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. 2020 Jan-Dec;27(1):1073274820954458.
doi: 10.1177/1073274820954458.

A Nomogram Based on Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) Ratio to Predict Prognosis After Surgery in Gastric Cancer Patients

Linfang Li  1 , Qiuyao Zeng  1 , Ning Xue  2 , Miantao Wu  1 , Yaqing Liang  1 , Qingxia Xu  2 , Lingmin Feng  3 , Shan Xing  1 , Shulin Chen  1
Affiliations

A Nomogram Based on Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) Ratio to Predict Prognosis After Surgery in Gastric Cancer Patients

Linfang Li et al. Cancer Control. 2020 Jan-Dec.

Abstract

Introduction: Using the TMN classification alone to predict survival in patients with gastric cancer has certain limitations, we conducted this study was to develop an effective nomogram based on aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio to predict overall survival (OS) in surgically treated gastric cancer.

Methods: we retrospectively analyzed 190 cases of gastric cancer and used Cox regression analysis to identify the significant prognostic factors for OS in patients with resectable gastric cancer. The predictive accuracy of nomogram was assessed using a calibration plot, concordance index (C-index) and decision curve. This was then compared with a traditional TNM staging system. Based on the total points (TPS) by nomogram, we further divided patients into different risk groups.

Results: multivariate analysis of the entire cohort revealed that independent risk factors for survival were age, clinical stage and AST/ALT ratio, which were entered then into the nomogram. The calibration curve for the probability of OS showed that the nomogram-based predictions were in good agreement with actual observations. Additionally, the C-index of the established nomogram for predicting OS had a superior discrimination power compared to the TNM staging system [0.794 (95% CI: 0.749-0.839) vs 0.730 (95% CI: 0.688-0.772), p < 0.05]. Decision curve also demonstrated that the nomogram was better than the TNM staging system. Based on TPS of the nomogram, we further subdivided the study cohort into 3 groups including low risk (TPS ≤ 158), middle risk (158 < TPS ≤ 188) and high risk (TPS > 188) categories. The differences in OS rate were significant among the groups.

Conclusion: the established nomogram is associated with a more accurate prognostic prediction for individual patients with resectable gastric cancer.

Keywords: AST/ALT ratio; classifier; gastric cancer; nomogram; prognosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Nomogram convey the results of prognostic models using age, clinical stage and SLR characteristics predict OS. The nomogram was used summing the points identified on the points scale for each variable. The total points projected on the bottom scales indicate the probability of 1-, 3- and 5-year survival.
Figure 2.
Figure 2.
The calibration curves for predicting patient OS at 1 year (A), 3 years (B) and 5 years (C) in the primary cohort. Nomogram model-predicted OS is plotted on the x-axis; actual OS is plotted on the y-axis. The reference line is 45 degree and indicates perfect calibration.
Figure 3.
Figure 3.
Decision curve analysis for 5-year survival predictions. In the decision curve analysis, the y-axis indicates net benefit. The straight line represents the assumption that all patients will die, and the horizontal line represents the assumption that no patients will die.
Figure 4.
Figure 4.
Kaplan-Meier curve of GC patients OS for 3 groups based on the predictor from the nomogram model.
See this image and copyright information in PMC

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