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Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer
BACKGROUND: Occult peritoneal metastasis (PM) in advanced gastric cancer (AGC) patients is highly possible to be missed on computed tomography (CT) images. Patients with occult PMs are subject to late detection or even improper surgical treatment. We therefore aimed to develop a radiomic nomogram to...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442651/ https://www.ncbi.nlm.nih.gov/pubmed/30689702 http://dx.doi.org/10.1093/annonc/mdz001 |
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author | Dong, D Tang, L Li, Z -Y Fang, M -J Gao, J -B Shan, X -H Ying, X -J Sun, Y -S Fu, J Wang, X -X Li, L -M Li, Z -H Zhang, D -F Zhang, Y Li, Z -M Shan, F Bu, Z -D Tian, J Ji, J -F |
author_facet | Dong, D Tang, L Li, Z -Y Fang, M -J Gao, J -B Shan, X -H Ying, X -J Sun, Y -S Fu, J Wang, X -X Li, L -M Li, Z -H Zhang, D -F Zhang, Y Li, Z -M Shan, F Bu, Z -D Tian, J Ji, J -F |
author_sort | Dong, D |
collection | PubMed |
description | BACKGROUND: Occult peritoneal metastasis (PM) in advanced gastric cancer (AGC) patients is highly possible to be missed on computed tomography (CT) images. Patients with occult PMs are subject to late detection or even improper surgical treatment. We therefore aimed to develop a radiomic nomogram to preoperatively identify occult PMs in AGC patients. PATIENTS AND METHODS: A total of 554 AGC patients from 4 centers were divided into 1 training, 1 internal validation, and 2 external validation cohorts. All patients’ PM status was firstly diagnosed as negative by CT, but later confirmed by laparoscopy (PM-positive n = 122, PM-negative n = 432). Radiomic signatures reflecting phenotypes of the primary tumor (RS1) and peritoneum region (RS2) were built as predictors of PM from 266 quantitative image features. Individualized nomograms of PM status incorporating RS1, RS2, or clinical factors were developed and evaluated regarding prediction ability. RESULTS: RS1, RS2, and Lauren type were significant predictors of occult PM (all P < 0.05). A nomogram of these three factors demonstrated better diagnostic accuracy than the model with RS1, RS2, or clinical factors alone (all net reclassification improvement P < 0.05). The area under curve yielded was 0.958 [95% confidence interval (CI) 0.923–0.993], 0.941 (95% CI 0.904–0.977), 0.928 (95% CI 0.886–0.971), and 0.920 (95% CI 0.862–0.978) for the training, internal, and two external validation cohorts, respectively. Stratification analysis showed that this nomogram had potential generalization ability. CONCLUSION: CT phenotypes of both primary tumor and nearby peritoneum are significantly associated with occult PM status. A nomogram of these CT phenotypes and Lauren type has an excellent prediction ability of occult PM, and may have significant clinical implications on early detection of occult PM for AGC. |
format | Online Article Text |
id | pubmed-6442651 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-64426512019-04-04 Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer Dong, D Tang, L Li, Z -Y Fang, M -J Gao, J -B Shan, X -H Ying, X -J Sun, Y -S Fu, J Wang, X -X Li, L -M Li, Z -H Zhang, D -F Zhang, Y Li, Z -M Shan, F Bu, Z -D Tian, J Ji, J -F Ann Oncol Original Articles BACKGROUND: Occult peritoneal metastasis (PM) in advanced gastric cancer (AGC) patients is highly possible to be missed on computed tomography (CT) images. Patients with occult PMs are subject to late detection or even improper surgical treatment. We therefore aimed to develop a radiomic nomogram to preoperatively identify occult PMs in AGC patients. PATIENTS AND METHODS: A total of 554 AGC patients from 4 centers were divided into 1 training, 1 internal validation, and 2 external validation cohorts. All patients’ PM status was firstly diagnosed as negative by CT, but later confirmed by laparoscopy (PM-positive n = 122, PM-negative n = 432). Radiomic signatures reflecting phenotypes of the primary tumor (RS1) and peritoneum region (RS2) were built as predictors of PM from 266 quantitative image features. Individualized nomograms of PM status incorporating RS1, RS2, or clinical factors were developed and evaluated regarding prediction ability. RESULTS: RS1, RS2, and Lauren type were significant predictors of occult PM (all P < 0.05). A nomogram of these three factors demonstrated better diagnostic accuracy than the model with RS1, RS2, or clinical factors alone (all net reclassification improvement P < 0.05). The area under curve yielded was 0.958 [95% confidence interval (CI) 0.923–0.993], 0.941 (95% CI 0.904–0.977), 0.928 (95% CI 0.886–0.971), and 0.920 (95% CI 0.862–0.978) for the training, internal, and two external validation cohorts, respectively. Stratification analysis showed that this nomogram had potential generalization ability. CONCLUSION: CT phenotypes of both primary tumor and nearby peritoneum are significantly associated with occult PM status. A nomogram of these CT phenotypes and Lauren type has an excellent prediction ability of occult PM, and may have significant clinical implications on early detection of occult PM for AGC. Oxford University Press 2019-03 2019-01-23 /pmc/articles/PMC6442651/ /pubmed/30689702 http://dx.doi.org/10.1093/annonc/mdz001 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Dong, D Tang, L Li, Z -Y Fang, M -J Gao, J -B Shan, X -H Ying, X -J Sun, Y -S Fu, J Wang, X -X Li, L -M Li, Z -H Zhang, D -F Zhang, Y Li, Z -M Shan, F Bu, Z -D Tian, J Ji, J -F Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer |
title | Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer |
title_full | Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer |
title_fullStr | Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer |
title_full_unstemmed | Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer |
title_short | Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer |
title_sort | development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442651/ https://www.ncbi.nlm.nih.gov/pubmed/30689702 http://dx.doi.org/10.1093/annonc/mdz001 |
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