Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1375-1387
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1375
Nomogram based on clinical characteristics for predicting overall survival in gastric cancer patients with preoperative anemia
Yan Long, Xiao-Lu Zhou, Cheng-Long Zhang, Ya-Nan Wang, Wen-Sheng Pan
Yan Long, Xiao-Lu Zhou, Wen-Sheng Pan, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Cheng-Long Zhang, Department of Traumatology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Ya-Nan Wang, College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, Zhejiang Province, China
Author contributions: All authors designed the study; Long Y, Zhou XL, Zhang CL, and Wang YN contributed to data collection; Long Y and Zhou XL contributed to manuscript preparation; Long Y, Zhou XL, Zhang CL, and Wang NY contributed to data analysis and interpretation; All authors acknowledge that they participated in critically revising the manuscript for important intellectual content and reading and approving the final draft submitted, and are accountable for the content of the manuscript.
Supported by the Major Science and Technology Project of Zhejiang Provincial Department of Science and Technology, No. 2020C03030; and the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission, No. 2022503200.
Institutional review board statement: This study was authorized by the Ethics Committee of Zhejiang Provincial People's Hospital, No. 2019KY017.
Informed consent statement: This study was eligible for waiver of informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Sheng Pan, MD, Doctor, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou 310014, Zhejiang Province, China. wspan223@163.com
Received: January 5, 2023
Peer-review started: January 5, 2023
First decision: April 3, 2023
Revised: April 20, 2023
Accepted: May 26, 2023
Article in press: May 26, 2023
Published online: July 27, 2023
Processing time: 197 Days and 7.9 Hours
Abstract
BACKGROUND

Preoperative anemia is associated with increased postoperative morbidity and mortality and increased perioperative transfusion risk. For surgical patients, this affects physical and cognitive ability and quality of life, but it is an important and modifiable risk factor.

AIM

To determine the effect of preoperative anemia on the prognosis of gastric cancer (GC) patients and generate a prognostic nomogram to predict the postoperative overall survival (OS) of GC patients with preoperative anemia.

METHODS

Clinicopathological and follow-up data of GC patients treated at Zhejiang Provincial People's Hospital (China) from 2010 to 2015 were collected. Independent prognostic factors were screened by univariate and multivariate Cox regression analyses. Then, these factors were used to construct a nomogram to predict 1-, 3-, and 5-year postoperative OS in preoperative anemic GC patients. The nomogram was assessed by calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

RESULTS

Nine hundred and sixty GC patients were divided into two groups (preoperatively anemic and nonanemic), and postoperative survival analysis was performed on both groups, yielding a shorter postoperative survival for preoperatively anemic patients than for nonanemic patients. A total of 347 GC patients with preoperative anemia were included. Age, preoperative alpha-fetoprotein level, monocyte count, lymphocyte count, clinicopathological stage, liver metastasis, and GC type were identified as independent prognostic factors for OS. The area under the ROC curve (AUC) of the nomogram for predicting 1-, 3-, and 5-year OS was 0.831, 0.845, and 0.840, respectively, for the training cohort, and the corresponding AUC values in the validation cohort were 0.827, 0.829, and 0.812, respectively. Calibration curves and DCA indicated good performance of the nomogram.

CONCLUSION

In all, we have successfully produced and verified a useful nomogram for predicting OS in GC patients with preoperative anemia. This nomogram based on a variety of clinicopathological indices can provide an effective prognostic assessment and help clinicians choose an appropriate treatment strategy for GC patients with preoperative anemia.

Keywords: Anemia; Gastric cancer; Nomogram; Overall survival

Core Tip: In this work, we evaluated a large amount of clinical information of gastric cancer patients that were collected and then screened for independent prognostic factors by univariate and multivariate Cox regression analyses. These independent prognostic factors were then used to construct a nomogram to predict 1-, 3-, and 5-year overall survival (OS) in gastric cancer patients with preoperative anemia, and the nomogram was evaluated by calibration curves, receiver operating characteristic curves, and decision curve analysis. Finally, we successfully developed and validated a valuable nomogram to predict OS in gastric cancer patients with preoperative anemia.