Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study
Background: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal tumor with high malignancy. The aim of this study was to comprehensively evaluate the distant metastasis pattern and establish nomograms predicting survival for SBA.Methods: From 2010 to 2015, patients diagnosed with SBA were id...
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2021.759162/full |
| _version_ | 1818402330679181312 |
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| author | Yanmei Gu Haixiao Deng Daijun Wang Yumin Li Yumin Li |
| author_facet | Yanmei Gu Haixiao Deng Daijun Wang Yumin Li Yumin Li |
| author_sort | Yanmei Gu |
| collection | DOAJ |
| description | Background: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal tumor with high malignancy. The aim of this study was to comprehensively evaluate the distant metastasis pattern and establish nomograms predicting survival for SBA.Methods: From 2010 to 2015, patients diagnosed with SBA were identified based on the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan–Meier survival analysis was applied to compare survival differences between metastasis patterns. Then, univariate and multivariate cox analyses were applied to screened out independent prognostic factors of cancer-specific survival (CSS) and overall survival (OS), and identify the risk factors for metastasis of SBA. To assess the discrimination and calibration of nomograms, the concordance index (C-index), calibration curves, receiver-operating characteristic curve (ROC), and decision curve analysis (DCA) were calculated.Results: Kaplan–Meier curves revealed that metastasis patterns were significantly correlated with CSS (p < 0.001) and OS (p < 0.001). Then, the metastasis pattern was showed to be an independent prognostic factor of OS and CSS in patients with SBA, as well as age, grade, T stage, N stage, surgery, retrieval of regional lymph nodes, and chemotherapy. Combining these factors, we constructed prognostic nomograms, which suggested that the metastasis pattern made the greatest contribution to the survival of patients with SBA. Nomograms for OS and CSS had a C-index of 0.787 and 0.793, respectively. Calibration curves showed an excellent agreement between probability and actual observation in the training and validation cohort. Decision curve analysis also exhibited its clinical value with an improved net benefit. In addition, the models we constructed had better prognostic accuracy and clinical utility than traditional TNM staging based on C-index and ROC. Further, Cox regression analysis showed that old age, poor differentiation, N2, and not receiving chemotherapy were the risk factors for prognosis in patients with metastatic SBA.Conclusion: As an independent prognostic factor, the metastasis pattern exhibited the greatest predictive effect on OS and CSS for patients with SBA. Adjuvant chemotherapy had a positive effect on the survival of patients with SBA. Nomograms for predicting 3-and 5-year OS and CSS of patients with SBA were constructed, which could identify patients with higher risk and might be superior in predicting the survival of patients with SBA than TNM staging. |
| first_indexed | 2024-12-14T08:06:39Z |
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| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-14T08:06:39Z |
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| series | Frontiers in Surgery |
| spelling | doaj.art-1b2a03e1a683486396014627ec169b092022-12-21T23:10:09ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-12-01810.3389/fsurg.2021.759162759162Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based StudyYanmei Gu0Haixiao Deng1Daijun Wang2Yumin Li3Yumin Li4Department of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, ChinaDepartment of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, ChinaDepartment of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, ChinaDepartment of General Surgery, Lanzhou University Second Hospital, The Second Clinical Medical College of Lanzhou University, Lanzhou, ChinaKey Laboratory of Digestive System Tumors of Gansu, Lanzhou, ChinaBackground: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal tumor with high malignancy. The aim of this study was to comprehensively evaluate the distant metastasis pattern and establish nomograms predicting survival for SBA.Methods: From 2010 to 2015, patients diagnosed with SBA were identified based on the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan–Meier survival analysis was applied to compare survival differences between metastasis patterns. Then, univariate and multivariate cox analyses were applied to screened out independent prognostic factors of cancer-specific survival (CSS) and overall survival (OS), and identify the risk factors for metastasis of SBA. To assess the discrimination and calibration of nomograms, the concordance index (C-index), calibration curves, receiver-operating characteristic curve (ROC), and decision curve analysis (DCA) were calculated.Results: Kaplan–Meier curves revealed that metastasis patterns were significantly correlated with CSS (p < 0.001) and OS (p < 0.001). Then, the metastasis pattern was showed to be an independent prognostic factor of OS and CSS in patients with SBA, as well as age, grade, T stage, N stage, surgery, retrieval of regional lymph nodes, and chemotherapy. Combining these factors, we constructed prognostic nomograms, which suggested that the metastasis pattern made the greatest contribution to the survival of patients with SBA. Nomograms for OS and CSS had a C-index of 0.787 and 0.793, respectively. Calibration curves showed an excellent agreement between probability and actual observation in the training and validation cohort. Decision curve analysis also exhibited its clinical value with an improved net benefit. In addition, the models we constructed had better prognostic accuracy and clinical utility than traditional TNM staging based on C-index and ROC. Further, Cox regression analysis showed that old age, poor differentiation, N2, and not receiving chemotherapy were the risk factors for prognosis in patients with metastatic SBA.Conclusion: As an independent prognostic factor, the metastasis pattern exhibited the greatest predictive effect on OS and CSS for patients with SBA. Adjuvant chemotherapy had a positive effect on the survival of patients with SBA. Nomograms for predicting 3-and 5-year OS and CSS of patients with SBA were constructed, which could identify patients with higher risk and might be superior in predicting the survival of patients with SBA than TNM staging.https://www.frontiersin.org/articles/10.3389/fsurg.2021.759162/fullsmall bowel adenocarcinomacancer-specific survivaloverall survivalnomogrammetastasis |
| spellingShingle | Yanmei Gu Haixiao Deng Daijun Wang Yumin Li Yumin Li Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study Frontiers in Surgery small bowel adenocarcinoma cancer-specific survival overall survival nomogram metastasis |
| title | Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study |
| title_full | Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study |
| title_fullStr | Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study |
| title_full_unstemmed | Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study |
| title_short | Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study |
| title_sort | metastasis pattern and survival analysis in primary small bowel adenocarcinoma a seer based study |
| topic | small bowel adenocarcinoma cancer-specific survival overall survival nomogram metastasis |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2021.759162/full |
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