| Background:Evidence for middle-aged(45-65)patients with gastric cancer(GC)is limited.The purpose of this study was to identify risk factors that affect the overall survival(OS)of non-metastatic middle-aged patients,and to use data from surveillance,epide miological,and end result(SEER)databases to build predictive models for overall survival(normogram).It provides a reference for patients to formulate accurate,comprehensive and individualized treatment strategies to improve the quality of life and survival conditions of middle-aged gastric cancer patientsMethods:Statistical analysis was performed on patients with non-metastatic GC(n=4238)45-65 years of age in the SEER database from 2004 to 2015.A Cox proportional hazard regression model was established using the SEER data set,and a line chart was drawn to construct a predictive model for overall survival.Differences between different groups were tested by X2.Log-Rank statistical method was used for univariate analysis of Overall Survival OS and Cancer-Specific Survival CSS of gastric stromal tumor patients,and Kanlan-Meier survival curves were drawn.Cox regression was used to analyze independent prognostic factors.Use R software to draw a line chart and calculate the C-index and calibration curve to verify the prediction performance.Based on the clinical data of patients with gastric stromal cancer from January 2013 to December 2016,the clinical characteristics of patients with gastric stromal cancer were retrospectively analyzed.Results:Through Surveillance,Epidemiology,and End Results(SEER)database analysis.We have divided the age of middle-aged gastric cancer patients into three stages.According to the analysis,the number of patients in the 58-65 age group was the largest(49.1%),followed by 49-57(39.4%),and the smallest number was 45-48(11.5%).We found that the largest percentage was the white race population(67.4%);the black race population was the least(13.9%).White races may be more susceptible to gastric cancer,while black races are the least susceptible.The number of married patients was 2,917,which was more than 1,321 unmarried patients.Cardiac carcinoma(38%)occurred most frequently in middle-aged gastric cancer,followed by gastric antrum(20.6%),followed by gastric minor curvature(422 cases,9.9%).In the overall sample,there were 3,716(87.6%)without distant metastases,and 522(12.4%)with distant metastases.Univariate analysis showed that race,tumor location,tumor pathological classification,positive and negative lymph nodes,marital status,surgery,and the presence or absence of distant metastases were the overall survival(OS)and tumor-specific survival(CSS)of middle-aged gastric cancer patients.)Prognostic factors(P<0.05).And age is not a patient's tumor-specific survival(CSS).According to the analysis of the tumor location,the three-year OS of the four sites with the most occurrence sites-cardiac,gastric antrum,gastric minor curvature,and gastric body patients were 51.6%,49.6%,58.8%,and 51.9%,respectively.54.5%,50.9%,61.6%,53.9%.Among patients with distant metastasis,the 3-year OS was 14.5%,and 3-year CSS was 15.4%),and patients without distant metastasis had 3-year OS of 56.9%and 3-year CSS of 59.6%.Compared with the two,Patients without metastasis have a better prognosis.Among surgical patients,patients who undergo surgical treatment(3-year OS:52.2%,3-year CSS:54.7%)survive better,which suggests that surgery is an effective measure to improve the prognosis of middle-aged gastric cancer patients.Multivariate analysis results showed that gender,age,marital status,tumor size,pathological classification,surgery,and the presence or absence of distant metastases were independent prognostic factors for overall survival and specific survival of middle-aged gastric cancer patients(P<0.05).Subgroup analysis:The prognosis of the lower part of the stomach is the worst.When analyzing the relationship between the tumor location of middle-aged gastric cancer and distant metastasis,it was found that the proportion of distant metastases in the gastric body was the highest(45.6%),followed by the cardia(37.5%)and the lowest in the pylorus(16.8%).This suggests that the middle stomach(body)is more susceptible to distant metastases than the upper stomach(cardiac)and lower stomach(pylorus).2.The internal verification consistency index(C-index)of the nomogram is 0.729(95%CI=0.7192-0.7388)? 0.742(95%CI=0.7302-0.7511),which indicates that the prediction performance is good.The calibration curve in the graphic verification is close to a straight line with a slope of 1,indicating that the nomogram can accurately predict the overall survival rate of patients with gastric stromal tumors.3.1n the single-center sample statistics,there were 75 males(72.8%)and 28 females(27.2%)The number of males was far more than that of females.Most patients are older than 55 years.In the clinical manifestations of patients,the majority of patients with upper abdominal pain were symptoms,with 37 cases(35.9%),and 23 patients with bloating and vomiting(22.3%).Thirteen patients(12.6%)were symptom-eating,and 30 patients(29.1%)had other digestive symptoms such as nausea and melena.In collecting tumor markers from patients,17 AFP-positive patients(16.5%),86 AFP-negative patients(83.5%);51 CEA-positive patients(42.7%);a total of CA199-positive patients Forty-four(42.7%)patients with CA199 below normal were 59(57.3%).A total of 43 patients passed chemotherapy(41.7%),and a total of 60 patients(58.3%)received non-chemotherapy and unknown patients.The univariate analysis of the data showed that the clinical manifestations of the patients(P=0.006),and the pathological changes Type(P=0.002),the tumor markers CEA(P<0.001)and CA199(P<0.001)correlated with the prognosis of middle-aged gastric cancer.Patients with CAA and CA199 positive tumor markers had a worse prognosis than patients with negative tumor markers.No significant difference was found in the effects of other variables on the overall survival of patients(P>0.05).Conclusion:(1)Marital status,tumor location,tumor pathological type,patient's surgery and chemotherapy status,and tumor metastasis are the overall survival(OS)and tumor of middle-aged gastric cancer patients.Independent prognostic factors for specific survival(CSS).(2)Male,older middle-aged patients,upper pain,and tumors in the stomach.The tumor markers CEA and CA199 are the prognostic factors of middle-aged gastric cancer patients.(3)The nomogram can accurately predict the overall survival rate of patients with gastric stromal tumors,and provides a basis for clinicians to develop individualized treatment strategies for patients. |
PDF Full Text Request