Nomograms for pre- and postoperative prediction of long-term survival among proximal gastric cancer patients: A large-scale, single-center retrospective study

Table 1 Comparison of preoperative and postoperative clinicopathology data in the training and validation sets

	Model set (n = 560)		Validation set (n = 186)	P value
Age (yr)				0.648
< 65	313		98
≥ 65	247		88
Gender				0.446
Female	98		35
Male	462		151
BMI (kg/m2)				0.382
< 25	473		162
≥ 25	87		24
Preoperative tumor size(cm)				0.736
< 5	272		93
≥ 5	288		93
Preoperative N stage				0.965
N0	269		89
N+	291		97
Preoperative T stage				0.066
T1-3	190		77
T4	370		109
Preoperative CA19-9 (U/mL)				0.643
< 33.35	463		151
≥ 33.35	97		35
Preoperative CEA (µg/mL)				0.487
< 4	365		116
≥ 4	195		70
ASA score				0.511
1	309		114
2	195		58
3	55		14
4	1		0
Accompanying disease				0.087
No	359		132
Yes	201		54
History of epigastric operation				0.432
No	544		183
Yes	16		3
Preoperative Charlson score				0.311
0	368		133
1-2	184		50
≥ 3	8		3
HB, g/L				0.208
≥ 9.0	500		172
< 9.0	60		14
ALB, g/L				0.096
≥ 35	418		150
< 35	142		36
Fibrinogen, g/L				0.067
< 4	364		107
≥ 4	196		79
3- to 6-mo weight reduction				0.835
No	321		105
Yes	239		81
Lymph node ratio	0.158 ± 0.200		0.192 ± 0.227	0.069
Postoperative T stage				0.248
T1	73		35
T2	67		19
T3	162		54
T4a	258		78
Postoperative N stage				0.583
N0	169		65
N1	95		26
N2	101		34
N3	195		61
Involvement of the esophagus with the tumor				0.028
No	370		139
Yes	190		47
Postoperative tumor size (cm)				0.233
< 5	231		86
≥ 5	329		100
LVI				0.72
No	408		133
Yes	152		53
Postoperative blood transfusion				0.745
No	498		167
Yes	62		19
General complications				0.495
No	486		165
Yes	74		21
Presence of digestive tract fistula				0.498
No	552		182
Yes	8		4
Postoperative obstruction				1
No	553		184
Yes	7		2
Infection of incisional wound				0.339
No	555		186
Yes	5		0
Intra-abdominal infection				0.422
No	549		184
Yes	11		2
Pulmonary infection				0.459
No	521		170
Yes	39		16
Peritoneal lymphatic fistula				0.751
No	550		182
Yes	10		4
Intra-abdominal hemorrhage				0.74
No	552		183
Yes	8		3
Neoadjuvant chemotherapy				1
No	548		183
Yes	12		3
Adjuvant chemotherapy				0.069
No	258		100
Yes	302		86

Table 2 Preoperative analysis of overall survival

	Univariate analysis		Multivariate analysis
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Preoperative tumor size(cm)		< 0.001		0.012
< 5	Ref		Ref
≥ 5	2.953 (2.227-3.915)		1.480 (1.090-2.010)
Preoperative N stage		< 0.001		< 0.001
N0	Ref		Ref
N+	3.219 (2.428-4.268)		2.069 (1.536-2.787)
Preoperative T stage		< 0.001		< 0.001
T1-3	Ref		Ref
T4	4.550 (3.132-6.609)		2.767 (1.846-4.148)
Preoperative CA19-9 (U/mL)		< 0.001		0.003
< 33.35	Ref		Ref
≥ 33.35	2.250 (1.750-2.894)		1.569 (1.166-2.110)
ASA score		< 0.001		< 0.001
1	Ref		Ref
2	1.725 (1.299-2.289)		1.675 (1.257-2.230)
3	3.805 (2.677-5.409)		3.257 (2.271-4.670)
3- to 6-mo weight loss		< 0.001		0.036
No	Ref		Ref
Yes	1.588 (1.231-2.049)		1.316 (1.019-1.701)
Age (yr)		0.008
< 65	Ref
≥ 65	1.412 (1.095-1.821)
Gender		0.318
Female	Ref
Male	1.178 (0.854-1.625)
BMI (kg/m2)		0.473
<25	Ref
≥ 25	0.875 (0.609-1.259)
Accompanying disease		0.673
No	Ref
Yes	0.944 (0.724-1.232)
History of abdominal surgery		0.704
No	Ref
Yes	1.146 (0.566-2.321)
Preoperative Charlson score
0	Ref
1-2	1.007 (0.768-1.322)	0.959
≥ 3	2.202 (0.973-4.982)	0.058
Preoperative CEA (µg/mL)		<0.001
< 4	Ref
≥ 4	1.673 (1.294-2.164)
HB, g/L		0.265
≥ 9.0	Ref
< 9.0	1.239 (0.850-1.808)
ALB, g/L		0.014
≥ 35	Ref
< 35	1.410 (1.072-1.854)
Fibrinogen, g/L		0.003
< 4	Ref
≥ 4	1.471 (1.137-1.904)

Table 3 Postoperative analysis of overall survival

	Univariate analysis		Multivariate analysis
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Postoperative T stage		< 0.001		0.005
T1	Ref		Ref
T2	2.743 (1.054-7.139)		2.210 (0.843-5.794)
T3	6.359 (2.759-14.657)		2.730 (1.130-6.594)
T4a	9.829 (4.345-22.235)		3.847 (1.595-9.278)
Postoperative N stage		< 0.001		< 0.001
N0	Ref		Ref
N1	1.371 (0.820-2.290)		0.962 (0.564-1.639)
N2	1.984 (1.250-3.151)		1.251 (0.767-2.041)
N3	5.967 (4.109-8.663)		2.659 (1.708-4.139)
Postoperative tumor size(cm)		< 0.001		0.022
< 5	Ref		Ref
≥ 5	2.938 (2.172-2.973)		1.503 (1.060-2.132)
Lymphatic vascular infiltration (LVI)		< 0.001		< 0.001
No	Ref		Ref
Yes	3.185 (2.447-4.146)		2.690 (2.036-3.554)
Postoperative blood transfusion		< 0.001		0.025
No	Ref		Ref
Yes	1.971 (1.402-2.771)		1.505 (1.052-2.153)
General complications		0.001		0.028
No	Ref		Ref
Yes	1.784 (1.278-2.490)		1.477 (1.042-2.093)
Digestive tract fistula		0.125
No	Ref
Yes	2.001 (0.825-4.855)
Postoperative obstruction		0.033
No	Ref
Yes	2.629 (1.083-6.386)
Incisional infection		0.984
No	Ref
Yes	0.986 (0.245-3.966)
Abdominal infection		0.964
No	Ref
Yes	1.021 (0.421-2.476)
Pulmonary infection		0.001
No	Ref
Yes	2.104 (1.378-3.211)
Peritoneal lymphatic fistula		0.565
No	Ref
Yes	1.297 (0.535-3.147)
intra-Abdominal hemorrhage		0.093
No	Ref
Yes	2.136 (0.880-5.181)
Tumor involvement of the esophagus		0.328
No	Ref
Yes	1.141 (0.876-1.487)
Neoadjuvant chemotherapy		0.012
No	Ref
Yes	2.480 (1.225-5.022)
Adjuvant chemotherapy
No	Ref
Yes	1.166 (0.902-1.507)	0.242
Lymph node ratio	1.697 (0.998-2.867)	0.053

Table 4 Preoperative and postoperative nomograms accurately predicting overall survival in upper stomach cancer patients

	Training set		Validation set
	Preoperative nomogram	Postoperative nomogram	Preoperative nomogram	Postoperative nomogram
Area under the curve	0.811	0.799	0.821	0.774
Cutoff point	18	18	18	18
Sensitivity, %	0.736	0.706	0.768	0.855
Specificity, %	0.753	0.764	0.744	0.598
Positive predictive value, %	0.749	0.818	0.755	0.704
Negative predictive value, %	0.741	0.634	0.828	0.787
Positive likelihood ratio	2.98	2.99	3	2.127
Negative likelihood ratio	0.351	0.385	0.304	0.242