Development and validation of a prognostic nomogram in gastric cancer with hepatitis B virus infection

Abstract

BackgroundPatients with HBsAg-positive gastric cancer (GC) are a heterogeneous group, and it is not possible to accurately predict the overall survival (OS) in these patients.MethodsWe developed and validated a nomogram to help improve prediction of OS in patients with HBsAg-positive GC. The nomogram was established by a development cohort (n = 245), and the validation cohort included 84 patients. Factors in the nomogram were identified by univariate and multivariate Cox hazard analysis. We tested the accuracy of the nomograms by discrimination and calibration, and plotted decision curves to assess the benefits of nomogram-assisted decisions in a clinical context. Then we evaluated the risk in the two cohort.ResultsSignificant predictors were age, tumor stage, distant metastases, gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP). The proportional-hazards model (nomogram) was based on pre-treatment characteristics. The nomogram had a concordance index (C-index) of 0.812 (95% CI 0.762–0.862), which was superior than the C-index of AJCC TNM Stage (0.755, 95% CI 0.702–0.808). The calibration plot in the validation cohort based on 5 predictors suggested good agreement between actual and nomogram-predicted OS probabilities. The decision curve showed that the nomogram in predicting OS is better than that of TNM staging system in all range. Moreover, patients were divided into three distinct risk groups for OS by the nomogram: low risk group, middle risk group and high risk group, respectively.ConclusionThis nomogram, using five pre-treatment characteristics, improves prediction of OS in patients with HBsAg-positive gastric cancer. It represents an improvement in prognostication over the current TNM stage. To generalize the use of this nomogram in other groups, additional validation with data from other institutions is required.

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“…Nomograms have been successfully established to predict the survival of patients with GC. A previous report described the construction of a nomogram combined with five clinicopathological features to predict the prognosis of GC with hepatitis B virus infection, which demonstrated a significant predictive value (19). Roberto et al built a nomogram of postoperative survival probability of GC patients based on age, preoperative performance, lymph node invasion, presence of residual tumors, and depth of tumor invasion (20).…”

“…Nomograms have been successfully established to predict the survival of patients with GC. A previous report described the construction of a nomogram combined with five clinicopathological features to predict the prognosis of GC with hepatitis B virus infection, which demonstrated a significant predictive value ( 19 ). Roberto et al.…”