Nomogram to predict overall survival of patients receiving radical gastrectomy and incomplete peri-operative adjuvant...

Area of Science:

• Oncology
• Surgical Oncology
• Medical Statistics

Background:

• Gastric cancer (GC) remains a significant global health challenge.
• Incomplete peri-operative adjuvant chemotherapy (PAC) poses a challenge in predicting survival for stage II/III GC patients.
• Accurate prognostic tools are crucial for guiding treatment decisions and patient counseling.

Purpose of the Study:

• To develop and validate a nomogram for predicting survival probability in stage II/III GC patients who received incomplete PAC.
• To compare the clinical utility of the developed nomogram against the established TNM staging system.

Main Methods:

• Retrospective review of 1,070 stage II/III GC patients from two tertiary hospitals who underwent curative resection and 1-5 cycles of PAC.
• Development of a nomogram using Cox regression analysis in a training cohort (70%) and validation in a separate cohort (30%).
• Evaluation of nomogram performance using concordance index, calibration curves, and decision curve analysis (DCA).

Main Results:

• Lower BMI (<18.5 kg/m²), total gastrectomy, stage III disease, and fewer PAC cycles were independent predictors of poorer survival.
• The nomogram demonstrated good discrimination (C-index: 0.768 training, 0.742 validation) and calibration for 1-, 3-, and 5-year survival.
• Decision curve analysis indicated superior net clinical benefit compared to the TNM staging system.

Conclusions:

• The developed nomogram is an accurate and validated tool for predicting survival in stage II/III GC patients with incomplete PAC.
• The findings underscore the importance of completing PAC and highlight the nomogram's potential to improve clinical decision-making.
• The nomogram offers a more precise prognostic assessment than the traditional TNM staging system for this patient group.