Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2022; 14(2): 143-160
Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.143
Nomograms predicting prognosis of patients with pathological stages T1N2-3 and T3N0 gastric cancer
Yu-Fei Wang, Xin Yin, Tian-Yi Fang, Yi-Min Wang, Dao-Xu Zhang, Yao Zhang, Xi-Bo Wang, Hao Wang, Ying-Wei Xue
Yu-Fei Wang, Xin Yin, Tian-Yi Fang, Yi-Min Wang, Dao-Xu Zhang, Yao Zhang, Xi-Bo Wang, Hao Wang, Ying-Wei Xue, Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Author contributions: Wang YF and Yin X designed and conceived this study, and they contributed equally to this work; Wang YF, Yin X, Fang TY, and Wang YM interpreted and analyzed the data; Xue YW revised the manuscript for important intellectual content; Wang YF, Yin X, Fang TY, Wang YM, Zhang DX, Zhang Y, Wang XB, and Wang H participated in the patient information collection; all authors read and approved the final manuscript.
Supported by Nn10 Program of Harbin Medical University Cancer Hospital, China, No. Nn10 PY 2017-03.
Institutional review board statement: The study was approved by the Ethics Committee of the Affiliated Tumor Hospital of Harbin Medical University.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: Patients’ data were saved in the Gastric Cancer Information Management System v1.2 of Harbin Medical University Cancer Hospital (Copyright No. 2013SR087424, http//:www.sgihmu.com).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Wei Xue, PhD, Chief Doctor, Professor, Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Harbin 150081, Heilongjiang Province, China. xueyingwei@hrbmu.edu.cn
Received: June 6, 2021
Peer-review started: June 6, 2021
First decision: July 16, 2021
Revised: July 24, 2021
Accepted: January 6, 2022
Article in press: January 6, 2022
Published online: February 27, 2022
Processing time: 261 Days and 5.1 Hours
Abstract
BACKGROUND

Patients with pathological stages T1N2-3 (pT1N2-3) and pT3N0 gastric cancer (GC) have not been routinely included in the target population for postoperative chemotherapy according to the Japanese Gastric Cancer Treatment Guideline, and their prognosis is significantly different.

AIM

To identify the high-risk patients after radical surgery by analyzing biomarkers and clinicopathological features and construct prognostic models for them.

METHODS

A total of 459 patients with pT1N2-3/pT3N0 GC were retrospectively selected for the study. The Chi-square test was used to analyze the differences in the clinicopathological features between the pT1N2-3 and pT3N0 groups. The Kaplan–Meier analysis and log-rank test were used to analyze overall survival (OS). The independent risk factors for patient prognosis were analyzed by univariate and multivariate analyses based on the Cox proportional hazards regression model. The cutoff values of continuous variables were identified by receiver operating characteristic curve. The nomogram models were constructed with R studio.

RESULTS

There was no statistically significant difference in OS between the pT1N2-3 and pT3N0 groups (P = 0.374). Prealbumin (P = 0.040), carcino-embryonic antigen (CEA) (P = 0.021), and metastatic lymph node ratio (mLNR) (P = 0.035) were independent risk factors for prognosis in the pT1N2-3 group. Age (P = 0.039), body mass index (BMI) (P = 0.002), and gastrectomy (P < 0.001) were independent risk factors for prognosis in the pT3N0 group. The area under the curve values of the nomogram models for predicting the 5-year prognosis of the pT1N2-3 group and pT3N0 group were 0.765 and 0.699, respectively.

CONCLUSION

Nomogram model combining prealbumin, CEA, and mLNR levels can be used to predict the prognosis of pT1N2-3 GC. Nomogram model combining age, BMI, and gastrectomy can be used to predict the prognosis of pT3N0 GC.

Keywords: Gastric cancer; Biomarker; Clinicopathological feature; Adjuvant chemotherapy; Prognosis; Nomogram

Core Tip: Patients with pathological stage T1N2-3 (pT1N2-3) and pT3N0 gastric cancer (GC) have not been routinely included in the target population for postoperative chemotherapy, and their prognosis is significantly different. The study aimed to identify the high-risk patients after radical surgery by analyzing biomarkers and clinicopathological features and construct prognostic models for them. Our results showed that the predictive models constructed by peripheral blood biomarkers and clinicopathological features can evaluate the prognosis of patients with pT1N2-3 and pT3N0 GC, which is worthy of further validation and promotion in clinical practice.