Abstract
BackgroundPrediction of disease-specific survival (DSS) for individual patient with gastric cancer after R0 resection remains a clinical concern. Since the clinicopathologic characteristics of gastric cancer vary widely between China and western countries, this study is to evaluate a nomogram from Memorial Sloan-Kettering Cancer Center (MSKCC) for predicting the probability of DSS in patients with gastric cancer from a Chinese cohort.MethodsFrom 1998 to 2007, clinical data of 979 patients with gastric cancer who underwent R0 resection were retrospectively collected from Peking University Cancer Hospital & Institute and used for external validation. The performance of the MSKCC nomogram in our population was assessed using concordance index (C-index) and calibration plot.ResultsThe C-index for the MSKCC predictive nomogram was 0.74 in the Chinese cohort, compared with 0.69 for American Joint Committee on Cancer (AJCC) staging system (P<0.0001). This suggests that the discriminating value of MSKCC nomogram is superior to AJCC staging system for prognostic prediction in the Chinese population. Calibration plots showed that the actual survival of Chinese patients corresponded closely to the MSKCC nonogram-predicted survival probabilities. Moreover, MSKCC nomogram predictions demonstrated the heterogeneity of survival in stage IIA/IIB/IIIA/IIIB disease of the Chinese patients.ConclusionIn this study, we externally validated MSKCC nomogram for predicting the probability of 5- and 9-year DSS after R0 resection for gastric cancer in a Chinese population. The MSKCC nomogram performed well with good discrimination and calibration. The MSKCC nomogram improved individualized predictions of survival, and may assist Chinese clinicians and patients in individual follow-up scheduling, and decision making with regard to various treatment options.
Highlights
Gastric cancer rates have decreased substantially over the past few decades, the disease remains one of the most frequent malignancies worldwide
Gastric cancer are treated based on the American Joint Committee on Cancer (AJCC) staging groups, including the clinical parameters of pathologic depth of invasion (T), the number of metastatic lymph nodes (N), and distant metastasis (M) [7]
Our results suggest that the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram performed well with good discrimination and calibration in predicting disease-specific survival (DSS) probability of Chinese patients with gastric cancer
Summary
Gastric cancer rates have decreased substantially over the past few decades, the disease remains one of the most frequent malignancies worldwide. Surgery remains the primary curative treatment for gastric cancer without metastasis [3,4]. With the addition of pre- and postoperative adjuvant therapy, 5-year survival rate of gastric cancer has been improved up to 30–35% [5,6]. Gastric cancer are treated based on the American Joint Committee on Cancer (AJCC) staging groups, including the clinical parameters of pathologic depth of invasion (T), the number of metastatic lymph nodes (N), and distant metastasis (M) [7]. Prediction of disease-specific survival (DSS) for individual patient with gastric cancer after R0 resection remains a clinical concern. Since the clinicopathologic characteristics of gastric cancer vary widely between China and western countries, this study is to evaluate a nomogram from Memorial Sloan-Kettering Cancer Center (MSKCC) for predicting the probability of DSS in patients with gastric cancer from a Chinese cohort
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