Nomograms for predicting survival in patients with metastatic gastric adenocarcinoma who undergo palliative gastrectomy

Abstract

Background Recently, evidence has emerged that palliative gastrectomy in patients with stage IV gastric cancer may offer some survival benefits. However, the decision whether to perform primary tumor surgery remains challenging for surgeons, and investigations into models that are predictive of prognosis are scarce. Current study aimed to develop and validate prognostic nomograms for patients with metastatic gastric adenocarcinoma treated with palliative gastrectomy. Methods The development dataset comprised 1186 patients from the Surveillance, Epidemiology, and End Results Program who were diagnosed with metastatic gastric adenocarcinoma in 2004–2011, while the validation dataset included 407 patients diagnosed in 2012–2015. Variables were incorporated into a Cox proportional hazards model to identify independent risk factors for survival. Both pre- and postoperative nomograms for predicting 1- or 2-year survival probabilities were constructed using the development dataset. The concordance index (c-index) and calibration curves were plotted to determine the accuracy of the nomogram models. Finally, the cut-off value of the calculated total scores based on preoperative nomograms was set and validated by comparing survival with contemporary cases without primary tumor surgery. Results Age, tumor size, location, grade, T stage, N stage, metastatic site, scope of gastrectomy, number of examined lymph node(s), chemotherapy and radiotherapy were risk factors of survival and were included as variables in the postoperative nomogram; the c-indices of the development and validation datasets were 0.701 (95% confidence interval [CI]: 0.693–0.710) and 0.699 (95% CI: 0.682–0.716), respectively. The preoperative nomogram incorporated age, tumor size, location, grade, depth of invasion, regional lymph node(s) status, and metastatic site. The c-indices for the internal (bootstrap) and external validation sets were 0.629 (95% CI: 0.620–0.639) and 0.607 (95% CI: 0.588–0.626), respectively. Based on the preoperative nomogram, patients with preoperative total score > 28 showed no survival benefit with gastrectomy compared to no primary tumor surgery. Conclusions Our survival nomograms for patients with metastatic gastric adenocarcinoma undergoing palliative gastrectomy can assist surgeons in treatment decision-making and prognostication.

Clinicopathological Characteristics and Response to Chemotherapy in Treatment-Naive Epstein–Barr Virus Associated Gastric Cancer: A Retrospective Study

“…Furthermore, no discrepancy in DFS with regard to PD-L1 expression was also reported in another study (19). When we look back into the data of the whole gastric cancer, the prognostic value of PD-L1 in OS is also debatable (20)(21)(22). Excluding other confounding factors such as tumor stage, T stage, or N stage, we found that PD-L1 expression was associated with longer DFS.…”

The incidence, risk factors and predictive nomograms for early death among patients with stage IV gastric cancer: a population-based study

“…GC is a major cause of cancer mortality worldwide (1), and the clinical stage is one of the key factors affecting the prognosis (13)(14)(15). Although many previous studies have investigated the prognosis of patients with stage IV GC (9,(16)(17)(18)(19), little is known about early death. To the best of our knowledge, the present study is the first to explore the early mortality and associated factors among stage IV GC patients.…”

“…In addition to race and surgery, other factors were also reported to be associated with prognosis in the previous studies (17,40). Ma (41).…”

“…Although several previous studies have constructed nomograms to predict the prognosis of patients with stage IV GC (17,40,41,43,44), to the best of our knowledge, no studies have developed nomograms to predict early death in patients with stage IV GC. In the present study, we developed two nomograms to predict the risk of allcause early death and cancer-specific early death.…”

Development and validation of a Surveillance, Epidemiology, and End Results (SEER)-based prognostic nomogram for predicting survival in elderly patients with gastric cancer after surgery

“…Third, among all four classic distant metastasis lesions, lung, brain, bone and liver, only lung metastasis was identified as a contributor to OS nomogram while none of distant metastatic lesions was associated with CSS nomogram. A similar study focusing on the nomograms of metastatic gastric adenocarcinoma with palliative gastrectomy reported that metastasis was one of the major contributors (20). However, distant lymph node metastasis and visceral metastasis were mainly evaluated.…”