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Honghong Zheng,1,* Zhehong Li,2,* Shuai Zheng,1 Jianjun Li,1 Ji Yang,1 Enhong Zhao1 1Department of Gastrointestinal Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China; 2Department of Orthopedic, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Enhong Zhao, The Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi St., Chengde, 067000, People’s Republic of China, Email zhenghh1215@163.comPurpose: Patients with middle-aged and elderly rectal cancer (MERC) usually have poor prognosis after surgery. This study aimed to develop a nomogram to achieve individualized prediction of overall survival (OS) in patients with MERC and to guide follow-up and subsequent diagnosis and treatment plans.Patients and Methods: A total of 349 patients were randomly assigned to the training and validation cohorts in a 7:3 ratio. Multivariate Cox regression analysis was performed using the results of univariate Cox regression analysis to confirm independent prognostic factors of OS. Thereafter, the nomogram was built using the “rms” package. Subsequently, discriminative ability and calibration of the nomogram were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Integrated discrimination improvement (IDI), net reclassification improvement (NRI), and the area under the ROC curves (AUC) were compared between the nomogram and the tumor-node-metastasis (TNM) staging system (8th edition). Finally, we established a predictive model to assess the survival benefit of patients with MERC by calculating nomogram scores for each patient.Results: Six variables were identified as independent prognostic factors and included in the nomogram: smoking history, family history, hematochezia, tumor size, N stage, and M stage. Based on these factors, we successfully constructed a nomogram and evaluated its discriminative and predictive abilities using ROC curves, calibration curves, and DCA. ROC curves, IDI, and NRI showed that the nomogram had outstanding clinical utility compared with the TNM staging system (8th edition) for OS prediction. The predictive model successfully distinguished between high-, medium-, and low-risk MERC patients.Conclusion: Our nomogram provided a more satisfactory survival prediction ability than the TNM staging system (8th edition) for MERC patients. In addition, the nomogram was able to accurately categorize patients into different risk groups after surgery.Keywords: nomogram, rectal cancer, web-based nomogram, overall survival, prognosis

Background: External beam radiation therapy (EBRT) for hepatocellular carcinoma (HCC) is rarely used in clinical practice. This study aims to develop and validate a prognostic nomogram model to predict overall survival (OS) in HCC patients treated with EBRT. Method: We extracted eligible data of HCC patients between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Those patients were randomly divided into a training cohort (n=1004) and an internal validation cohort (n=429), and an external validation cohort composed of a Chinese cohort (n=95). A nomogram was established based on the independent prognostic variables identified from univariate and multivariate Cox regression analyses. The effective performance of the nomogram was evaluated using the concordance index (Cindex), receiver operating characteristic curve (ROC), and calibration curves. The clinical practicability was evaluated using decision curve analysis (DCA). Results: T stage, N stage, M stage, AFP, tumor size, surgery, and chemotherapy were independent prognostic risk factors that were all included in the nomogram to predict OS in HCC patients with EBRT. In the training cohort, internal validation cohort, and external validation cohort, the C-index of the prediction model was 0.728 (95% confidence interval (CI): 0.716-0.740), 0.725 (95% CI:0.701-0.750), and 0.696 (95% CI:0.629-0.763), respectively. The 6-, 12-,18- and 24-month areas under the curves (AUC) of ROC in the training cohort were 0.835-0.823-0.810, and 0.801, respectively; and 0.821 -0.809 -0.813 and 0.804 in the internal validation cohort, respectively; and 0.749-0.754-0.791 and 0.798 in the external validation cohort, respectively. The calibration curves indicated that the predicted value of the prediction model performed well. The DCA curves showed better clinical practicability. In addition, based on the nomogram, we established a webbased nomogram to predict the OS of these patients visually. Conclusion: Based on the SEER database and an independent external cohort from China, we established and validated a nomogram to predict OS in HCC patients treated with EBRT. In addition, for the first time, a web-based nomogram model can help clinicians judge the prognoses of these patients and make better clinical decisions. [ABSTRACT FROM AUTHOR]

Background: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma with a high mortality rate, so it is necessary to create models to predict overall survival of MCC. We developed an easy-to-use web-based calculator to predict the OS of MCC patients based on the nomogram. Methods: MCC patients between 2004 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to training and validation cohorts. Patients between 2016-2017 serve as the external validation cohort. Relevant risk factors were identified by univariate and multivariate COX hazards regression methods and combined to produce nomograms. The concordance index (C-index), area under the receiver operating characteristic (AUC) curve, and calibration plots have demonstrated the predictive power of the nomograms. Decision curve analysis (DCA) was used to measure nomograms in clinical practice. Patients were divided into three groups according to the scores of the nomogram. Results: A total of 3480 patients were randomly assigned to the training group and validation group in this study. Meaningful prognostic factors were applied to the establishment of nomograms. The C-index for OS was 0.725 (95% CI: 0.706-0.741) in the training cohort and 0.710 (95% CI: 0.683-0.737) in the validation cohort. In the external validation cohort, C-index was 0.763 (95% CI: 0.734--0.792). The C-index of training cohort, validation cohort and external validation cohort for CSS were 0.743 (95% CI:0.725-0.761), 0.739(95%CI:0.712- 0.766) and 0.774 (95%CI:0.735-0.813), respectively. The AUC and calibration plots of 1-, 3-, and 5-year OS rates showed that the nomogram had good predictive power. DCA demonstrated that the nomogram constructed in this study could provide a clinical net benefit. Our calculator demonstrated excellent predictive capabilities for better risk grouping of MCC patients. Conclusion: We created novel nomograms of prognostic factors for MCC, which more accurately and comprehensively predicted 1-, 3-, and 5-year OS/ CSS in MCC patients. We established a calculator which can easily and quickly calculate the risk grouping of MCC patients by inputting clinically relevant characteristics. This can help clinicians identify high-risk patients as early as possible, carry out personalized treatment, follow-up, and monitoring, and improve the survival rate of MCC patients. [ABSTRACT FROM AUTHOR]

ObjectiveCongenital heart disease (CHD) is complex in its etiology. Its genetic causes have been investigated, whereas the non-genetic factor related studies are still limited. We aimed to identify dominant parental predictors and develop a predictive model and nomogram for the risk of offspring CHD.MethodsThis was a retrospective study from November 2017 to December 2021 covering 44,578 participants, of which those from 4 hospitals in eastern China were assigned to the development cohort and those from 5 hospitals in central and western China were used as the external validation cohort. Univariable and multivariable analyses were used to select the dominant predictors of CHD among demographic characteristics, lifestyle behaviors, environmental pollution, maternal disease history, and the current pregnancy information. Multivariable logistic regression analysis was used to construct the model and nomogram using the selected predictors. The predictive model and the nomogram were both validated internally and externally. A web-based nomogram was developed to predict patient-specific probability for CHD.ResultsDominant risk factors for offspring CHD included increased maternal age [odds ratio (OR): 1.14, 95% CI: 1.10–1.19], increased paternal age (1.05, 95% CI: 1.02–1.09), maternal secondhand smoke exposure (2.89, 95% CI: 2.22–3.76), paternal drinking (1.41, 95% CI: 1.08–1.84), maternal pre-pregnancy diabetes (3.39, 95% CI: 1.95–5.87), maternal fever (3.35, 95% CI: 2.49–4.50), assisted reproductive technology (2.89, 95% CI: 2.13–3.94), and environmental pollution (1.61, 95% CI: 1.18–2.20). A higher household annual income (100,000–400,000 CNY: 0.47, 95% CI: 0.34–0.63; > 400,000 CNY: 0.23, 95% CI: 0.15–0.36), higher maternal education level (13–16 years: 0.68, 95% CI: 0.50–0.93; ≥ 17 years: 0.87, 95% CI: 0.55–1.37), maternal folic acid (0.21, 95% CI: 0.16–0.27), and multivitamin supplementation (0.33, 95% CI: 0.26–0.42) were protective factors. The nomogram showed good discrimination in both internal [area under the receiver-operating-characteristic curve (AUC): 0.843] and external validations (development cohort AUC: 0.849, external validation cohort AUC: 0.837). The calibration curves showed good agreement between the nomogram-predicted probability and actual presence of CHD.ConclusionWe revealed dominant parental predictors and presented a web-based nomogram for the risk of offspring CHD, which could be utilized as an effective tool for quantifying the individual risk of CHD and promptly identifying high-risk population.

Abstract Background Leiomyosarcoma (LMS) is one of the most common soft tissue sarcomas. LMS is prone to distant metastasis (DM), and patients with DM have a poor prognosis. Aim In this study, we investigated the risk factors of DM in LMS patients and the prognostic factors of LMS patients with DM. Methods and results LMS patients diagnosed between 2010 and 2016 were extracted from the Surveillance, Epidemiology, and End Result (SEER) database. Patients were randomly divided into the training set and validation set. Univariate and multivariate logistic regression analyses were performed, and a nomogram was established. The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram. Based on the nomogram, a web‐based nomogram is established. The univariate and multivariate Cox regression analyses were used to assess the prognostic risk factors of LMS patients with DM. Eventually, 2184 patients diagnosed with LMS were enrolled, randomly divided into the training set (n = 1532, 70.14%) and validation set (n = 652, 29.86%). Race, primary site, grade, T stage, and tumor size were correlated with DM incidence in LMS patients. The AUC of the nomogram is 0.715 in training and 0.713 in the validation set. The calibration curve and DCA results showed that the nomogram performed well in predicting the DM risk. A web‐based nomogram was established to predict DM's risk in LMS patients (https://wenn23.shinyapps.io/riskoflmsdm/). Epithelioid LMS, in uterus, older age, giant tumor, multiple organ metastasis, without surgery, and chemotherapy had a poor prognosis. Conclusions The established web‐based nomogram (https://wenn23.shinyapps.io/riskoflmsdm/) is an accurate and personalized tool to predict the risks of LMS developing DM. Advanced age, larger tumor, multiple organ metastasis, epithelioid type, uterine LMS, no surgery, and no chemotherapy were associated with poor prognosis in LMS patients with DM.

Objectives: This study investigated risk factors and constructed an online tool to predict distant metastasis (DM) risk in patients with leiomyosarcoma (LMS) after surgical resection., Methods: Data regarding patients with LMS who underwent surgical resection between 2010 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Data were collected regarding patients with LMS who underwent surgical resection at Tianjin Medical University Cancer Hospital and Institute (TJMUCH) between October 2010 and July 2018. Patients were randomly divided into training and validation sets. Logistic regression analyses were performed; a nomogram was established. The area under the curve (AUC) and calibration curve were used to evaluate the nomogram, which served as the basis for a web-based nomogram., Results: This study included 4461 and 76 patients from the SEER database and TJMUCH, respectively. Age, ethnicity, grade, T stage, N stage, radiotherapy, and chemotherapy were associated with DM incidence. C-index values were 0.815 and 0.782 in the SEER and Chinese datasets, respectively; corresponding AUC values were 0.814 and 0.773, respectively. A web-based nomogram (https://weijunqiang-leimyosarcoma-seer.shinyapps.io/dynnomapp/) was established., Conclusions: Our web-based nomogram is an accurate and user-friendly tool to predict DM risk in patients with LMS; it can aid clinical decision-making.

Objective: To identify risk factors and develop predictive web-based nomograms for the early death of patients with bone metastasis of lung adenocarcinoma (LUAD)., Methods: Patients in the Surveillance, Epidemiology, and End Results database diagnosed with bone metastasis of LUAD between 2010 and 2016 were included and randomly divided into training and validation sets. Early death-related risk factors (survival time ≤7 months) were evaluated by logistic regression. Two predictive nomograms were established and validated by calibration curves, receiver operating characteristic curves, and decision curve analysis., Results: A total of 9189 patients (56.59%) died from all causes within 7 months of being diagnosed, including 8585 patients (56.67%) who died from cancer-specific causes. Age >65 years, sex (men), T stage (T3 and T4), N stage (N2 and N3), brain metastasis, and liver metastasis were risk factors for all-cause and cancer-specific early death. The area under the curves of the nomograms for all-cause and cancer-specific early death prediction were 0.754 and 0.753 (training set) and 0.747 and 0.754 (validation set), respectively. Further analysis showed that the two nomograms performed well., Conclusions: Our two web-based nomograms for all-cause and cancer-specific early death provide valuable tools for predicting early death in these patients.

Background: This study sought to assess the prognostic factors for leiomyosarcoma (LMS) patients with lung metastasis and construct web-based nomograms to predict overall survival (OS) and cancer-specific survival (CSS)., Method: Patients diagnosed with LMS combined with lung metastasis between 2010 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The patients were randomly divided into a training set and a testing set. The X-tile analysis provides the best age and tumor size cut-off point, and changes continuous variables into categorical variables. The independent prognostic factors were determined by Cox regression analysis, and 2 nomograms were established. Receiver operating characteristic curves and calibration curves were used to evaluate the nomograms. Based on the nomograms, 2 web-based nomograms were established., Results: Two hundred and twenty-eight cases were included in the OS nomogram construction, and were randomly divided into a training set (n=160) and a validation set (n=68). Age, T stage, bone metastasis, surgery, chemotherapy, marital status, tumor size, and tumor site were found to be correlated with OS. One hundred and eighty-three cases were enrolled in the CSS nomogram construction, and randomly divided into a training set (n=129) and a validation set (n=54). Age, bone metastasis, surgery, chemotherapy, tumor size, and tumor site were found to be correlated with CSS. Two nomograms were established to predict OS and CSS. In the training set, the areas under the curve of the nomogram for predicting 1-, 2-, and 3-year OS were 0.783, 0.830, and 0.832, respectively, and those for predicting 1-, 2-, and 3-year CSS were 0.889, 0.777, and 0.884, respectively. Two web-based nomograms were established to predict OS (https://wenn23.shinyapps.io/lmslmosapp/), and CSS (https://wenn23.shinyapps.io/lmslmcssapp/)., Conclusion: The developed web-based nomogram is a useful tool for accurately analyzing the prognosis of LMS patients with lung metastasis, and could help clinical doctors to make personalized clinical decisions., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-21-598). The authors have no conflicts of interest to declare., (2021 Journal of Thoracic Disease. All rights reserved.)