Nomogram for Predicting Survival in Advanced Gastric Cancer after Neoadjuvant Chemotherapy and Radical Surgery

Abstract

Background. Neoadjuvant chemotherapy (NAC) with subsequent radical surgery has become a popular treatment modality for advanced gastric cancer (AGC) worldwide. However, the survival benefit is still controversial, and prognostic factors remain undetermined. Aim. To identify clinical parameters that are associated with the survival of AGC patients after NAC and radical surgery and to establish a nomogram integrating multiple factors to predict survival. Methods. We reviewed the medical profiles of 215 AGC patients who received NAC and radical resection, and clinical parameters concerning NAC, surgery, pathological findings, and adjuvant chemotherapy were analyzed using a Cox regression model to determine their impact on survival. Based on these factors, a nomogram was developed and validated. Results. The overall 1-year and 3-year survival rates were 85.8% and 55.6%, respectively. Younger age (<60 years old), increased examined lymph nodes (exLNs), successful R0 resection, the achievement of pathological complete response (pCR), and acceptance of adjuvant chemotherapy were positive predictors of survival. The C-index of the established nomogram was 0.785. The area under receiver operating curve (ROC) at 1/3 years of prediction was 0.694/0.736, respectively. The model showed an ideal calibration following internal bootstrap validation. Conclusion. A nomogram predicting survival after NAC and surgery was established. Since this nomogram exhibited satisfactory and stable predictive power, it can be inferred that this is a practical tool for predicting AGC patient survival after NAC and radical surgery.

Development of a novel staging classification for Siewert II adenocarcinoma of the esophagogastric junction after neoadjuvant chemotherapy

“…Liu et al [ 4 ] suggested that a nomogram could be a promising clinical tool for assessing OS in patients with Siewert type II AEG after preoperative radiotherapy. Moreover, factors other than ypT and ypN stages significantly influence patient prognosis, therefore, they should be considered when establishing individual prediction models[ 31 - 34 ]. In this study, data were retrieved from a specific cancer database (SEER) to identify potential prognostic factors, specifically for patients with Siewert II AEG receiving NAC.…”

Surgery for locally advanced gastric cancer in the era of neoadjuvant therapies: something new?

“…In the recent years, NAC was introduced into the integrated treatment modality for LAGC and soon became popular [3].…”

“…Neoadjuvant chemotherapy (NAC) with subsequent radical surgery has become a popular treatment modality for LAGC worldwide. However, the survival bene t is still controversial, and prognostic factors remain undetermined [3].…”

Prognostic Nomogram Combining Preoperative Neutrophil to Lymphocyte Ratio and Clinicopathologic Features for Gastric Cancer Patients after Distal Radical Gastrectomy: Based on Propensity Score Matching

“…However, there have been some shortcomings. In a study published in 2021, the model was validated internally using the bootstrap method, lacking external validation in an independent cohort from a different institution [ 29 ]. Another study developed and validated a nomogram for GC patients using a multicenter database in Korea [ 30 ], however, it mainly focused on the clinical features and pathological results.…”

“…Recently, it has been shown that the nomogram, which is a simple graphical visualization combining and quantifying all independent prognostic factors, plays an increasingly vital role in medical sciences and clinical studies [ 27 ]. Although there are some prognostic nomograms available for gastric cancer [ 28 , 29 , 30 ], only a few of them considered the patient’s inflammatory and nutritional factors, which are simple and effective risk factors. Therefore, in order to predict the prognosis of GC accurately, we incorporated the clinicopathologic features and preoperative inflammatory and nutritional factors to propose a nomogram and perform tests to validate whether this model could predict the prognosis more accurately compared with traditional TNM staging systems.…”