Risk factors and nomogram for early mortality in young patients with non-metastatic gastric cancer

Accurate identification of patients at risk of early death among young, non-metastatic gastric cancer cases at initial diagnosis may assist clinicians in optimizing treatment strategies. This study aimed to identify risk factors associated with early mortality in young patients with non-metastatic gastric cancer and to develop a clinically applicable nomogram for individualized risk prediction.

Eligible patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and Sun Yat-sen University Cancer Center Gansu Hospital. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors of early mortality. A nomogram was constructed based on the identified factors, and its performance was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curves, the Hosmer-Lemeshow test, and decision curve analysis (DCA) across training, internal validation, and external validation cohorts.

The results revealed that T stage, N stage, radiotherapy, marital status, surgical treatment, tumor grade, and tumor size were independent predictors of early mortality. The nomogram demonstrated good discriminative ability, with C-index values of 0.748, 0.792, and 0.758 and area under the curve (AUC) of 0.81, 0.792, and 0.757 in the respective cohorts. Bootstrap resampling indicated good calibration, with low absolute prediction errors.

We have successfully developed effective nomograms to provide a reliable and practical tool for predicting early mortality and supporting clinical decision-making in young patients with non-metastatic gastric cancer.