Construction and validation of a prognostic nomogram model for gastric cancer liver metastasis_Chinese Journal of Evidence-Based Medicine

Authors：

HU Lei ^1,2 , CHEN Yue ¹ , CAO Guodong ² , XIONG Maoming ² ,  CHEN Bo ²

1. The First College of Clinical Science, Anhui Medical University, Hefei 230012, P. R. China;
2. Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, P. R. China;

Corresponding author：

CHEN Bo, Email: chenbo@ahmu.edu.cn

Keywords：

Gastric cancer; Liver metastasis; SEER database; Prognosis; Nomogram

DOI：

10.7507/1672-2531.202111084

Video：

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Objective To establish a prediction model for the 1-, 3-, and 5-year survival rates in patients with gastric cancer liver metastases (GCLM) by analyzing prognostic factors based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods Clinical and pathological data from 591 patients diagnosed with GCLM between 2010 and 2015 were obtained from the SEER database. The population was randomly divided into a training cohort and an internal validation cohort at a 7 to 3 ratio. Independent predictors of GCLM were analyzed using univariate and multifactorial Cox regression. Consequently, nomograms were constructed. The model's accuracy was verified by calibration curve, ROC curve, and the C-index, and the clinical utility of the model was analyzed through decision curve analysis. Results Tumor differentiation grade, surgical status, and chemotherapy were significantly associated with the prognosis of GCLM patients, and these three factors were included in constructing the prognostic model and plotting the nomogram. The C-index was 0.706 (95%CI 0.677 to 0.735) and 0.749 (95%CI 0.710 to 0.788) for the training set and the internal validation cohort, respectively. The results of the ROC curve analysis indicated that the area under the curve (AUC) was over 0.7 at 1, 3, and 5 years for both the training and validation cohorts. Conclusion The prediction model of the GCLM is developed based on the 3 factors, i.e., tumor differentiation grade, surgery, and chemotherapy, and shows good prediction accuracy and thus may promote clinical decision making and individualized treatment of GCLM patients.

Citation： HU Lei, CHEN Yue, CAO Guodong, XIONG Maoming, CHEN Bo. Construction and validation of a prognostic nomogram model for gastric cancer liver metastasis. Chinese Journal of Evidence-Based Medicine, 2022, 22(7): 768-777. doi: 10.7507/1672-2531.202111084 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Sekiguchi M, Oda I, Matsuda T, et al. Epidemiological trends and future perspectives of gastric cancer in eastern Asia. Digestion, 2022, 103(1): 22-28.
3.	Chen ZD, Zhang PF, Xi HQ, et al. Recent advances in the diagnosis, staging, treatment, and prognosis of advanced gastric cancer: a literature review. Front Med (Lausanne), 2021, 8: 744839.
4.	Saze Z, Kase K, Nakano H, et al. Functional benefits of the double flap technique after proximal gastrectomy for gastric cancer. BMC Surg, 2021, 21(1): 392.
5.	Guo Y, Dong X, Jin J, et al. The expression patterns and prognostic value of the proteasome activator subunit gene family in gastric cancer based on integrated analysis. Front Cell Dev Biol, 2021, 9: 663001.
6.	Saito T, Kosugi T, Nakamura N, et al. Treatment response after palliative radiotherapy for bleeding gastric cancer: a multicenter prospective observational study (JROSG 17-3). Gastric Cancer, 2022, 25(2): 411-421.
7.	Thrift AP, El-Serag HB. Burden of gastric cancer. Clin Gastroenterol Hepatol, 2020, 18(3): 534-542.
8.	Lu J, Huang CM, Zheng CH, et al. Prognostic value of tumor size in patients with remnant gastric cancer: is the seventh UICC stage sufficient for predicting prognosis. PLoS One, 2014, 9(12): e115776.
9.	Zhao B, Mei D, Zhang J, et al. Impact of skip lymph node metastasis on the prognosis of gastric cancer patients who underwent curative gastrectomy. J Buon, 2019, 24(2): 693-700.
10.	Li H, Wang C, Lan L, et al. High expression of vinculin predicts poor prognosis and distant metastasis and associates with influencing tumor-associated NK cell infiltration and epithelial-mesenchymal transition in gastric cancer. Aging (Albany NY), 2021, 13(4): 5197-5225.
11.	Park HS, Kim YM, Kim S, et al. High endothelial venule is a surrogate biomarker for T-cell inflamed tumor microenvironment and prognosis in gastric cancer. J Immunother Cancer, 2021, 9(10): e003353.
12.	Ohno S, Fujii T, Ueda S, et al. Predictive factors and timing for liver recurrence after curative resection of gastric carcinoma. Am J Surg, 2003, 185(3): 258-263.
13.	Sakamoto Y, Ohyama S, Yamamoto J, et al. Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery, 2003, 133(5): 507-511.
14.	白婕, 张建. 胃癌同时性肝转移综合治疗进展综述. 继续医学教育, 2021, 35(10): 87-91.
15.	Sano T, Coit DG, Kim HH, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer, 2017, 20(2): 217-225.
16.	Ramos MFKP, Ribeiro Júnior U, Viscondi JKY, et al. Risk factors associated with the development of gastric cancer - case-control study. Rev Assoc Med Bras (1992), 2018, 64(7): 611-619.
17.	Katoh H, Ishikawa S. Lifestyles, genetics, and future perspectives on gastric cancer in East Asian populations. J Hum Genet, 2021, 66(9): 887-899.
18.	Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
19.	Bakhti SZ, Latifi-Navid S, Safaralizadeh R. Helicobacter pylori-related risk predictors of gastric cancer: The latest models, challenges, and future prospects. Cancer Med, 2020, 9(13): 4808-4822.
20.	Valentini V, van Stiphout RG, Lammering G, et al. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol, 2011, 29(23): 3163-3172.
21.	Fukuchi M, Ishiguro T, Ogata K, et al. Prognostic role of conversion surgery for unresectable gastric cancer. Ann Surg Oncol, 2015, 22(11): 3618-3624.
22.	Markar SR, Mackenzie H, Mikhail S, et al. Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England. Gastric Cancer, 2017, 20(2): 379-386.
23.	Liao YY, Peng NF, Long D, et al. Hepatectomy for liver metastases from gastric cancer: a systematic review. BMC Surg, 2017, 17(1): 14.
24.	Li Z, Fan B, Shan F, et al. Gastrectomy in comprehensive treatment of advanced gastric cancer with synchronous liver metastasis: a prospectively comparative study. World J Surg Oncol, 2015, 13: 212.
25.	Ohnuma H, Sato Y, Onoyama N, et al. Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis. J Cancer Res Clin Oncol, 2021, 147(8): 2385-2396.
26.	National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology. Gastric Cancer (Version 5), 2017. Available at: www. nccn. org/patients.
27.	Yang H, Sui Y, Guo X, et al. Endostar continuous intravenous infusion combined with S-1 and oxaliplatin chemotherapy could be effective in treating liver metastasis from gastric cancer. J Cancer Res Ther, 2018, 14(Suppl): S1148-S1151.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Sekiguchi M, Oda I, Matsuda T, et al. Epidemiological trends and future perspectives of gastric cancer in eastern Asia. Digestion, 2022, 103(1): 22-28.
3. Chen ZD, Zhang PF, Xi HQ, et al. Recent advances in the diagnosis, staging, treatment, and prognosis of advanced gastric cancer: a literature review. Front Med (Lausanne), 2021, 8: 744839.
4. Saze Z, Kase K, Nakano H, et al. Functional benefits of the double flap technique after proximal gastrectomy for gastric cancer. BMC Surg, 2021, 21(1): 392.
5. Guo Y, Dong X, Jin J, et al. The expression patterns and prognostic value of the proteasome activator subunit gene family in gastric cancer based on integrated analysis. Front Cell Dev Biol, 2021, 9: 663001.
6. Saito T, Kosugi T, Nakamura N, et al. Treatment response after palliative radiotherapy for bleeding gastric cancer: a multicenter prospective observational study (JROSG 17-3). Gastric Cancer, 2022, 25(2): 411-421.
7. Thrift AP, El-Serag HB. Burden of gastric cancer. Clin Gastroenterol Hepatol, 2020, 18(3): 534-542.
8. Lu J, Huang CM, Zheng CH, et al. Prognostic value of tumor size in patients with remnant gastric cancer: is the seventh UICC stage sufficient for predicting prognosis. PLoS One, 2014, 9(12): e115776.
9. Zhao B, Mei D, Zhang J, et al. Impact of skip lymph node metastasis on the prognosis of gastric cancer patients who underwent curative gastrectomy. J Buon, 2019, 24(2): 693-700.
10. Li H, Wang C, Lan L, et al. High expression of vinculin predicts poor prognosis and distant metastasis and associates with influencing tumor-associated NK cell infiltration and epithelial-mesenchymal transition in gastric cancer. Aging (Albany NY), 2021, 13(4): 5197-5225.
11. Park HS, Kim YM, Kim S, et al. High endothelial venule is a surrogate biomarker for T-cell inflamed tumor microenvironment and prognosis in gastric cancer. J Immunother Cancer, 2021, 9(10): e003353.
12. Ohno S, Fujii T, Ueda S, et al. Predictive factors and timing for liver recurrence after curative resection of gastric carcinoma. Am J Surg, 2003, 185(3): 258-263.
13. Sakamoto Y, Ohyama S, Yamamoto J, et al. Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery, 2003, 133(5): 507-511.
14. 白婕, 张建. 胃癌同时性肝转移综合治疗进展综述. 继续医学教育, 2021, 35(10): 87-91.
15. Sano T, Coit DG, Kim HH, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer, 2017, 20(2): 217-225.
16. Ramos MFKP, Ribeiro Júnior U, Viscondi JKY, et al. Risk factors associated with the development of gastric cancer - case-control study. Rev Assoc Med Bras (1992), 2018, 64(7): 611-619.
17. Katoh H, Ishikawa S. Lifestyles, genetics, and future perspectives on gastric cancer in East Asian populations. J Hum Genet, 2021, 66(9): 887-899.
18. Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
19. Bakhti SZ, Latifi-Navid S, Safaralizadeh R. Helicobacter pylori-related risk predictors of gastric cancer: The latest models, challenges, and future prospects. Cancer Med, 2020, 9(13): 4808-4822.
20. Valentini V, van Stiphout RG, Lammering G, et al. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol, 2011, 29(23): 3163-3172.
21. Fukuchi M, Ishiguro T, Ogata K, et al. Prognostic role of conversion surgery for unresectable gastric cancer. Ann Surg Oncol, 2015, 22(11): 3618-3624.
22. Markar SR, Mackenzie H, Mikhail S, et al. Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England. Gastric Cancer, 2017, 20(2): 379-386.
23. Liao YY, Peng NF, Long D, et al. Hepatectomy for liver metastases from gastric cancer: a systematic review. BMC Surg, 2017, 17(1): 14.
24. Li Z, Fan B, Shan F, et al. Gastrectomy in comprehensive treatment of advanced gastric cancer with synchronous liver metastasis: a prospectively comparative study. World J Surg Oncol, 2015, 13: 212.
25. Ohnuma H, Sato Y, Onoyama N, et al. Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis. J Cancer Res Clin Oncol, 2021, 147(8): 2385-2396.
26. National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology. Gastric Cancer (Version 5), 2017. Available at: www. nccn. org/patients.
27. Yang H, Sui Y, Guo X, et al. Endostar continuous intravenous infusion combined with S-1 and oxaliplatin chemotherapy could be effective in treating liver metastasis from gastric cancer. J Cancer Res Ther, 2018, 14(Suppl): S1148-S1151.

Chinese Journal of Evidence-Based Medicine

Construction and validation of a prognostic nomogram model for gastric cancer liver metastasis

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