J Cancer 2017; 8(17):3498-3505. doi:10.7150/jca.19879 This issue Cite

Research Paper

Development and Validation of a Nomogram to Predict the Benefit of Adjuvant Radiotherapy for Patients with Resected Gastric Cancer

Shu-Qiang Yuan1*, Wen-Jing Wu2,3*, Miao-Zhen Qiu4,5*, Zi-Xian Wang4*, Lu-Ping Yang4, Ying Jin4, Jing-Ping Yun6, Yuan-Hong Gao7, Yu-Hong Li4, Zhi-Wei Zhou1, Feng Wang4✉, Rui-Hua Xu4✉

1. Department of Gastric Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China;
2. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen University Memorial Hospital, Guangzhou, 510120, China;
3. Department of Breast Oncology, Sun Yat-sen University Memorial Hospital, Guangzhou, 510120, China;
4. Department of Medical Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China;
5. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
6. Department of Pathology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China;
7. Department of Radiotherapy, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
*These authors contributed equally to this study.

Citation:
Yuan SQ, Wu WJ, Qiu MZ, Wang ZX, Yang LP, Jin Y, Yun JP, Gao YH, Li YH, Zhou ZW, Wang F, Xu RH. Development and Validation of a Nomogram to Predict the Benefit of Adjuvant Radiotherapy for Patients with Resected Gastric Cancer. J Cancer 2017; 8(17):3498-3505. doi:10.7150/jca.19879. https://www.jcancer.org/v08p3498.htm
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Abstract

Background: The US guidelines for gastric cancer (GC) recommend adjuvant radiotherapy (ART) combined with 5-fluorouracil as a standard treatment for patients with resected locally advanced GC. However, patient selection criteria for optimizing the use of adjuvant therapies are lacking. In this study, we developed and validated a nomogram to predict the individualized overall survival (OS) benefit of ART among patients with resected ≥stage IB GC.

Patients and Methods: The 2002-2006 Surveillance, Epidemiology, and End Results (SEER) data of 5,206 patients with resected GC were used as a training set for the development of a nomogram. The 2007-2008 SEER data of 1,986 patients with resected GC were used as validation data.

Results: In the multivariate analysis weighted by inverse propensity score, the efficacy of ART varied by the ratio of positive to examined nodes (Pinteraction<0.01). The magnitude of this difference was included in the nomogram with associated prognosticators to predict the 3- and 5-year OS with and without ART. The nomogram showed significant prognostic superiority to the 8th TNM staging in the training set (Concordance index, 0.68 versus 0.65; P<0.01) and the validation set (Concordance index, 0.68 versus 0.64; P<0.01). Moreover, the calibration was accurate, and the actual efficacy of ART was positively correlated with the nomogram-estimated survival benefit from ART (Pinteraction<0.01 and Pinteraction=0.02 in the training set and the validation set, respectively).

Conclusion: The nomogram can aid individualized clinical decision making by estimating the 3- and 5-year OS and potential benefits of ART among patients with resected GC.

Keywords: gastric cancer, adjuvant radiotherapy, survival, nomogram, Surveillance, Epidemiology, and End Results (SEER).


Citation styles

APA
Yuan, S.Q., Wu, W.J., Qiu, M.Z., Wang, Z.X., Yang, L.P., Jin, Y., Yun, J.P., Gao, Y.H., Li, Y.H., Zhou, Z.W., Wang, F., Xu, R.H. (2017). Development and Validation of a Nomogram to Predict the Benefit of Adjuvant Radiotherapy for Patients with Resected Gastric Cancer. Journal of Cancer, 8(17), 3498-3505. https://doi.org/10.7150/jca.19879.

ACS
Yuan, S.Q.; Wu, W.J.; Qiu, M.Z.; Wang, Z.X.; Yang, L.P.; Jin, Y.; Yun, J.P.; Gao, Y.H.; Li, Y.H.; Zhou, Z.W.; Wang, F.; Xu, R.H. Development and Validation of a Nomogram to Predict the Benefit of Adjuvant Radiotherapy for Patients with Resected Gastric Cancer. J. Cancer 2017, 8 (17), 3498-3505. DOI: 10.7150/jca.19879.

NLM
Yuan SQ, Wu WJ, Qiu MZ, Wang ZX, Yang LP, Jin Y, Yun JP, Gao YH, Li YH, Zhou ZW, Wang F, Xu RH. Development and Validation of a Nomogram to Predict the Benefit of Adjuvant Radiotherapy for Patients with Resected Gastric Cancer. J Cancer 2017; 8(17):3498-3505. doi:10.7150/jca.19879. https://www.jcancer.org/v08p3498.htm

CSE
Yuan SQ, Wu WJ, Qiu MZ, Wang ZX, Yang LP, Jin Y, Yun JP, Gao YH, Li YH, Zhou ZW, Wang F, Xu RH. 2017. Development and Validation of a Nomogram to Predict the Benefit of Adjuvant Radiotherapy for Patients with Resected Gastric Cancer. J Cancer. 8(17):3498-3505.

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