A Predictive Model for Gastric Cancer-Specific Death after Gastrectomy: A Competing-Risk Nomogram

Abstract

Background: We aimed to assess the likelihood of cause-specific death and other causes of death after gastrectomy for gastric cancer (GC). Additionally, a competing-risk nomogram was developed for patient counseling and decision-making.

Methods: Eligible GC patients who had gastrectomy between 2007 and 2015 were included in the study from the Surveillance, Epidemiology, and End Results (SEER) database. Death from gastric cancer and death from other causes were considered as separate competing events. Cumulative incidence functions (CIF) were calculated for each event, and a competing-risk nomogram was developed.

Results: Overall, 8,808 patients who underwent gastrectomy were analyzed. Among them, 4,659 (52.90%) died from gastric cancer and 1,284 (14.58%) died from other causes. The five-year cumulative incidence of cause-specific death for gastric cancer was 50.4%, and 10.2% for deaths from other causes. Several independent factors, such as age at diagnosis, tumor site, grade, size, lymph node examination results, pathological T status, pathological N status, metastatic status, Lauren classification, radiation, and chemotherapy, were found to be associated with gastric cancer-specific death. The nomogram, based on results from the competing risk regression model, demonstrated good performance.

Conclusion: We have developed a nomogram aimed at predicting gastric cancer-specific mortality in patients following gastrectomy. The model has undergone internal validation, demonstrating good accuracy and reliability. It serves as useful tool that can assist physicians and patients in making more informed clinical decisions.

Keywords: Competing-risk nomogram; Gastric cancer; Survival.

Fig. 1:

Cumulative incidence curves of death based on characteristics (solid line represents cause-specific death; dotted line represents other cause of death)

Fig. 2:

Competing-risk nomogram for predicting probabilities of cause-specific death of 1-, 3-, 5- year for postsurgical gastric cancer patients. CSD: cause-specific death

Fig. 3:

A calibration plot for assessing the accuracy of the competing-risk nomograms

Fig. 4:

Decision curve analysis for the risk model for cause-specific mortality and the Cox model for any causes of death.