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J Cancer 2017; 8(6):950-958. doi:10.7150/jca.17370 This issue Cite

Research Paper

Comparison of prognostic nomograms based on different nodal staging systems in patients with resected gastric cancer

Zi-Xian Wang^1*, Miao-Zhen Qiu^{1, 2*}, Yu-Ming Jiang^3*, Zhi-Wei Zhou⁴, Guo-Xin Li^3✉, Rui-Hua Xu^1✉

1. Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, China.
2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
3. Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China;
4. Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, China.
* These authors contributed equally to this study.

✉ Corresponding authors: Rui-Hua Xu, Department of Medical Oncology; Sun Yat-Sen University Cancer Center, 651 Dong Feng Road East, Guangzhou 510060, China; Tel and Fax: +86-20-8734 3468; E-mail: xurhorg.cn. Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China; Tel and Fax: +86-20-6278 7170; E-mail: gzliguoxincom. More

Abstract

Purpose: Previous studies addressing the optimal nodal staging system in patients with resected gastric cancer have shown inconsistent results, and the optimal system for development of prognostic nomograms remains unclear. In this study, we compared prognostic nomograms based on the metastatic lymph node (MLN) count, lymph node ratio (LNR), and log odds of metastatic lymph nodes (LODDS) to predict the 5-year overall survival in patients with resected gastric cancer.

Methods: We analysed 15,320 patients with resected gastric cancer in the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2010. Missing data were handled using multiple imputation. When assessed as a continuous covariate with restricted cubic splines, each MLN, LNR, and LODDS variable was incorporated into a nomogram with other significant prognosticators to predict the 5-year overall survival. A two-centre Chinese dataset (1,595 cases) was used as external validation data.

Results: The discriminatory abilities of the MLN-, LNR-, and LODDS-based nomograms were comparable (concordance indices: 0.744, 0.741, and 0.744, respectively, in the SEER set, P > 0.152 for all pairwise comparisons; 0.715, 0.712, and 0.713, respectively, in the Chinese set, P > 0.445 for all pairwise comparisons). The discriminatory abilities of the three nomograms were all superior to the American Joint Committee on Cancer (AJCC) TNM classification (concordance indices: 0.713, P < 0.001 for all in the SEER set; and 0.693, P < 0.001 for all in the Chinese set). The discriminatory abilities of the nomograms were comparable regardless of the number of nodes examined. Moreover, decision curve analyses indicated similar net benefits of using the nomograms.

Conclusion: MLN-, LNR-, and LODDS should be considered equally in the development of multivariate prognostic models and nomograms to refine the prediction of survival among patients with resected gastric cancer.

Keywords: gastric cancer, nomogram, metastatic lymph node (MLN) count, lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS).

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