A nomogram to predict overall survival and disease-free survival after curative resection of gastric adenocarcinoma.
BACKGROUND
The American Cancer Society projects there will be over 22,000 new cases, resulting in nearly 11,000 deaths, related to gastric adenocarcinoma in the US in 2014. The aim of the current study was to find clinicopathologic variables associated with disease-free survival (DFS) and overall survival (OS) following curative resection of gastric adenocarcinoma, and create a nomogram for individual risk prediction.


METHODS
A nomogram to predict DFS and OS following surgical resection of gastric adenocarcinoma was constructed using a multi-institutional cohort of patients who underwent surgery for primary gastric adenocarcinoma at seven major institutions in the US between January 2000 and August 2013. Discrimination and calibration of the nomogram were tested by C-statistic, Kaplan-Meier curves, and calibration plots.


RESULTS
A total of 719 patients who underwent surgery for primary gastric adenocarcinoma were included in the study. Using the backward selection of clinically relevant variables with Akaike information criteria, age, sex, tumor site, depth of invasion, and lymph node ratio (LNR) were selected as factors predictive of OS, while age, tumor site, depth of invasion, and LNR were incorporated in the prediction of DFS. A nomogram was constructed to predict OS and DFS using these variables. Discrimination and calibration of the nomogram revealed good predictive abilities (C-index, DFS 0.711; OS 0.702).


CONCLUSIONS
Independent predictors of recurrence and death following surgery for primary gastric adenocarcinoma were used to create a nomogram to predict DFS and OS. The nomogram was able to stratify patients into prognostic groups, and performed well on internal validation.
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Yuhree
Y
Kim
Gaya
G
Spolverato
Aslam
A
Ejaz
Malcolm H
MH
Squires
George
G
Poultsides
Ryan C
RC
Fields
Mark
M
Bloomston
Sharon M
SM
Weber
Konstantinos
K
Votanopoulos
Alexandra W
AW
Acher
Linda X
LX
Jin
William G
WG
Hawkins
Carl
C
Schmidt
David
D
Kooby
David
D
Worhunsky
Neil
N
Saunders
Edward A
EA
Levine
Clifford S
CS
Cho
Shishir K
SK
Maithel
Timothy M
TM
Pawlik
D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology