Full
Outline
To analyze clinical characteristics affecting survival outcomes in gastric adenocarcinoma (GAC) patients with second primary malignancies (SPM) and construct a predictive model with a web-based calculator.
Patients diagnosed with GAC between January 2010 and December 2017 in the SEER database (n=24 085) were analyzed, comparing non-SPM (n=22 963) and SPM cohorts (n=1 122). SPM patients were randomized (3:1) into training (n=842) and internal validation cohorts (n=280). Univariate/multivariate Cox regression identified prognostic factors for model construction. Model performance was evaluated via ROC curves, calibration plots, and decision curve analysis (DCA). A web-based calculator was deployed using DynNom (https://kunma697.shinyapps.io/dynnomapp-1/). External validation used 192 SPM patients diagnosed at Yantai Yuhuangding Hospital (2010-2017).
χ² tests revealed SPM patients had higher age (56.3%), earlier T-stage (T1:29.2%; T2:10.5%), predominant gastric cardia involvement (43.7%), fewer distant metastases (12.3%), and higher rates of radiotherapy (32.5%) and surgery (77.2%) vs. non-SPM (P<0.05). Cox analyses identified GAC primary site, T-stage, SEER stage, radiotherapy/surgery history, plus SPM grade/stage/treatment history as significant predictors (P<0.05). AUCs in the training cohort were 0.771 (95%CI:0.722~0.820), 0.839 (95%CI:0.796~0.882), and 0.836 (95%CI: 0.792~0.879) for 1-/3-/5-year survival; internal validation showed 0.751 (95%CI: 0.700~0.801), 0.746 (95%CI: 0.695~0.797), and 0.772 (95%CI: 0.723~0.821); external validation yielded 0.713 (95%CI: 0.648~0.778), 0.805 (95%CI: 0.749~0.861), and 0.851 (95%CI: 0.801~0.901). Calibration indicated high prediction-actuality concordance; DCA confirmed clinical utility.
The model and web calculator incorporating GAC/SPM characteristics effectively predict SPM patient prognosis.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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