(25.7)	37(43.5)
男	398(74.3)	48(56.5)
肿瘤位置			<0.010
胃底贲门与胃体小弯	265(49.4)	57(67.1)
胃体大弯	88(16.4)	7(8.2)
胃窦大小弯及幽门	183(34.2)	21(24.7)
T分期			<0.010
T₁	132(24.6)	0(0.0)
T₂	67(12.5)	2(2.4)
T₃	231(43.1)	59(69.4)
T₄	106(19.8)	24(28.2)
N分期			<0.010
N₀	201(37.5)	5(5.9)
N₁	96(17.9)	13(15.3)
N₂	79(14.7)	26(30.6)
N₃	160(29.9)	41(48.2)
分化程度			<0.010
低分化	390(72.8)	50(58.8)
中分化	99(18.5)	35(41.2)
高分化	47(8.7)	0(0.0)
CEA	2.3(1.3,3.5)	3.3(1.91,11.2)	<0.010
≤10 ng/ml	516(96.3)	63(74.1)
>10 ng/ml	20(3.7)	22(25.9)
AFP	1.7(0.9,3.0)	4.9(2.0,20.2)	<0.010
≤10 ng/ml	495(92.4)	52(61.2)
>10 ng/ml	41(7.6)	33(38.8)
CA125	8(5.3,11.6)	13.2(8.3,21.8)	<0.010
≤30.2 U/ml	516(96.3)	68(80.0)
>30.2 U/ml	20(3.7)	17(20.0)
CA242	4.2(2.8,7.6)	9.62(3.74,41)	<0.010
≤10 U/ml	444(82.8)	43(50.6)
>10 U/ml	92(17.2)	42(49.4)
CA199	10.4(6.7,17.6)	19.2(9.1,151.8)	<0.010
≤27 U/ml	447(83.4)	48(56.5)
>27 U/ml	89(16.6)	37(43.5)
CA724	1.8(1.1,3.8)	3.3(1.4,10.2)	<0.010
≤6.9 U/ml	464(86.6)	57(67.1)
>6.9 U/ml	72(13.4)	28(32.9)
OPNI	46.9(43.8,49.7)	44.7(41.1,47.7)	<0.010
PLR	116.5(89.4,153.0)	140.9(105.6,201.4)	<0.010
NLR	2(1.5,2.6)	2.7(2.1,3.6)	<0.010

预测变量	曲线下面积(AUC)	95%置信区间(CI)	cut-off值
OPNI	0.648	0.586-0.710	42.650
PLR	0.634	0.571-0.698	126.710
NLR	0.704	0.647-0.760	2.215
CEA	0.655	0.587-0.723	4.650
AFP	0.738	0.676-0.799	4.855
CA125	0.720	0.664-0.776	13.050
CA242	0.667	0.595-0.739	10.675
CA199	0.642	0.566-0.718	26.315
CA724	0.623	0.553-0.694	5.070
预测变量	灵敏度	特异度	P值
OPNI	0.424	0.815	<0.010
PLR	0.635	0.591	<0.010
NLR	0.718	0.618	<0.010
CEA	0.388	0.882	<0.010
AFP	0.506	0.866	<0.010
CA125	0.518	0.799	<0.010
CA242	0.494	0.847	<0.010
CA199	0.447	0.832	<0.010
CA724	0.447	0.808	<0.010

预测变量	曲线下面积(AUC)	95%置信区间(CI)	cut-off值
OPNI	0.648	0.586-0.710	42.650
PLR	0.634	0.571-0.698	126.710
NLR	0.704	0.647-0.760	2.215
CEA	0.655	0.587-0.723	4.650
AFP	0.738	0.676-0.799	4.855
CA125	0.720	0.664-0.776	13.050
CA242	0.667	0.595-0.739	10.675
CA199	0.642	0.566-0.718	26.315
CA724	0.623	0.553-0.694	5.070
预测变量	灵敏度	特异度	P值
OPNI	0.424	0.815	<0.010
PLR	0.635	0.591	<0.010
NLR	0.718	0.618	<0.010
CEA	0.388	0.882	<0.010
AFP	0.506	0.866	<0.010
CA125	0.518	0.799	<0.010
CA242	0.494	0.847	<0.010
CA199	0.447	0.832	<0.010
CA724	0.447	0.808	<0.010

参数	单因素分析
参数	OR值	P值	95%置信区间（CI）
肿瘤位置	0.370	0.020	0.160-0.840
T分期	2.668	0.102	0.910-2.530
N分期	10.300	<0.010	3.980-26.670
年龄	7.200	<0.010	3.890-13.320
性别	0.450	<0.010	0.280-0.720
分化程度	2.760	0.017	1.700-4.480
OPNI	0.310	<0.010	0.190-0.500
PLR	2.520	<0.010	1.570-4.050
NLR	4.100	0.020	2.480-6.790
CEA	9.010	<0.010	4.660-17.430
AFP	7.660	0.012	4.460-13.150
CA125	6.450	<0.010	3.220-12.910
CA242	4.710	0.010	2.910-7.620
CA199	3.870	0.671	2.380-6.290
CA724	3.170	<0.010	1.890-5.300
参数	多因素分析
参数	OR值	P值	95% 置信区间（CI）
肿瘤位置	0.206	<0.010	0.070-0.830
T分期	-	-	-
N分期	3.990	0.030	1.160-15.530
年龄	4.830	<0.010	2.250-11.370
性别	0.260	<0.010	0.120-0.540
分化程度	3.410	0.012	1.630-7.250
OPNI	0.660	0.280	0.310-1.400
PLR	1.110	0.800	0.500-2.480
NLR	2.320	0.040	0.830-5.190
CEA	8.740	<0.010	2.710-28.850
AFP	1.540	0.470	0.460-4.940
CA125	2.440	0.080	0.910-6.600
CA242	2.930	0.030	1.070-7.980
CA199	-	-	-
CA724	1.170	0.760	0.420-3.050

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