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
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is an important public health burden worldwide. The TNM staging system based on tumor infiltration, regional lymph node metastasis, and distant metastasis is considered as the conventional criterion for evaluating prognosis and guiding treatment after surgery. Adjuvant chemotherapy can effectively reduce the disease recurrence. Based on the results of the Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer (ACTS-GC), stage II/III disease as the standard target of adjuvant chemotherapy after surgery, with the exception of pathological stages T1N2-3 (pT1N2-3) and pT3N0. However, in these two groups, there is still a portion of high-risk patients with a poor prognosis.

Research motivation

Analyzing the independent risk factors for the prognosis of pT1N2-3 and pT3N0 GC patients will provide a basis for clinicians to treat and predict the prognosis of these patients in the future.

Research objectives

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

Research methods

This retrospective study analyzed the clinicopathological characteristics and long-term survival data of 459 patients with pT1N2-3/pT3N0 GC, all of whom underwent radical gastrectomy at the Harbin Medical University Cancer Hospital between January 2000 and April 2016. 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 analyzed by receiver operating characteristic curve. The nomogram models were constructed with R studio.

Research results

According to the postoperative pathology report, there were 89 and 370 patients in the pT1N2-3 group and pT3N0 group, respectively. 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 pT1N2-3b 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 predicting the 5-year prognosis of the pT1N2-3 group and pT3N0 group were 0.765 and 0.699, respectively.

Research conclusions

The nomogram model based on peripheral blood biomarkers and clinicopathological features, including prealbumin, CEA, and mLNR, can be used to predict the prognosis of pT1N2-3 GC patients. Age, BMI, and gastrectomy can be used to predict the prognosis of pT3N0 GC patients.

Research perspectives

Further multicentric studies are needed to expand the sample size and external validation of the nomogram models will be performed to determine their predictive ability.