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. 2013 May;20(5):1623-30.
doi: 10.1245/s10434-012-2723-6. Epub 2012 Nov 10.

Conditional probability of survival nomogram for 1-, 2-, and 3-year survivors after an R0 resection for gastric cancer

Johan L Dikken  1 , Raymond E Baser, Mithat Gonen, Michael W Kattan, Manish A Shah, Marcel Verheij, Cornelis J H van de Velde, Murray F Brennan, Daniel G Coit
Affiliations

Conditional probability of survival nomogram for 1-, 2-, and 3-year survivors after an R0 resection for gastric cancer

Johan L Dikken et al. Ann Surg Oncol. 2013 May.

Abstract

Background: Survival estimates after curative surgery for gastric cancer are based on AJCC staging, or on more accurate multivariable nomograms. However, the risk of dying of gastric cancer is not constant over time, with most deaths occurring in the first 2 years after resection. Therefore, the prognosis for a patient who survives this critical period improves. This improvement over time is termed conditional probability of survival (CPS). Objectives of this study were to develop a CPS nomogram predicting 5-year disease-specific survival (DSS) from the day of surgery for patients surviving a specified period of time after a curative gastrectomy and to explore whether variables available with follow-up improve the nomogram in the follow-up setting.

Methods: A CPS nomogram was developed from a combined US-Dutch dataset, containing 1,642 patients who underwent an R0 resection with or without chemotherapy/radiotherapy for gastric cancer. Weight loss, performance status, hemoglobin, and albumin 1 year after resection were added to the baseline variables of this nomogram.

Results: The CPS nomogram was highly discriminating (concordance index: 0.772). Surviving 1, 2, or 3 years gives a median improvement of 5-year DSS from surgery of 7.2, 19.1, and 31.6 %, compared with the baseline prediction directly after surgery. Introduction of variables available at 1-year follow-up did not improve the nomogram.

Conclusions: A robust gastric cancer nomogram was developed to predict survival for patients alive at time points after surgery. Introduction of additional variables available after 1 year of follow-up did not further improve this nomogram.

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Figures

FIG. 1
FIG. 1
Hazard of death from gastric cancer for all patients (N = 1642). DSS disease-specific survival
FIG. 2
FIG. 2
Nomogram predicting 5-year disease-specific survival from the day of surgery based on 1,642 patients who underwent an R0 resection for gastric cancer. GEJ gastroesophageal junction. Instructions: Locate the patient's sex on the sex axis. Draw a line straight upward to the points axis to determine how many points toward gastric cancer-specific death the patient receives for his or her sex. Repeat this process for the other axes, each time drawing straight upward to the points axis. Sum the points achieved for each predictor and locate this sum on the total points axis. Draw a line straight down to the disease-specific survival axes to find the patient's probability of 5-year DSS from the day of surgery, directly after surgery, or 1, 2, or 3 years after surgery
FIG. 3
FIG. 3
Calibration plots for the 5-year disease-specific survival nomogram (N = 1642). a Predicting 5-year DSS directly after surgery (0-year survivors). b Predicting 5-year DSS conditional on surviving of gastric cancer for 1, 2, or 3 years. In the example the nomogram predicts a 5-year DSS of 40 %. Step 1 Draw a line from the original (0-year survival prediction) axis. Step 2 The probability for this patient to survive the first 5 years after surgery, without dying of gastric cancer is: 40 % directly after surgery (0 years survival); 45 % after surviving 1 year without dying of gastric cancer; 57 % after surviving 2 years without dying of gastric cancer; 70 % after surviving 3 years without dying of gastric cancer
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