Prognosis prediction model for a special entity of gastric cancer, linitis plastica

Abstract

Background: Gastric linitis plastica (GLP) is characteristic by its poor prognosis and highly aggressive characteristics compared with other types of gastric cancer (GC). However, the guidelines have not yet been distinguished between GLP and non-GLP. Methods: A total of 342 eligible patients with GLP identified in the Surveillance, Epidemiology, and End Results (SEER) dataset were randomly divided into training set (n=298) and validation set (n=153). A nomogram would be developed with the constructed predicting model based on the training cohort's data, and the validation cohort would be used to validate the model. Principal component analysis (PCA) was used to evaluate the differences between groups. Cox regression and LASSO (least absolute shrinkage and selection operator) were used to construct the models. Calibration curve, time-dependent receiver operating characteristic (ROC) curve, concordance index (C-index) and decision curve analysis (DCA) were used to evaluate the predicting performance. Restricted mean survival time (RMST) was used to analyze the curative effect of adjuvant therapy. Results: For patients in training cohort, univariable and multivariable Cox analyses showed that age, examined lymph nodes (LN.E), positive lymph nodes (LN.P), lesion size, combined resection, and radiotherapy are independent prognostic factors for overall survival (OS), while chemotherapy can not meet the proportional hazards (PHs) assumption; age, race, lesion size, LN.E, LN.P, combined resection and marital status are independent prognostic factors for cancer-specific survival (CSS). The C-index of the nomogram was 0.678 [95% confidence interval (CI), 0.660-0.696] and 0.673 (95% CI, 0.630-0.716) in the training and validation cohort, respectively. Meanwhile, the C-index of the CSS nomogram was 0.671 (95% CI, 0.653-0.699) and 0.650 (95% CI, 0.601-0.691) in the training and validation cohort for CSS,respectively. Furthermore, the nomogram was well calibrated with satisfactory consistency. RMST analysis further determined that chemotherapy and radiotherapy might be beneficial for improving 1-and 3-year OS and CSS, but not the 5-year CSS.Conclusions: We developed nomograms to help predict individualized prognosis for GLP patients. The new model might help guide treatment strategies for patients with GLP.

The Genomic Signatures of Linitis Plastica Signal the Entrance into a New Era: Novel Approaches for Diagnosis and Treatment

“…Another approach for increasing the OS involves the simultaneous use of pharmacological ascorbate, which, in mouse models, exhibits selective cytotoxicity on cancer cells, along with oxaliplatin, resulting in better outcomes than chemotherapy alone. In a similar pattern, targets in the NAD+ pathway may prove useful in combination with radiotherapy [33]. Future perspectives include controlling immune checkpoint inhibitors, such as those blocking the interaction between PD1 and PD-L1 and utilizing viruses such as G47D, a modified Herpes simplex virus type 1, which has shown encouraging results in mouse models against solid tumors by inhibiting the growth of subcutaneous cancerous cells [33,34].…”

“…In a similar pattern, targets in the NAD+ pathway may prove useful in combination with radiotherapy [33]. Future perspectives include controlling immune checkpoint inhibitors, such as those blocking the interaction between PD1 and PD-L1 and utilizing viruses such as G47D, a modified Herpes simplex virus type 1, which has shown encouraging results in mouse models against solid tumors by inhibiting the growth of subcutaneous cancerous cells [33,34].…”