Abstract
BackgroundSurvival times differ among patients with advanced gastric carcinoma. A precise and universal prognostic evaluation strategy has not yet been established. The current study aimed to construct a prognostic scoring model for mortality risk stratification in patients with advanced gastric carcinoma.MethodsPatients with advanced gastric carcinoma from two hospitals (development and validation cohort) were included. Cox proportional hazards regression analysis was conducted to identify independent risk factors for survival. A prognostic nomogram model was developed using R statistics and validated both in bootstrap and external cohort. The concordance index and calibration curves were plotted to determine the discrimination and calibration of the model, respectively. The nomogram score and a simplified scoring system were developed to stratify patients in the two cohorts.ResultsDevelopment and validation cohort was comprised of 401 and 214 gastric cancer patients, respectively. Mucinous or non-mucinous histology, ECOG score, bone metastasis, ascites, hemoglobin concentration, serum albumin level, lactate dehydrogenase level, carcinoembryonic antigen level, and chemotherapy were finally incorporated into prognostic nomogram. The concordance indices were 0.689 (95% CI: 0.664 ~ 0.714) and 0.673 (95% CI: 0.632 ~ 0.714) for bootstrap and external validation. 100 and 200 were set as the cut-off values of nomogram score, patients in development cohort were stratified into low-, intermediate- and high-risk groups with median overall survival time 15.8 (95% CI: 12.2 ~ 19.5), 8.4 (95% CI: 6.7 ~ 10.2), and 3.9 (95% CI: 2.7 ~ 5.2) months, respectively; the cut-off values also worked well in validation cohort with different survival time in subgroups. A simplified model was also established and showed good consistency with the nomogram scoring model in both of development and validation cohorts.ConclusionThe prognostic scoring model and its simplified surrogate can be used as tools for mortality risk stratification in patients with advanced gastric carcinoma.
Highlights
Survival times differ among patients with advanced gastric carcinoma
Patient characteristics At first, 499 and 214 eligible cases were identified in the hospital information system of Anhui Medical University (AHMU) and Ma’anshan Municipal People’s Hospital (MMH) respectively
The median overall survival for patients in the AHMU and MMH cohorts were 11.0 and 6.5 months, respectively
Summary
Survival times differ among patients with advanced gastric carcinoma. A precise and universal prognostic evaluation strategy has not yet been established. The current study aimed to construct a prognostic scoring model for mortality risk stratification in patients with advanced gastric carcinoma. Data from a cancer registry in Shanghai, China showed that the five-year survival rate of stage IV gastric cancer diagnosed between 2002 and 2003 was not more than 10%, with a median survival time of approximately 8 months [2]. As early as 2004, Chau et al [11] developed a four-factor prognostic model that incorporated performance status, liver metastases, peritoneal metastases, and alkaline phosphatase levels. In this prognostic model, advanced gastric cancer patients were distinctly stratified into three risk groups. We performed a prognostic model research using two isolated datasets of patients derived from two different cohorts of Chinese patients to create a scoring system and tried to stratify advanced gastric cancer patients into different prognostic subgroups
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