Abstract:

Objective

To investigate the predictive effect of constructing a nomogram model based on inflammatory response scoring system to predict the prognosis of all esophageal and gastric nodular adenocarcinoma patients after radical surgery.

Methods

A retrospective case-series analysis + cohort study of 364 patients with AEG who underwent radical surgery from January 2013 to November 2020.The patients were randomly divided into a training cohort (n=182 cases) and a validation cohort (n=182 cases) in a 1:1 ratio using a computer random number generator.Multivariate COX regression was used to screen potential independent prognostic factors of AEG, and a column graph was constructed to predict 3-year overall survival (OS) rate of AEG patients.Bootstrapping method was used for internal cross-validation to evaluate the accuracy of the nomogram.Combining the training cohort with the validation cohort, the Harrell method was used to evaluate the differentiation performance of the nomogram model, and the calibration curve, receiver operating characteristic(ROC) curve and decision making (DCA) curve were drawn to further evaluate the prediction ability of the model.The scores of all patients were calculated according to the constructed column graph model, and the optimal cut-off value of the scores was obtained through X-tile software.The overall cohort, training cohort and verification cohort were divided into high-risk group (≥optimal cut-off value) and low-risk group (＜optimal cut-off value) according to the optimal cut-off value.Kaplan-Meier analysis of 3-year OS was performed in high and low risk groups of each cohort.

Results

In the training cohort, 73 patients died and 109 survived.There were significant differences in BMI, TNM stage, T stage, N stage, maximum tumor diameter, vascular invasion,nerve invasion, D-dimer, NLR, PLR and AFR between the two groups (P＜0.05).According to the NPA-IRS scoring system, the OS rate of AEG patients with different scores showed a certain grade trend difference (χ²=24.583,P＜0.001).Multivariate COX regression analysis showed that D-dimer, nerve infiltration, TNM stage, N stage and NPA-IRS scoring system were independent risk factors for the prognosis of AEG patients (P＜0.05).Calibration curves of internal verification and external verification showed that the nomogram prediction was in good agreement with the reality.The time ROC curve showed that the model had good prediction performance (AUC of internal verification was 0.858 and AUC of external verification was 0.789).Kaplan-Meier analysis showed that the nomogram prediction model had good OS risk stratification performance.

Conclusions

The prediction model based on D-dimer, nerve infiltration, TNM stage, N stage and NPA-IRS scoring system can provide an important basis for the prognosis assessment of AEG patients.

Key words: Adenocarcinoma of the Esophagogastric Junction, Prognosis, Inflammation, Nomograms