Abstract
BackgroundPatients with HBsAg-positive gastric cancer (GC) are a heterogeneous group, and it is not possible to accurately predict the overall survival (OS) in these patients.MethodsWe developed and validated a nomogram to help improve prediction of OS in patients with HBsAg-positive GC. The nomogram was established by a development cohort (n = 245), and the validation cohort included 84 patients. Factors in the nomogram were identified by univariate and multivariate Cox hazard analysis. We tested the accuracy of the nomograms by discrimination and calibration, and plotted decision curves to assess the benefits of nomogram-assisted decisions in a clinical context. Then we evaluated the risk in the two cohort.ResultsSignificant predictors were age, tumor stage, distant metastases, gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP). The proportional-hazards model (nomogram) was based on pre-treatment characteristics. The nomogram had a concordance index (C-index) of 0.812 (95% CI 0.762–0.862), which was superior than the C-index of AJCC TNM Stage (0.755, 95% CI 0.702–0.808). The calibration plot in the validation cohort based on 5 predictors suggested good agreement between actual and nomogram-predicted OS probabilities. The decision curve showed that the nomogram in predicting OS is better than that of TNM staging system in all range. Moreover, patients were divided into three distinct risk groups for OS by the nomogram: low risk group, middle risk group and high risk group, respectively.ConclusionThis nomogram, using five pre-treatment characteristics, improves prediction of OS in patients with HBsAg-positive gastric cancer. It represents an improvement in prognostication over the current TNM stage. To generalize the use of this nomogram in other groups, additional validation with data from other institutions is required.
Highlights
Patients with HBsAg-positive gastric cancer (GC) are a heterogeneous group, and it is not possible to accurately predict the overall survival (OS) in these patients
All the patients were classified as the first record of hospitalizations and the clinical information were extracted from Electronic Medical Record (EMR) system
Age, TNM stage, tumor stage, node stage, distant metastases, lactate dehydrogenase (LDH), gamma-glutamyl transpeptidase (GGT), total bile acid (TBA), alkaline phosphatase (ALP), ALB, apolipoprotein B (ApoB), Fbg were related to OS
Summary
Patients with HBsAg-positive gastric cancer (GC) are a heterogeneous group, and it is not possible to accurately predict the overall survival (OS) in these patients. Gastric cancer (GC) is one of the most common malignancies and ranks the second leading cause of cancer death worldwide, with about one million new cases reported every year [1] It was commonly diagnosed and were recognized as leading causes of cancer death in China [1]. Large variations are reported in the clinical outcomes, even patients with the same stage and similar treatment strategies [9, 12, 13]. This findings indicate that the present staging system is inadequate for predicting recurrence and does not reflect the biological heterogeneity of HBsAg-positive GC patients [12]. Many other risk factors, such as age, sex and LFT should be considered for predicting individualized prognosis
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