Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy

Abstract Background: Surgery is the only way to cure gastric adenocarcinoma (GAC), and chemotherapy is the basic adjuvant management for GAC. A prognostic model for predicting the individual disease-specific survival (DSS) rates of GAC patients who receive surgery and chemotherapy has not been established. Objective: We aimed to establish a survival nomogram for GAC patients who receive surgery and chemotherapy. Methods: We identified 5764 GAC patients who had received surgery and chemotherapy from the SEER (Surveillance, Epidemiology, and End Results) database. Approximately 80% (n=4034) of the included patients were randomly assigned to the training set, and the remaining patients (n=1729) were assigned to the external validation set. Nomogram was established by the training set and validated by the validation set. Results: Based on the results of a multivariate analysis, a nomogram was developed that encompassed age at diagnosis, number of regional lymph nodes examined, number of positive regional lymph nodes, sex, race, grade, derived AJCC stage, summary stage, and radiotherapy status. The C-index (Harrell’s concordance index) of the model was higher than that of the traditional seventh AJCC staging system (0.707 vs 0.661). Calibration plots of the nomogram showed that the probability of DSS optimally corresponded to the survival rate. Integrated discrimination improvement (IDI) and categorical net reclassification improvement (NRI) showed visible improvement. IDI for 3-, 5- and 10- year DSS were 0.058, 0.059 and 0.058, respectively (P>0.05), and NRI for 3-, 5- and 10- year DSS were 0.380 (95% CI=0.316–0.470), 0.407 (95% CI=0.350–0.505), and 0.413 (95% CI=0.336–0.519), respectively. Decision curve analysis supported that the constructed nomogram was superior to the AJCC staging system. Conclusion: The proposed nomogram provides more-reliable DSS predictions for GAC patients who receive surgery and chemotherapy in the general population. According to validation, the new nomogram will be beneficial in facilitating individualized survival predictions and useful when performing clinical decision-making for GAC patients who receive surgery and chemotherapy.

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Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy

BMC Cancer ◽

10.1186/s12885-019-6495-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Chao-Yang Wang ◽

Jin Yang ◽

Hao Zi ◽

Zhong-Li Zheng ◽

Bing-Hui Li ◽

...

Keyword(s):

Lymph Nodes ◽

Gastric Adenocarcinoma ◽

Clinical Decision Making ◽

External Validation ◽

Staging System ◽

Training Set ◽

Regional Lymph Nodes ◽

Ajcc Staging System ◽

Validation Set ◽

Ajcc Staging

Abstract Background Surgery is the only way to cure gastric adenocarcinoma (GAC), and chemotherapy is the basic adjuvant management for GAC. A significant prognostic nomogram for predicting the respective disease-specific survival (DSS) rates of GAC patients who receive surgery and chemotherapy has not been established. Objective We were planning to establish a survival nomogram model for GAC patients who receive surgery and chemotherapy. Methods We identified 5764 GAC patients who had received surgery and chemotherapy from the record of Surveillance, Epidemiology, and End Results (SEER) database. About 70% (n = 4034) of the chosen GAC patients were randomly assigned to the training set, and the rest of the included ones (n = 1729) were assigned to the external validation set. A prognostic nomogram was constructed by the training set and the predictive accuracy of it was validated by the validation set. Results Based on the outcome of a multivariate analysis of candidate factors, a nomogram was developed that encompassed age at diagnosis, number of regional lymph nodes examined after surgery, number of positive regional lymph nodes, sex, race, grade, derived AJCC stage, summary stage, and radiotherapy status. The C-index (Harrell’s concordance index) of the nomogram model was some larger than that of the traditional seventh AJCC staging system (0.707 vs 0.661). Calibration plots of the constructed nomogram displayed that the probability of DSS commendably accord with the survival rate. Integrated discrimination improvement (IDI) revealed obvious increase and categorical net reclassification improvement (NRI) showed visible enhancement. IDI for 3-, 5- and 10- year DSS were 0.058, 0.059 and 0.058, respectively (P > 0.05), and NRI for 3-, 5- and 10- year DSS were 0.380 (95% CI = 0.316–0.470), 0.407 (95% CI = 0.350–0.505), and 0.413 (95% CI = 0.336–0.519), respectively. Decision curve analysis (DCA) proved that the constructed nomogram was preferable to the AJCC staging system. Conclusion The constructed nomogram supplies more credible DSS predictions for GAC patients who receive surgery and chemotherapy in the general population. According to validation, the new nomogram will be beneficial in facilitating individualized survival predictions and useful when performing clinical decision-making for GAC patients who receive surgery and chemotherapy.

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Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy

10.21203/rs.2.10550/v2 ◽

2019 ◽

Author(s):

Chao-Yang Wang ◽

Jin Yang ◽

Hao Zi ◽

Zhong-Li Zheng ◽

Bing-Hui Li ◽

...

Keyword(s):

Lymph Nodes ◽

Gastric Adenocarcinoma ◽

Clinical Decision Making ◽

External Validation ◽

Staging System ◽

Training Set ◽

Regional Lymph Nodes ◽

Ajcc Staging System ◽

Validation Set ◽

Ajcc Staging

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Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy

10.21203/rs.2.10550/v3 ◽

2019 ◽

Author(s):

Chao-Yang Wang ◽

Jin Yang ◽

Hao Zi ◽

Zhong-Li Zheng ◽

Bing-Hui Li ◽

...

Keyword(s):

Lymph Nodes ◽

Gastric Adenocarcinoma ◽

Clinical Decision Making ◽

External Validation ◽

Staging System ◽

Training Set ◽

Regional Lymph Nodes ◽

Ajcc Staging System ◽

Validation Set ◽

Ajcc Staging

Abstract Background: Surgery is the only way to cure gastric adenocarcinoma (GAC), and chemotherapy is the basic adjuvant management for GAC. A significant prognostic nomogram for predicting the respective disease-specific survival (DSS) rates of GAC patients who receive surgery and chemotherapy has not been established.Objective: We were planning to establish a survival nomogram model for GAC patients who receive surgery and chemotherapy. Methods: We identified 5764 GAC patients who had received surgery and chemotherapy from the record of Surveillance, Epidemiology, and End Results (SEER ) database. About 70% ( n =4034) of the chosen GAC patients were randomly assigned to the training set, and the rest of the included ones ( n =1729) were assigned to the external validation set. A prognostic nomogram was constructed by the training set and the predictive accuracy of it was validated by the validation set. Results: Based on the outcome of a multivariate analysis of candidate factors, a nomogram was developed that encompassed age at diagnosis, number of regional lymph nodes examined after surgery, number of positive regional lymph nodes , sex , race, grade, derived AJCC stage, summary stage , and radiotherapy status. The C-index (Harrell’s concordance index) of the nomogram model was some larger than that of the traditional seventh AJCC staging system (0.707 vs 0.661). Calibration plots of the constructed nomogram displayed that the probability of DSS commendably accord with the survival rate. Integrated discrimination improvement (IDI) revealed obvious increase and categorical net reclassification improvement (NRI) showed visible enhancement. IDI for 3-, 5- and 10- year DSS were 0.058, 0.059 and 0.058, respectively ( P >0.05), and NRI for 3-, 5- and 10- year DSS were 0.380 (95% CI=0.316–0.470), 0.407 (95% CI=0.350–0.505), and 0.413 (95% CI=0.336–0.519), respectively. Decision curve analysis (DCA) proved that the constructed nomogram was preferable to the AJCC staging system. Conclusion: The constructed nomogram supplies more credible DSS predictions for GAC patients who receive surgery and chemotherapy in the general population. According to validation, the new nomogram will be beneficial in facilitating individualized survival predictions and useful when performing clinical decision-making for GAC patients who receive surgery and chemotherapy.

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Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

10.21203/rs.3.rs-26209/v2 ◽

2020 ◽

Author(s):

Wenwen Zheng ◽

Weiwei Zhu ◽

Shengqiang Yu ◽

Kangqi Li ◽

Yuexia Ding ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Staging System ◽

Survival Prediction ◽

Seer Database ◽

Training Set ◽

Ajcc Staging System ◽

Validation Set ◽

Ajcc Staging ◽

Metastatic Rcc

Abstract Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity. We aimed to develop a novel nomogram to predict overall survival (OS) for this population. Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients were randomly assigned to a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validations via the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P <0.001) and the validation set (C-indexes, 0.676 vs. 0.600, P <0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values. The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction. Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.

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Development and Validation of a Nomogram to Predict Overall Survival for Patients with Metastatic Renal Cell Carcinoma

10.21203/rs.3.rs-26209/v1 ◽

2020 ◽

Author(s):

Wenwen Zheng ◽

Weiwei Zhu ◽

Shengqiang Yu ◽

Kangqi Li ◽

Yuexia Ding ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Overall Survival ◽

Staging System ◽

Survival Prediction ◽

Seer Database ◽

Training Set ◽

Ajcc Staging System ◽

Validation Set ◽

Ajcc Staging ◽

Metastatic Rcc

Abstract Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity.We aimed to develop a novel nomogram to predict overall survival (OS) for this population.Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients wererandomly assignedto a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validationsvia the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis.The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P<0.001) and the validation set (C-indexes, 0.675 vs. 0.600, P<0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values.The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction.Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.

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Seventh edition (2010) of gastric adenocarcinoma AJCC staging system: Is there room for improvement?

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.77 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 77-77

Author(s):

Manali I. Patel ◽

Kim F Rhoads ◽

Yifei Ma ◽

James M. Ford ◽

Jeffrey A. Norton ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Adenocarcinoma ◽

Health Planning ◽

Gastroesophageal Junction ◽

Staging System ◽

Rank Test ◽

Population Database ◽

Curative Intent ◽

Ajcc Staging System ◽

Ajcc Staging

77 Background: The gastric cancer AJCC staging system recently underwent significant modifications of the T and N categories as well as stage groupings. The new system has not been validated on a US population database, but studies on Asian patients have reported no difference in survival between stages IB and IIA, as well as IIB and IIIA. Methods: California Cancer Registry data linked to Office of Statewide Health Planning and Development discharge abstracts were used to identify patients with gastric adenocarcinoma (gastroesophageal junction tumors excluded) who underwent curative-intent surgical resection from 2002 to 2006. AJCC stage was reclassified based on the 7th edition. Disease-specific survival (DSS) probabilities were calculated using the Kaplan-Meier method and compared using the log rank test. Results: Of 4,985 patients identified, 2,262 had complete pathologic data and known cause of death. Median age was 70 years and 60% were males. Median number of examined lymph nodes was 12 and 39% of patients received adjuvant chemotherapy. The 7th edition AJCC system did not distinguish outcome adequately between stages IB and IIA (P = .25), or IIB and IIIA (P = .33, Table ). By merging stage II into one category and moving T2N1 to stage IB and T2N2, T1N3 to stage IIIA, we propose a new grouping system which showed improved discriminatory ability ( Table ). Conclusions: In this first study validating the new 7th edition AJCC staging system for gastric cancer on a US population, we found stages IB and IIA, as well as IIB and IIIA to perform similarly. We propose a revised stage grouping for the AJCC system that better discriminates between outcomes. [Table: see text]

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Prognostic nomogram based on log odds of positive lymph nodes for gastric carcinoma patients after surgical resection

Future Oncology ◽

10.2217/fon-2019-0473 ◽

2019 ◽

Vol 15 (36) ◽

pp. 4207-4222

Author(s):

Enfa Zhao ◽

Changli Zhou ◽

Shimin Chen

Keyword(s):

Gastric Carcinoma ◽

Lymph Nodes ◽

Staging System ◽

Predictive Performance ◽

Cancer Specific Survival ◽

Node Ratio ◽

Log Odds ◽

Ajcc Staging System ◽

Ajcc Staging ◽

Positive Lymph Nodes

Aim: To build a prognostic nomogram based on log odds of positive lymph nodes for patients with gastric carcinoma (GC) after resection, and to compare the predictive performance with the American Joint Committee on Cancer (AJCC) staging system and lymph node ratio (LNR). Methods: Multivariate analyses were performed to identify the independent variables for cancer-specific survival (CSS). A nomogram was constructed based on independent clinicopathological factors. Results: The C-indices for predicting CSS were 0.674 in development cohort and 0.647 in validation cohort, which were higher than that of the AJCC staging system and LNR. Conclusion: The nomogram was more accurate than the AJCC staging system and LNR for predicting CSS in patients undergoing resection for GC.

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Development and validation of a Nomogram for predicting the Overall Survival of Patients With Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas

10.21203/rs.3.rs-258185/v1 ◽

2021 ◽

Author(s):

Zhilong Liu ◽

Haohui Yu ◽

Mingrong Cao ◽

Jiexing Li ◽

Yulin Huang ◽

...

Keyword(s):

Overall Survival ◽

Pancreatic Ductal Adenocarcinoma ◽

Staging System ◽

The United States ◽

Ductal Adenocarcinoma ◽

Seer Database ◽

Training Set ◽

Head Of The Pancreas ◽

Ajcc Staging System ◽

Ajcc Staging

Abstract Background: The purpose of this study is to develop and validate a nomogram to predict the overall survival (OS) of patients with Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas (PDAC-HP).Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we collected patients with PDAC-HP in the United States between 2004 and 2015. Patients were randomly divided into training set and validating set at a ratio of 7:3. The training set is used to develop a nomogram for predicting OS. These indicators such as the C index, the area under curve (AUC) of the receiver operating characteristic (ROC), calibration plots and the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) were used to evaluate the prediction accuracy of the nomogram.Results: A total of 33,893 patients with PDAC-HP over 20 years old were diagnosed between 2004 and 2015 were collected from the SEER database. Using multivariable Cox regression analysis, we identified eight risk factors that were associated with OS, such as age at diagnosis, sex, marital status at diagnosis, race, AJCC staging, surgery, radiotherapy and chemotherapy. A nomogram was constructed based on these variables. Compared with the AJCC staging system, the nomogram has a better C index and AUC in the training set and validatiing set. The calibration plots indicated that the nomogram was able to accurately predict the OS of patients with PDAC-HP at 1, 3, and 5 years.Conclusions: We developed and validated a nomogram, and predicted the OS of patients with PDAC-HP at 1, 3, and 5 years. Compared with the AJCC staging system, the nomogram we constructed has better performance. It shows that our nomogram could be served as an effective tool for prognostic evaluation of patients with PDAC-HP.

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Validation of the 8th Edition of the American Joint Committee on Cancer Staging System for Gallbladder Cancer and Implications for the Follow-up of Patients without Node Dissection

Cancer Research and Treatment ◽

10.4143/crt.2019.271 ◽

2020 ◽

Vol 52 (2) ◽

pp. 455-468

Author(s):

You-Na Sung ◽

Minjeong Song ◽

Jae Hoon Lee ◽

Ki Byung Song ◽

Dae Wook Hwang ◽

...

Keyword(s):

Lymph Nodes ◽

Gallbladder Cancer ◽

Staging System ◽

Cancer Staging ◽

Significant Survival ◽

Nodal Dissection ◽

Ajcc Staging System ◽

Ajcc Staging ◽

Survival Differences ◽

8Th Edition

PurposeThe 8th edition of gallbladder cancer staging in the American Joint Committee on Cancer (AJCC) staging system changed the T and N categories.Materials and MethodsIn order to validate the new staging system, a total of 348 surgically resected gallbladder cancers were grouped based on the 8th edition of the T and N categories and compared with patients’ survival.ResultsSignificant differences were noted between T1b-T2a (p=0.003) and T2b-T3 (p < 0.001) tumors, but not between Tis-T1a, T1a-T1b, and T2a-T2b tumors. However, significant survival differences were observed both by the overall and pair-wise (T1-T2, T2-T3) comparisons (all, p < 0.001) without dividing T1/T2 subcategories. When cases with ≥ 6 examined lymph nodes were evaluated, significant survival differences were observed among the entire comparison (p < 0.001) and pair-wise comparisons of N0-N1 (p=0.001) and N1-N2 (p=0.039) lesions. When cases without nodal dissection (NX) were additionally compared, significant survival differences were observed between patients with N0-NX (p=0.001) and NX-N1 (p < 0.001) lesions.ConclusionThe T category in the 8th edition of the AJCC staging system did not completely stratify the prognosis of patients with gallbladder cancer. Modification by eliminating T subcategories can better stratify the prognosis. In contrast, the N category clearly determines patients’ survival with ≥ 6 examined lymph nodes. The survival time in patients of gallbladder cancers without nodal dissection is between N0 and N1 cases. Therefore, close postoperative followed up is recommended for those patients.

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