Abstract
Background: Human epidermal growth factor receptor 2 (HER2) status remains an outcome-associated biomarker independent from known prognostic factors in advanced gastric cancer (AGC). The purpose of this study was to develop nomograms that combine HER2 status and the other prognostic factors to predict the survival outcome of individual patients with AGC starting first-line treatment. Methods: We retrospectively analyzed consecutive 838 patients with AGC starting first-line chemotherapy at single institution between January 2005 and December 2012. We established the nomograms that calculated the predicted probability of survival at different time points: 1 and 2 years for overall survival (OS). Gender, ECOG performance status (PS), histological subtype, number of metastatic sites, serum alkaline phosphatase level, starting year of first-line chemotherapy, and HER2 status were included in the Cox proportional hazards models as covariates. Missing covariate data were estimated using multiple imputation methods. The discriminatory ability and accuracy of the models were assessed using Harrell's c-index. Results: At a median follow-up of 12.3 months (range, 0.2 to 92.5 months), 757 (90.3%) patients died at the time of analysis. The median OS was 12.5 months [95% confidence interval (CI), 11.8 to 13.2 months]. Patient characteristics were as follows: median age (range), 64 (22-93); male/female, 65%/35%; ECOG PS (0/1/ > 1), 34%/51%/15%; and HER2 status (positive/negative/unknown), 10%/45%/45%. HER2 positivity showed a trend toward improvement in OS [hazard ratio 0.87 (95% CI, 0.70 to 1.08)]. The developed nomogram is capable of predicting OS with c-index of 0.68. Conclusions: We established nomograms including HER2 status to predict the OS for individual patients with AGC. A validation study is warranted to evaluate the effectiveness of this nomogram.
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