Recent advances in our understanding of gastric cancer biology have prompted a shift towards more personalized therapy. However, results are based on population-based survival analyses, which evaluate the average survival effects of entire treatment groups or single prognostic variables. This study uses a personalized survival modelling approach called individual survival distributions (ISDs) with the multi-task logistic regression (MTLR) model to provide novel insight into personalized survival in gastric adenocarcinoma. We performed a pooled analysis using 1043 patients from a previously characterized database annotated with molecular subtypes from the Cancer Genome Atlas, Asian Cancer Research Group, and tumour microenvironment (TME) score. The MTLR model achieved a 5-fold cross-validated concordance index of 72.1 ± 3.3%. This model found that the TME score and chemotherapy had similar survival effects over the entire study time. The TME score provided the greatest survival benefit beyond a 5-year follow-up. Stage III and Stage IV disease contributed the greatest negative effect on survival. The MTLR model weights were significantly correlated with the Cox model coefficients (Pearson coefficient = 0.86,p< 0.0001). We illustrate how ISDs can accurately predict the survival time for each patient, which is especially relevant in cases of molecular subtype heterogeneity. This study provides evidence that the TME score is principally associated with long-term survival in gastric adenocarcinoma. Additional external validation and investigation into the clinical utility of this ISD model in gastric cancer is an area of future research.
对胃癌生物学机制认识的近期进展推动了个体化治疗的发展。然而现有研究结果多基于群体生存分析，仅能评估整个治疗组或单一预后变量的平均生存效应。本研究采用一种名为个体生存分布（ISD）的个性化生存建模方法，结合多任务逻辑回归（MTLR）模型，为胃腺癌的个体化生存预测提供新视角。我们整合分析了1043例患者的临床数据，这些数据源自已建立的数据库，并标注有癌症基因组图谱、亚洲癌症研究组提供的分子亚型及肿瘤微环境（TME）评分。MTLR模型的5折交叉验证一致性指数达到72.1±3.3%。该模型发现TME评分与化疗在整个研究期间具有相似的生存效应，而在5年随访期后TME评分显示出最大的生存获益。III期和IV期疾病对生存预后产生最显著的负面影响。MTLR模型权重与Cox模型系数显著相关（Pearson系数=0.86，p<0.0001）。我们展示了ISD如何精准预测每位患者的生存时间，这在分子亚型异质性病例中尤为重要。本研究证实TME评分主要与胃腺癌的长期生存相关。未来研究需对该ISD模型在胃癌中的临床应用价值进行外部验证和深入探索。
肿瘤(癌症)患者之家