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Postoperative Nomogram for Disease-Specific Survival After an R0 Resection for Gastric Carcinoma

Michael W. Kattan, Martin S. Karpeh, Madhu Mazumdar, Murray F. Brennan

From the Departments of Urology, Epidemiology and Biostatistics, and Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

Address reprint requests to Murray F. Brennan, MD, Memorial Sloan-Kettering Cancer Center, Department of Surgery, 1275 York Ave, C1275 New York, NY 10021; e-mail: brennanm{at}mskcc.org.

Purpose: Few published studies have addressed individual patient risk after R0 resection for gastric cancer. We developed and internally validated a nomogram that combines these factors to predict the probability of 5-year gastric cancer–specific survival on the basis of 1,039 patients treated at a single institution.

Methods: Nomogram predictor variables included age, sex, primary site (distal one-third, middle one-third, gastroesophageal junction, and proximal one-third), Lauren histotype (diffuse, intestinal, mixed), number of positive lymph nodes resected, number of negative lymph nodes resected, and depth of invasion. Death as a result of gastric cancer was the predicted end point. The concordance index was used as an accuracy measure, with bootstrapping to correct for optimistic bias. Calibration plots were constructed.

Results: Gastric cancer–specific survival at 5 years was 50%. A nomogram was constructed on the basis of a Cox regression model. The bootstrap-corrected concordance index was 0.80. When compared with the predictive ability of American Joint Committee on Cancer stage, the nomogram discrimination was superior (P < .001). Nomogram calibration appeared to be excellent.

Conclusion: A nomogram was developed to predict 5-year disease-specific survival after R0 resection for gastric cancer. This tool should be useful for patient counseling, follow-up scheduling, and clinical trial eligibility determination.

Supported by a grant from the Gelb Foundation.

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