A Nomogram Model For Predicting Death Within One Year After Radical Gastrectomy For Gastric Cancer

Objective To explore the risk factors related to death within one year after radical gastrectomy for gastric cancer,and to establish a prognosis nomogram of predicting death within one year after radical gastrectomy for gastric cancer.Methods From December 2006 to June 2013,the clinical data of 1969 patients who underwent radical gastrectomy at the Gastric Surgery Department of Fujian Medical University Union Hospital were prospectively collected and retrospectively analyzed.Among them,202 cases(short-term death group)whose survival period is less than 1 year,and 1767 cases(no short-term death group)whose survival period is more than 1 year.The differences in clinicopathological data between the two groups were compared.Univariate and multivariate analysis of the related factors of death within one year after radical gastrectomy was performed by the Cox proportional hazards model.Establish a prognosis nomogram of predicting death within one year after radical gastrectomy for gastric cancer based on independent prognostic factors.The Bootstrap method is used to calculate the nomogram model C index.The calibration curve of the predicted value and the actual value is drawn to evaluate accuracy and prediction ability of the model.It is compared with the prediction ability of the 7th edition of the American Cancer Joint Committee AJCC-TNM staging.Using R software,we draw the decision curve of the nomogram model and evaluate the clinical application value of the model.Results Among the whole group of patients,1478 were males(75%),491 were females(25%),and the mean age was(60.9±11.1)years.There were statistical differences in age,Body mass index(BMI),American Association of Anesthesiologists(ASA),Hemoglobin(Hb),Serum albumin(Alb),tumor size,c T staging,c N staging,and c TNM staging between the short-term death group and no short-term death group.Univariate prognosticanalysis finds that factors affecting death within one year include age,BMI,ASA,Hb,Alb,and tumor size,c T staging,and c N staging.Further multivariate prognostic analysis finds that independent risk factors for death within one year after radical resection of gastric cancer include age ≥ 70 years,BMI ≤ 18.5 kg/㎡,c N stage,tumor diameter ≥ 50 mm.A nomogram model for predicting one-year mortality after radical resection of gastric cancer is established accordingly.C index of the model is 0.791,the accuracy of prediction higher than the 7th edition AJCC-TNM staging(C index=0.760,P<0.05).Decision curve analysis of this nomogram model shows that in most risk thresholds,it has an ideal net clinical benefit rate and has good clinical application value.Conclusion The nomogram established in this research can accurately predict the risk of death within one year after radical gastrectomy,and can help clinicians find high-risk patients who die within one year after surgery to formulate best individualized treatment and strict follow-up plan.For patients with a high risk of death within one year after surgery,increasing the prudence and reasonability of their surgical decision to facilitate counseling and communication with patients and their relatives.