Development and External Validation of a Simplified Nomogram Predicting Individual Survival After R0 Resection for Gastric Cancer: An International, Multicenter Study
- 244 Downloads
Previous studies have developed three nomograms for the individual prediction of overall survival after gastric cancer surgery. In this study, the performance of these nomograms was evaluated and compared with that of a simplified nomogram in a multinational cohort of patients.
Clinical data from patients who underwent resection (R0) with curative intent for GC at three specialized centers (two from China and one from Italy) and data from the Surveillance, Epidemiology, and End Results database were retrospectively analyzed.
The study analyzed 9810 patients, and the simplified nomogram was developed based on the following factors present in all models: age, sex, depth of invasion, and number of metastatic lymph nodes. In the decision curve analyses, the simplified nomogram demonstrated similar net benefit gains relative to previous models. The discriminative ability of the simplified nomogram was similar to those of the three existing nomograms, and calibration of the simplified nomogram resulted in a predicted survival similar to the actual survival. The predictive ability of the simplified nomogram was superior to that of the American Joint Committee on Cancer (AJCC) stage using Eastern and Western validation data (p < 0.01). Additionally, the simplified nomogram predicted the probabilities within each AJCC stage to illustrate the heterogeneity of risk within each stage.
The novel simplified nomogram simplifies the assessment of individual survival after R0 resection for GC without sacrificing predictive ability. It also has potential for use with other databases and for clinical applications.
This study was funded by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province (2016Y9031), the Construction Project of Fujian Province Minimally Invasive Medical Center (No. 171), the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013), the QIHANG funds of Fujian Medical University (No. 2016QH025), and the CARIT Foundation (Fondazione Cassa di Risparmio di Terni e Nami; No. 0024137).
The authors declare that they have no conflict of interest.
- 15.Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma. 2nd English ed. Gastric Cancer. 1998;1:10–24.Google Scholar
- 16.Japanese Gastric Cancer Association. Japanese Classification of gastric carcinoma. 3rd English ed. Gastric Cancer. 2011;14:101–12.Google Scholar
- 17.Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed. Springer, New York, 2010.Google Scholar