Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab

作者：Custodio A^*; Carmona Bayonas A; Jimenez Fonseca P; Sanchez M L; Viudez A; Hernandez R; Cano J M; Echavarria I; Pericay C; Mangas M; Visa L; Buxo E; Garcia T; Rodriguez Palomo A; Alvarez Mancenido F; Lacalle A; Macias I; Azkarate A; Ramchandani A; Fernandez Montes A; Lopez C; Longo F; Sanchez Bayona R; Limon M L; Diaz Serrano A; Hurtado A; Madero R; Gomez C; Gallego J

来源：British Journal of Cancer, 2017, 116(12): 1526-1535.

DOI：10.1038/bjc.2017.122

• advanced oesophagogastric adenocarcinoma
• polychemotherapy
• HER2
• overall survival
• nomogram
• web-based calculator

Background: To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy.
Methods: Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination.
Results: The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5-6.6), 9.4 (95% CI, 8.5-10.6), and 14 months (95% CI, 11.8-16) for high-, intermediate-, and low-risk groups, respectively (Po0.001), in the derivation set and 4.6 (95% CI, 3.3-8.1), 12.7 (95% CI, 11.3-14.3), and 18.3 months (95% CI, 14.6-24.2) for high-, intermediate-, and low-risk groups, respectively (Po0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591-0.631) and 0.673 (95% CI, 0.636-0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index = 0.583; P = 0.00046) and Japan Clinical Oncology Group prognostic indices (c-index = 0.611; P = 0.03351).
Conclusions: We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design.

• 出版日期2017-6-6