Development And Validation Of Prognostic Nomograms For Patients With Primary Gastrointestinal Non-hodgkin Lymphomas

Part I Development and internal validation of prognostic nomograms for patients with primary gastrointestinal Non-Hodgkin lymphomasObjective:To construct and authenticate nomograms to project overall survival(OS)and cancer-specifc survival(CSS)in primary gastrointestinal non-Hodgkin lymphomas(PGINHL).Methods:Suitable patients were chosen from the Surveillance,Epidemiology and End Results database.The Cox regression model was used to acquire independent predictive factors to develop nomograms for projecting OS and CSS.The performance of the nomograms was validated using the Harrell's concordance index(C-index),receiver operating characteristic(ROC)curve(AUC),calibration curves,and decision curve analysis(DCA)and was compared with that of the AJCC 7th staging system.Survival curves were obtained using the Kaplan–Meier method,while the log-rank test was used to compare the diference among the groups.Results:The C-index of the nomograms for OS and CSS was 0.735(95%CI=0.719–0.751)and 0.761(95%CI=0.739–0.783),respectively,signifying substantial predictive accuracy.These outcomes were reproducible when the nomograms were used for the internal validation cohorts.Moreover,assessments of the C-index,AUC,and DCA between the nomogram and the AJCC 7th staging system showed that the former was better for evaluation and was more clinically useful.Conclusion:We constructed the nomogram which could predict 1-,3-,and 5-year OS and CSS of patients with PGINHL.Our nomogram showed good performance,suggesting that it can be used as an efficacious instrument for predictive assessment of patients with PGINHL.Part II External validation of prognostic nomograms of primary gastrointestinal non-Hodgkin's lymphomaObjective:To externally validate nomograms for OS and CSS of PGINHL previously established in our study.Methods:From March 2012 to June 2019,80 patients with PGINHL who were pathologically confirmed to be PGINHL in Yijishan Hospital of Wannan Medical College were include in this study.We collected clinicopathlogical include gender,age,pathological subtype,primary site,AJCC 7th staging system,radiotherapy,surgery,chemotherapy,survival status,survival time according to that of previously established prediction model.The predictive prognostic ability of our predictive model were evaluated using AUC and DCA compared with those of AJCC 7th staging system.Results:The 1-,3-,and 5-year OS and CSS were 0.79,0.78,0.66,and 0.78,0.78,and 0.64,respectively,while the AJCC 7th staging system 1-,3-,and 5-year OS and CSS were 0.67,0.67,0.65,and 0.67,0.65,and 0.67,respectively.The results showed that our prognostic models have higher predictive prognostic ability than the AJCC 7th staging system.The results of DCA showed our prognostic models have the wider clinical applicability than AJCC 7~thh staging system.Conclusion:The previously established OS and CSS prediction models in our study have higher prdictive prognosic ability and wider clinical applicability than AJCC 7th staging system.