A Predictive Nomogram for Early Mortality in Stage IV Gastric Cancer

Abstract

BACKGROUND The study was intended to establish predictive nomogram models for predicting total early mortality (the probability of surviving less than or equal to 3 months) and cancer-specific early mortality in patients with stage IV gastric cancer. This was the first study to establish prognostic survival in patients with stage IV gastric cancer. MATERIAL AND METHODS Patients from the SEER database were identified using inclusion and exclusion criteria. Their clinical characteristics were statistically analyzed. The Kaplan-Meier method and the log-rank test were used to compare the influences of different factors on survival time. Logistic regression models were conducted to explore the correlative factors of early mortality. A nomogram was established based on factors significant in the logistic regression model and an internal validation was performed. RESULTS Of the 11,036 eligible patients included in the study, 4932(44.7%) patients resulted in total early death (42.6% died of the cancer and 2.1% died of other reasons). Larger tumor size, poor differentiation, and liver metastasis were positively related to cancer-specific early mortality. Surgery was negatively related to total early mortality and cancer-specific early mortality, while cardia was only negatively associated with total early death. Predictive nomogram models for total early mortality and cancer-specific early mortality have been validated internally. The areas under the receiver operating characteristics curve were 73.5%, and 68.0%, respectively, and the decision curve analysis also proved the value of the models. CONCLUSIONS The nomogram models proved to be a suitable tool for predicting the early mortality in stage IV gastric cancer.

Figure 1

Flowchart for selection of the stage IV gastric cancer patients.

Figure 2

Trend and distribution of early mortality of stage IV gastric cancer patients stratified by: age (A), gastric cancer sites (B), distant metastases by organs (C), number of metastasized organs (D).

Figure 3

Kaplan-Meier survival curve for (A) age, (B) primary site, (C) liver metastases, (D) lung metastases, (E) histological grade, (F) surgery in stage IV gastric cancer patients.

Figure 4

Nomogram for predicting all causes of early mortality (A) and cancer-specific early mortality in stage IV gastric cancer patients (B).

Figure 5

The calibration curve and receiver operating characteristics curve for assessing the calibration and discrimination of the nomogram in predicting all causes of early mortality (A, C) and cancer-specific early mortality (B, D).

Figure 6

The decision curve analysis for assessing clinical utility of the nomogram in predicting all causes of early mortality (A) and cancer-specific early mortality (B).