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The development and external validation of a nomogram predicting overall survival of gastric cancer patients with inadequate lymph nodes based on an international database

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Abstract

Background

Inadequate sampling of lymph nodes could lead to stage migration and indicate a poor prognosis for gastric cancer after curative surgery. Some emerging novel predictors and the application of a nomogram could increase the accuracy of survival prediction.

Methods

An international database regarding gastric cancer was employed as the primary cohort. The patients with inadequate (< 30) lymph nodes (LN) were analyzed by Cox proportional hazards regression. Based on the selected model, a nomogram was plotted and calibrated against an external validation database.

Results

A total of 1109 patients were included in the primary cohort, and there were 6584 patients in the validation cohort. There were significant differences regarding the clinical characteristics between the two cohorts. The model containing age, T stages, N stages, metastatic lymph nodes (mLN), and the number of total LN retrieved (TLN) showed superiority over the conventional TNM stages. Harrell's concordance index of the nomogram and TNM stages was 0.744 and 0.717, respectively. The external validation demonstrated a good concordance with the nomogram-predicted survival.

Conclusions

The nomogram including age, T stages, N stages, mLN, and TLN had a better accuracy than the conventional TNM staging system in predicting overall survival for gastric cancer patients with inadequate (< 30) LN.

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Acknowledgements

We thank the IMIGASTRIC program for its contribution in promoting the collaborative work between Peking University Cancer Hospital and St. Mary’s Hospital.

Funding

No funding supported this study.

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Author notes

  1. Shuangxi Li, Jacopo Desiderio and Ziyu Li contributed equally to the study and are co-first authors.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China

    Shuangxi Li, Ziyu Li & Jiafu Ji

  2. Department of Digestive Surgery, St. Mary’s Hospital, Terni, Italy

    Jacopo Desiderio & Amilcare Parisi

  3. Department of Surgical Sciences, PhD Program in Advanced Surgical Technologies, La Sapienza University of Rome, Rome, Italy

    Jacopo Desiderio

  4. Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, University of Texas Health At San Antonio, San Antonio, USA

    Federico Tozzi

Authors
  1. Shuangxi Li
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  2. Jacopo Desiderio
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  3. Ziyu Li
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  4. Federico Tozzi
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  5. Jiafu Ji
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Correspondence to Jiafu Ji or Amilcare Parisi.

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Li, S., Desiderio, J., Li, Z. et al. The development and external validation of a nomogram predicting overall survival of gastric cancer patients with inadequate lymph nodes based on an international database. Int J Clin Oncol 26, 867–874 (2021). https://doi.org/10.1007/s10147-021-01875-2

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  • DOI: https://doi.org/10.1007/s10147-021-01875-2

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