Development and external validation of a nomogram predicting overall survival for Gastric adenocarcinoma patients with radical gastrectomy

AbstractPurpose The aim of this study was to develop and externally validate a nomogram to accurately predict the overall survival (OS) of patients with gastric adenocarcinoma who underwent radical gastrectomy.Materials and Methods A total of 3492 patients with gastric adenocarcinoma who underwent radical gastrectomy from 2012 to 2017 were included as the training cohort. Survival analysis was performed via Kaplan Meier method and log-rank test. Independent postoperative prognostic factors in patients with gastric adenocarcinoma were analyzed using univariate and multifactorial COX analysis methods. The prognosis nomogram was established in the training cohort and verified externally in the Surveillance, Epidemiology and End Results (SEER) database.Results According to the univariate and multifactorial COX analyses, metastatic lymph node ratio (MLNR) and five other independent prognostic factors (age at surgery, type of gastrectomy, tumor size, T stage, and pathological grade) were included in the prognostic nomogram. The nomogram had better prognostic predictive ability than the American Joint Committee on Cancer (AJCC) TNM staging in both the training (C-index: 0.736 VS. 0.668) and external validation cohort (C-index: 0.712 VS. 0.627). The calibration plots showed that the predicted survival rate was in good agreement with the actual survival rate. And the decision curve analysis (DCA) curves revealed that nomogram showed stronger ability in predicting 1-year, 3-year, and 5-year OS.Conclusion This study estimated the excellent prognostic predictive power and clinical application potential of the MLNR-based nomogram, which may be used to facilitate postoperative clinical treatment decisions and potentially improve patient survival outcomes.Keywords: Gastric cancernomogramprognosismetastatic lymph node ratioSEER database Ethics approval and consent to participateThis research has been reviewed and approved by the Clinical Medical Research Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Quick-PJ 2022-13-22), and the ethical standards are strictly observed in the research process. In accordance with national legislation and institutional requirements, written informed consent for participation was not required for this study.Consent for publicationWritten informed consent was obtained from all participants.Authors’ contributionsXD, ZZ and ZH designed the experiments, ZH, FL, TC, JG and HW analyzed the data and wrote the manuscript. All authors discussed the results and commented on the final manuscript.Disclosure statementThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.DisclaimersThe authors declare that the views expressed in the submitted articles are our own and not the official position of the institutions or funders.Data availability statementAll data generated or analyzed during this study are included in this published article.Additional informationFundingThis present study was supported by grants from the National Natural Science Foundation of China [81960103 to XD], the Natural Science Foundation of Jiangxi province [20202ACBL206010 to XD].