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Postoperative prognostic nomogram for adult grade II/III astrocytoma in the Chinese Han population

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Abstract

Background

Prognostic models of glioma have been the focus of many studies. However, most of them are based on Western populations. Additionally, because of the complexity of healthcare data in China, it is important to select a suitable model based on existing clinical data. This study aimed to develop and independently validate a nomogram for predicting the overall survival (OS) with newly diagnosed grade II/III astrocytoma after surgery.

Methods

Data of 472 patients with astrocytoma (grades II–III) were collected from Qilu Hospital as training cohort while data of 250 participants from Linyi People's Hospital were collected as validation cohort. Cox proportional hazards model was used to construct the nomogram and individually predicted 1-, 3-, and 5-year survival probabilities. Calibration ability, and discrimination ability were analyzed in both training and validation cohort.

Results

Overall survival was negatively associated with histopathology, age, subtotal resection, multiple tumors, lower KPS and midline tumors. Internal validation and external validation showed good discrimination (The C-index for 1-, 3-, and 5-year survival were 0.791, 0.748, 0.733 in internal validation and 0.754, 0.735, 0.730 in external validation, respectively). The calibration curves showed good agreement between the predicted and actual 1-, 3-, and 5-year OS rates.

Conclusion

This is the first nomogram study that integrates common clinicopathological factors to provide an individual probabilistic prognosis prediction for Chinese Han patients with astrocytoma (grades II–III). This model can serve as an easy-to-use tool to advise patients and establish optimized surveillance approaches after surgery.

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Abbreviations

OS:

Overall survival

GBM:

Glioblastoma

WHO:

World Health Organization

IDH:

Isocitrate dehydrogenase

KPS:

Karnofsky performance status

LGGs:

Low-grade gliomas

SD:

Standard deviations

IQRs:

Interquartile ranges

AIC:

Akaike information criterion

C-index:

Concordance index

CI:

Confidence interval

MMSE:

Mini-Mental State Examination

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Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 81773547 to Fuzhong Xue), the Major Special Science and Technology Project of Shandong Province (Grant No. 21320004011801 to Fuzhong Xue), China Postdoctoral Science Foundation (Grant No. 2019M662373 to Fan Yang), Shandong Key Laboratory of Cardiovascular Disease Proteomics Open Research Program (Grant No. 2020XXGJB002 to Fan Yang), Shandong Key Laboratory of Brain Function Remodeling Open Research Program (Grant No. 2020NGN003 to Fan Yang), and Shandong Province major science and technology innovation project (Grant No. 2018CXGC1210 to Fuzhong Xue).

Author information

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong Province, China

    Lijie Wang, Jingtao Wang, Fan Yang & Fuzhong Xue

  2. Institute for Medical Dataology, Shandong University, Jinan, China

    Lijie Wang, Jingtao Wang, Xiaokang Ji, Fan Yang & Fuzhong Xue

  3. Cancer Center & the Research Center of Function Image on Brain Tumor, Linyi People’s Hospital, Shandong University, Linyi, China

    Jinling Zhang

  4. Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China

    Hao Xue, Lin Deng & Gang Li

  5. Institute of Brain and Brain-Inspired Science, Shandong Provincial Key Laboratory of Brain Function Remodeling, Shandong University, Jinan, China

    Hao Xue, Lin Deng & Gang Li

  6. Neurology Department & the Research Center of Function Image on Brain Tumor, Linyi People’s Hospital, Shandong University, Linyi, China

    Fengyuan Che

  7. Neurosurgery Department & the Research Center of Function Image on Brain Tumor, Linyi People’s Hospital, Shandong University, Linyi, China

    Xueyuan Heng

  8. Department of Radiology, Linyi People’s Hospital, Shandong University, Linyi, China

    Xuejun Zheng

  9. The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China

    Zilong Lu

  10. The Department for Chronic and Non-Communicable Disease and Endemic Disease Control and Prevention, Linyi Center for Disease Control and Prevention, Linyi, China

    Liuqing Yang

  11. Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Qihua Tan

  12. Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Qihua Tan

  13. Synthesis Electronic Technology Co., Ltd., Jinan, China

    Yeping Xu

  14. Institute for Sustainable Industries & Liveable Cities, College of Engineering and Science, Victoria University, Melbourne, VIC, Australia

    Yanchun Zhang

Authors
  1. Lijie Wang
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  2. Jinling Zhang
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  3. Jingtao Wang
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  4. Hao Xue
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  5. Lin Deng
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  7. Xueyuan Heng
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  8. Xuejun Zheng
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  9. Zilong Lu
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  10. Liuqing Yang
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  11. Qihua Tan
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  14. Xiaokang Ji
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  15. Gang Li
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  16. Fan Yang
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  17. Fuzhong Xue
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Contributions

LW, JW, GL, FY and FX contributed to the study conception and design. LW, JW, JZ, HX, LD, FC, XH, ZL, and LY performed the material preparation and data collection. LW, JW, JZ, HX, and LD performed the data analysis and wrote the manuscript. JZ, HX, XZ contributed to the interpretation. QT, YX, YZ, XJ, GL, FY, and FX revised the article critically for important intellectual content. All authors discussed the results and commented on the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Fan Yang or Fuzhong Xue.

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Competing interests

The authors made no disclosures. Author Yeping Xu was employed by the company Synthesis Electronic Technology Co., Ltd. Jinan, China. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval and consent to participate

The protocol of this study was approved by the Public Health Ethics Committee of Shandong University (Approval No. LL20200701). The requirement for informed consent was waived because of the retrospective nature of the study. The analysis used anonymous clinical data.

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Wang, L., Zhang, J., Wang, J. et al. Postoperative prognostic nomogram for adult grade II/III astrocytoma in the Chinese Han population. Health Inf Sci Syst 11, 23 (2023). https://doi.org/10.1007/s13755-023-00223-0

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