Published online Nov 6, 2019. doi: 10.12998/wjcc.v7.i21.3419
Peer-review started: March 18, 2019
First decision: May 24, 2019
Revised: June 29, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: November 6, 2019
Processing time: 236 Days and 16.9 Hours
Gastric cancer (GC) is the fourth most common malignant tumor worldwide and currently ranks second among the causes of cancer-related deaths. The biological behaviors of proximal GC and cancer in the lower portion of the stomach exhibit certain differences. Currently, although there has been great progress in the early diagnosis of and radical surgery and chemotherapy for proximal GC, the postoperative prognosis of patients with this type of cancer is still not ideal. Determining how to individualize treatment according to the characteristics of cancer patients and the features of the tumor is still a main problem in the treatment of proximal GC.
Searching for indicators that can effectively predict a poor prognosis in patients with GC may facilitate the formulation of an individualized treatment plan and thereby improve the prognosis of patients.
This study aimed to explore the postoperative prognosis of proximal GC patients and the related preoperative and postoperative factors and establish preoperative and postoperative nomogram prediction models based on the results.
Between January 2007 and June 2013, we prospectively collected and retrospectively analyzed the medical records of 746 patients with proximal GC, who were divided into a training set (n = 560, 75%) and a validation set (n = 186, 25%). A Cox regression analysis was used to identify the preoperative and postoperative risk factors for overall survival (OS).
Among the 746 patients examined, the 3- and 5-year OS rates were 66.1% and 58.4%, respectively. In the training set, preoperative T stage (cT), N stage (cN), CA19-9, tumor size, ASA core, and 3- to 6-mo weight loss were incorporated into the preoperative nomogram for the prediction of OS. In addition to these variables, LVI, postoperative tumor size, T stage, N stage, blood transfusions, and complications were incorporated into the postoperative nomogram. All calibration curves for the OS probability fit well. In the training set, the preoperative nomogram achieved a C-index of 0.751 [95% confidence interval (CI): 0.732-0.770] in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 86.8%, 73.0%, 43.72%, and 20.9%, P < 0.001). The postoperative nomogram had a C-index of 0.758 in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 82.6%, 74.3%, 45.9%, and 18.9%, P < 0.001).
The nomograms accurately predict the pre- and postoperative long-term survival of proximal GC patients.
This is a retrospective study only involving participants from Eastern countries. Compared with Western countries, the incidence of GC in Eastern countries is high, and there are more advanced GC patients. The biological characteristics of GC may differ between Eastern and Western countries. Therefore, we hope that the predictive model will be further validated and improved through a single-center RCT trial or even a multi-center prospective trial.