Frontiers in Oncology (Oct 2020)

Development and External Validation of a Nomogram to Predict Recurrence-Free Survival After R0 Resection for Stage II/III Gastric Cancer: An International Multicenter Study

  • Jun Lu,
  • Jun Lu,
  • Jun Lu,
  • Jun Lu,
  • Bin-bin Xu,
  • Bin-bin Xu,
  • Bin-bin Xu,
  • Bin-bin Xu,
  • Chao-hui Zheng,
  • Chao-hui Zheng,
  • Chao-hui Zheng,
  • Chao-hui Zheng,
  • Ping Li,
  • Ping Li,
  • Ping Li,
  • Ping Li,
  • Jian-wei Xie,
  • Jian-wei Xie,
  • Jian-wei Xie,
  • Jian-wei Xie,
  • Jia-bin Wang,
  • Jia-bin Wang,
  • Jia-bin Wang,
  • Jia-bin Wang,
  • Jian-xian Lin,
  • Jian-xian Lin,
  • Jian-xian Lin,
  • Jian-xian Lin,
  • Qi-yue Chen,
  • Qi-yue Chen,
  • Qi-yue Chen,
  • Qi-yue Chen,
  • Mark J. Truty,
  • Chang-ming Huang,
  • Chang-ming Huang,
  • Chang-ming Huang,
  • Chang-ming Huang

DOI
https://doi.org/10.3389/fonc.2020.574611
Journal volume & issue
Vol. 10

Abstract

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Background: The benefit of adjuvant chemotherapy varies widely among patients with stage II/III gastric cancer (GC), and tools predicting outcomes for this patient subset are lacking. We aimed to develop and validate a nomogram to predict recurrence-free survival (RFS) and the benefits of adjuvant chemotherapy after radical resection in patients with stage II/III GC.Methods: Data on patients with stage II/III GC who underwent R0 resection from January 2010 to August 2014 at Fujian Medical University Union Hospital (FMUUH) (n = 1,240; training cohort) were analyzed by Cox regression to identify independent prognostic factors for RFS. A nomogram including these factors was internally and externally validated in FMUUH (n = 306) and a US cohort (n = 111), respectively.Results: The multivariable analysis identified age, differentiation, tumor size, number of examined lymph nodes, pT stage, pN stage, and adjuvant chemotherapy as associated with RFS. A nomogram including the above 7 factors was significantly more accurate in predicting RFS compared with the 8th AJCC-TNM staging system for patients in the training cohort. The risk of peritoneal metastasis was higher and survival after recurrence was significantly worse among patients calculated by the nomogram to be at high risk than those at low risk. The nomogram's predictive performance was confirmed in both the internal and external validation cohorts.Conclusion: A novel nomogram is available as a web-based tool and accurately predicts long-term RFS for GC after radical resection. The tool can also be used to determine the benefit of adjuvant chemotherapy by comparing scores with and without this intervention.

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