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. 2020 Oct;11(5):964-982.
doi: 10.21037/jgo-20-217.

The incidence, risk factors and predictive nomograms for early death among patients with stage IV gastric cancer: a population-based study

Yi Yang  1 , Zi-Jiao Chen  1 , Su Yan  1
Affiliations
Free PMC article

The incidence, risk factors and predictive nomograms for early death among patients with stage IV gastric cancer: a population-based study

Yi Yang et al. J Gastrointest Oncol. 2020 Oct.
Free PMC article

Abstract

Background: Although advances in the treatment of stage IV gastric cancer (GC) patients, some patients were observed to die within 3 months of initial diagnosis. The present study aimed to explore the early mortality and risk factors for stage IV GC and further develop nomograms.

Methods: A total of 2,174 eligible stage IV GC patients were selected from the Surveillance, Epidemiology, and End Results database. Logistic regression analyses were used to determine the risk factors and develop the nomograms to predict all-cause early death and cancer-specific early death. The predictive performance of the nomograms was assessed by receiver operating characteristic curves (ROC), calibration plots and decision curve analyses (DCA) in both training and validation cohorts.

Results: Of 2,174 patients enrolled, 708 died within 3 months of initial diagnosis (n=668 for cancer-specific early death). Early mortality remained stable from 2010-2015. Non-Asian or Pacific Islander (API) race, poorer differentiation, middle sites of the stomach, no surgery, no radiotherapy, no chemotherapy, lung metastases and liver metastases were associated with high risk of both all-causes early death and cancer-specific early death. The nomograms constructed based on these factors showed favorable sensitivity, with the area under the ROC range of 0.816-0.847. The calibration curves and DCAs also exhibited adequate fit and ideal net benefit in prediction and clinical application.

Conclusions: Approximately one-third of stage IV GC patients experienced early death. These associated risk factors and predictive nomograms may help clinicians identify the patients at high risk of early death and be the reference for treatment choices.

Keywords: Gastric cancer (GC); Surveillance, Epidemiology, and End Results (SEER); early death; nomogram; stage IV.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-20-217). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of data selection from Surveillance, Epidemiology, and End Results (SEER) database.
Figure 2
Figure 2
Distribution of the incidence of cancer-specific early death (A) and all-cause early death (B) among stage IV gastric cancer patients.
Figure 3
Figure 3
Distribution of early death among stage IV gastric cancer patients stratified by year of diagnosis (A), metastatic site (B) and number of the metastatic organs (C).
Figure 4
Figure 4
Nomograms for predicting all-causes (A) and cancer-specific early death (B). Other, overlapping/NOS.
Figure 5
Figure 5
Receiver operating characteristic (ROC) curves for discrimination of the nomograms in predicting all-causes and cancer-specific early death in the training cohort (A, B) and the validation cohort (C, D).
Figure 6
Figure 6
Calibration curves for assessing the calibration of the nomogram in predicting all-causes and cancer-specific early death in the training cohort (A, B) and the validation cohort (C, D).
Figure 7
Figure 7
Decision curve analyses (DCAs) for the nomograms in predicting all-causes early death and cancer-specific early death in the training cohort (A, B) and the validation cohort (C, D).
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