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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1432281
This article is part of the Research Topic Gastric Cancer: Individualized Immunotherapeutic Approaches and Biomarker-Driven Strategies View all 5 articles

Construction of a nomogram with IrAE and Clinic Character to predict the survival of Advanced G/GEJ Adenocarcinoma Patients Undergoing Anti-PD-1 Treatment

Provisionally accepted
Han Wang Han Wang 1Jinhua Chen Jinhua Chen 2*Yilan Wu Yilan Wu 3*Xinli Wang Xinli Wang 1*Fangyu Lin Fangyu Lin 1Hao Chen Hao Chen 1*Yao Wang Yao Wang 1*Tao Jiang Tao Jiang 1Zhangchi Pan Zhangchi Pan 1*Xinyan Gao Xinyan Gao 1*Qing Liu Qing Liu 1*Xiaojiao Weng Xiaojiao Weng 1*Na Yao Na Yao 1*Yingjiao Zhu Yingjiao Zhu 1*Riping Wu Riping Wu 1Guizhen Weng Guizhen Weng 2Xiaoyan Lin Xiaoyan Lin 1,4*
  • 1 Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
  • 2 Fujian Medical University Union Hospital, Fuzhou, China
  • 3 The School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
  • 4 Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Provincial Cancer Hospital, Fuzhou, Fujian Province, China

The final, formatted version of the article will be published soon.

    Objective: This study aimed to develop and validate a survival prediction model and nomogram for patients with advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma treated with anti-programmed cell death 1 receptor (PD-1). The model includes immune-related adverse events (irAEs) and common clinical characteristics as predictive factors. Methods: A dataset of 255 adult patients with advanced G/GEJ adenocarcinoma was assembled. Significant irAEs affecting overall survival (OS) were integrated as a variable named "Protective irAE". Landmark analysis mitigated timing bias related to irAEs. 12 other variables were selected as candidate variables to construct the model. LASSO regression performed variable selection, and the variance inflation factor addressed multicollinearity. the forward likelihood ratio Cox regression was used to developed the model, excluding variables violating the proportional hazards assumption. The model was internally validated through bootstrap resampling and externally validated with a cohort from another hospital. Results: irAEs from the skin and endocrine systems were consolidated as protective irAE. The finalized model included seven variables: tumor stage, first-line anti-PD-1 treatment, peritoneal metastasis, Eastern cooperative oncology group performance status (ECOG PS) score, human epidermal growth factor receptor 2 (HER2) expression status, and controlling nutritional status (CONUT) score, and protective irAE. The model's concordance index was 0.66. Calibration and clinical decision curve analyses verified its accuracy and net benefit for 1- and 2-year survival rates. Conclusion: This study developed a prognostic prediction model integrating irAEs and common clinical characteristics, demonstrating good clinical practicality and accurate OS prediction for advanced G/GEJ adenocarcinoma patients. Eastern cooperative oncology group performance status (ECOG PS) score, human epidermal growth factor receptor 2 (HER2) expression status, and controlling nutritional status (CONUT) score.

    Keywords: gastric cancer, Gastroesophageal junction adenocarcinoma, Immune-related adverse events, anti-programmed cell death 1 receptor, Prognostic prediction model, nomogram

    Received: 13 May 2024; Accepted: 03 Jul 2024.

    Copyright: © 2024 Wang, Chen, Wu, Wang, Lin, Chen, Wang, Jiang, Pan, Gao, Liu, Weng, Yao, Zhu, Wu, Weng and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Jinhua Chen, Fujian Medical University Union Hospital, Fuzhou, China
    Yilan Wu, The School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
    Xinli Wang, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Hao Chen, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Yao Wang, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Zhangchi Pan, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Xinyan Gao, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Qing Liu, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Xiaojiao Weng, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Na Yao, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Yingjiao Zhu, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
    Xiaoyan Lin, Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China

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