Risk factors, prognostic factors, and nomograms for distant metastasis in patients with diagnosed duodenal cancer: A population-based study

doi:10.4251/wjgo.v16.i4.1384

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World Journal of Gastrointestinal Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical and Translational Research

World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1384-1420
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1384

Risk factors, prognostic factors, and nomograms for distant metastasis in patients with diagnosed duodenal cancer: A population-based study

Jia-Rong Shang, Chen-Yi Xu, Xiao-Xue Zhai, Zhe Xu, Jun Qian

Jia-Rong Shang, Chen-Yi Xu, Xiao-Xue Zhai, Jun Qian, Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China

Chen-Yi Xu, Department of Proctology, Nanjing Hospital of Chinese Medicine, Nanjing 210000, Jiangsu Province, China

Zhe Xu, Department of Digestive Cancer Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China

Co-first authors: Jia-Rong Shang and Chen-Yi Xu.

Co-corresponding authors: Zhe Xu and Jun Qian.

Author contributions: Shang JR and Xu CY made equal contributions to this work. They both played significant roles in the research, including study design, data collection, data analysis and interpretation, and manuscript drafting. Zhai XX collected data; Xu Z and Qian J provided guidance and support throughout the research, assisted in data collection and analysis, and actively participated in manuscript revision and editing. All authors have read and approved the final manuscript. The reason for listing them as co-first authors is based on their equal and significant contributions to the research project. This is evident in the following aspects: Research design and planning: co-first authors Shang JR and Xu CY played equally important roles in the design and planning of the research project. They jointly formulated the research framework, defined the main objectives, and determined the research methods. Data collection and analysis: Both co-first authors actively participated in data collection, organization, and analysis. They collaborated in handling a substantial amount of experimental data and conducted statistical analyses to ensure the scientific reliability of the study. Data interpretation and presentation: Shang JR and Xu CY worked together to interpret the experimental results and jointly wrote sections of the research report related to data presentation. They ensured that the data was presented to the readers in a clear and accurate manner. Manuscript drafting: Both authors contributed equally to drafting the research manuscript. They shared responsibilities in writing different sections of the research, including the introduction, methodology, results, and discussion. In summary, Shang JR and Xu CY demonstrated equal intellectual contributions throughout the entire research project, including research design, data processing, result interpretation, and manuscript writing. Therefore, they are considered qualified co-first authors. This arrangement reflects their collaborative and equal contributions to the project, ensuring fair and just authorship recognition. Xu Z and Qian J are designated as co-corresponding authors based on their equal contributions to the conception, design, and execution of the research project, illustrating their shared responsibility in the development and implementation of the study. They collaborated closely in the acquisition, analysis, and interpretation of data, ensuring a comprehensive and rigorous evaluation of the results. Both authors actively participated in drafting and critically revising the manuscript, providing intellectual input, and approving the final version for submission. They jointly supervised the research, overseeing various aspects of the project to guarantee its integrity and accuracy. Their collaborative efforts and equal contributions underscore the significance of designating them as co-corresponding authors.

Supported by State Administration of Traditional Chinese Medicine Base Construction Stomach Cancer Special Fund, No. Y2020CX57; Jiangsu Provincial Graduate Research and Practical Innovation Program Project, No. SJCX23-0799.

Institutional review board statement: This study complied with the principles of the Declaration of Helsinki. Because all data were derived from a public database and individual information was anonymous, it was permitted to obtain the data from the SEER database. Ethical review and approval were waived for this study, due to the data being publicly available and anonymous.

Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.

Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Data sharing statement: No additional data are available.

Corresponding author: Zhe Xu, MD, PhD, Chief Physician, Doctor, Surgeon, Surgical Oncologist, Department of Digestive Cancer Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Avenue, Qinhuai District, Nanjing 210000, Jiangsu Province, China. xi.88@163.com

Received: October 16, 2023
Peer-review started: October 16, 2023
First decision: December 19, 2023
Revised: December 24, 2023
Accepted: February 4, 2024
Article in press: February 4, 2024
Published online: April 15, 2024
Processing time: 177 Days and 11.7 Hours

ARTICLE HIGHLIGHTS

Research background

Duodenal cancer is a prevalent subtype of small intestinal cancer, and the prognosis for patients with distant metastasis (DM) in this type of cancer remains poor. However, there is a lack of studies focusing on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.

Research motivation

In this study, we aimed to utilize data from the Surveillance, Epidemiology, and End Results (SEER) database to investigate the risk factors for DM and identify prognostic factors in patients with duodenal cancer.

Research objectives

To develop nomogram predicting the risk of DM in patients with duodenal cancer and providing personalized prognosis predictions for those with DM, aiming to enhance clinical decision-making.

Research methods

Data from duodenal cancer patients (2010-2019) were extracted from the SEER database. Univariate and multivariate logistic regression identified independent DM risk factors, while Cox proportional hazards regression determined prognostic factors in duodenal cancer patients with DM. Novel nomograms were created and evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Research results

Among 2603 duodenal cancer patients, 17.56% had DM at diagnosis. Logistic analysis identified risk factors (gender, grade, tumor size, T stage, N stage, P < 0.05). Cox analyses revealed prognostic factors (age, histological type, T stage, tumor grade, tumor size, bone metastasis, chemotherapy, surgery, P < 0.05). Nomogram accuracy was confirmed in training, validation, and testing sets (ROC, calibration, DCA curves). Kaplan-Meier curves (P < 0.001) indicated precise prediction of DM occurrence and prognosis.

Research conclusions

This study on duodenal cancer highlights the poor prognosis linked to DM. Developed and evaluated using SEER database data, two nomograms predict DM risk and personalized prognosis. Validated for accuracy, these nomograms offer clinicians a valuable tool to enhance decision-making on DM risk and prognosis in duodenal cancer patients.

Research perspectives

Future research should prospectively validate the nomograms, integrating additional factors for enhanced predictive accuracy. External validation across diverse datasets and assessing the nomograms' impact on treatment decisions are crucial. Evaluating feasibility for routine clinical use, conducting long-term follow-up studies, and considering patient-reported outcomes aim to improve applicability and enhance decision-making for duodenal cancer patients with DM.