Lymph nodes ratio based nomogram predicts survival of resectable gastric cancer regardless of the number of examined lymph nodes
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Shangxiang Chen1,5,*, Huamin Rao2,*, Jianjun Liu3,*, Qirong Geng1,4,*, Jing Guo1,5, Pengfei Kong1,5, Shun Li1,5, Xuechao Liu1,5, Xiaowei Sun1,5, Youqing Zhan1,5 and Dazhi Xu1,5,*
1State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
2Department of Abdominal Surgery, Jiangxi Cancer Hospital, Nanchang, China
3Department of Breast Surgery, Anhui Provincial Cancer Hospital, West Branch of Anhui Provincial Hospital, Hefei, China
4Department of Hematology Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
5Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
*These authors have contributed equally to this work
Dazhi Xu, email: [email protected]
Keywords: nomogram, gastric cancer, curative resection, lymph nodes ratio, prognosis
Received: February 18, 2017 Accepted: March 27, 2017 Published: April 20, 2017
To develop a nomogram to predict the prognosis of gastric cancer patients on the basis of metastatic lymph nodes ratio (mLNR), especially in the patients with total number of examined lymph nodes (TLN) less than 15. The nomogram was constructed based on a retrospective database that included 2,205 patients underwent curative resection in Cancer Center, Sun Yat-sen University (SYSUCC). Resectable gastric cancer (RGC) patients underwent curative resection before December 31, 2008 were assigned as the training set (n=1,470) and those between January 1, 2009 and December 31, 2012 were selected as the internal validation set (n=735). Additional external validations were also performed separately by an independent data set (n=602) from Jiangxi Provincial Cancer Hospital (JXCH) in Jiangxi, China and a data set (n=3,317) from the Surveillance, Epidemiology, and End Results (SEER) database. The Independent risk factors were identified by Multivariate Cox Regression. In the SYSUCC set, TNM (Tumor-node-metastasis) and TRM-based (Tumor-Positive Nodes Ratio-Metastasis) nomograms were constructed respectively. The TNM-based nomogram showed better discrimination than the AJCC-TNM staging system (C-index: 0.73 versus 0.69, p<0.01). When the mLNR was included in the nomogram, the C-index increased to 0.76. Furthermore, the C-index in the TRM-based nomogram was similar between TLN ≥16 (C-index: 0.77) and TLN ≤15 (C-index: 0.75). The discrimination was further ascertained by internal and external validations. We developed and validated a novel TRM-based nomogram that provided more accurate prediction of survival for gastric cancer patients who underwent curative resection, regardless of the number of examined lymph nodes.
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