Development and validation of prognostic nomograms for pseudomyxoma peritonei patients after surgery

Abstract

Background: The aim of study was to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) of patients with pseudomyxoma peritonei (PMP) and compare the predictive accuracy with the American Joint Committee on Cancer (AJCC) staging system. Methods: Data of 4959 PMP patients who underwent surgical resection were collected between 2004 and 2015 from the Surveillance Epidemiology and End Results (SEER) database. All included patients were divided into training (n = 3307) and validation (n = 1652) cohorts. The Kaplan–Meier method and Cox proportional hazard model were applied. Nomograms were validated by discrimination and calibration. Finally, concordance index (C-index) was used to compare the predictive performance of nomograms with that of the AJCC staging system. Results: According to the univariate and multivariate analyses of training sets, both nomograms for predicting OS and CSS combining age, grade, location, N stage, M stage, and chemotherapy were identified. Nomograms predicting OS also incorporated T stage and the number of lymph nodes removed (LNR). The calibration curves showed good consistency between predicted and actual observed survival. Moreover, C-index values demonstrated that the nomograms predicting both OS and CSS were superior to the AJCC staging system in both cohorts. Conclusion: We successfully developed and validated prognostic nomograms for predicting OS and CSS in PMP patients. Two nomograms were more accurate and applicable than the AJCC staging system for predicting patient survival, which may help clinicians stratify patients into different risk groups, tailor individualized treatment, and accurately predict patient survival in PMP.

Nomogram to predict overall survival of patients with pseudomyxoma peritonei of appendiceal origin: A retrospective cohort study

“…A former study 13 developed a favorable nomogram for predicting survival in PMP patients, with a C-index of 0.757 in the training cohort; meanwhile, the present research established a nomogram with a C-index of 0.825, which seems to offer a better predictive ability than that of the former study. The main reason for this difference may be that the variables included in the prediction model were different between these two studies.…”

“…The main reason for this difference may be that the variables included in the prediction model were different between these two studies. The former investigation 13 was based on data from the SEER database, and some positive clinicopathological characteristics associated with prognosis were not available in the SEER database and thus could not be incorporated into the study analysis. However, our nomogram was developed based on our single‐center follow‐up database; so, the candidate predictors were relatively more comprehensive.…”

“…The long-term outcomes after treatment are impressive for patients with PMP, nevertheless, there's still a signi cant recurrence of the disease. [5,6] It has been con rmed that there are many factors related to the prognosis of PMP, for instense, sex [7], extent of previous surgery [8], histopathological grade of tumor, tumor marker levels [9], degree of radical surgery [1], and so on, among of tumor markers, CA19-9, CEA, and CA125 had been widely veri ed. [10] examined, If any discomfort occurs during discharge, the patient should return to the hospital at any time.…”

“…It has been confirmed that many factors—for instance, male sex, 6 high tumor marker levels, 7,8 high‐grade mucinous carcinoma peritonei (especially with signet ring cells), 9,10 debulking surgery, 11 and even KRAS mutation 12 —were all independently associated with poor prognosis in PMP. A recent study constructed a nomogram to predict the OS for PMP patients based on large‐scale population data from the Surveillance, Epidemiology and End Results (SEER) program database, where the C ‐index was 0.757 in the training cohort and 0.746 in the validation cohort 13 . To our knowledge, this is the first established prognostic nomogram for PMP; however, because this nomogram was constructed using a population‐based cancer database, the availability of predictive factors is limited and some bioinformatics factors, such as tumor markers, that have been proven to be predictive for PMP patients were not included in the study.…”

Survival prediction by Bayesian network modeling for pseudomyxoma peritonei after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy

“…The nomogram is a graphical representation that has been used to predict cancer survival in recent years. Two studies 27 , 28 had developed nomograms for predicting survival in PMP patients. Chen et al 27 performed a nomogram to predict OS incorporated with age, grade, location, T stage, N stage, M stage, lymph node removed and chemotherapy.…”