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. 2025 May 1;16(5):e00833.
doi: 10.14309/ctg.0000000000000833.

Nomogram Prediction for Gastric Cancer Development

Joo Hyun Lim  1   2 , Areum Han  3   4 , Soo-Jeong Cho  1 , Seokyung Hahn  5   6   7 , Sang Gyun Kim  1
Affiliations

Nomogram Prediction for Gastric Cancer Development

Joo Hyun Lim et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Helicobacter pylori ( Hp ) and gastric atrophy represent significant risk factors for gastric cancer (GC). Nevertheless, to date, no nomogram has been developed to predict GC based on the specific combination of risk factors present in individual cases.

Methods: A retrospective cohort study was conducted using health screening data collected between 2003 and 2018. Subjects with positive results for anti- Hp antibody were enrolled. Individuals were classified into 4 groups: low-B (low titer without atrophy), high-B (high titer without atrophy), high-C (high titer with atrophy), and low-C (low titer with atrophy). Nomogram prediction models were developed for overall GCs as well as intestinal and diffuse cancers, with each type considered a competing event, by using both Cox proportional and subdistribution hazard models. Prediction performance was evaluated using the concordance index (c-index) and the area under the curve through 10-fold cross-validation.

Results: During a median follow-up period of 5.7 years, 231 new GC cases developed among the total cohort of 28,311 subjects, including 159 intestinal type, 68 diffuse type, and 4 cases of unknown type. Multivariable analyses indicated that age, body mass index, family history, smoking, and classification into the high-C or low-C group were significant predictors of GC. The nomograms for intestinal type, diffuse type, and total GC demonstrated area under the curve values of 0.82, 0.62, and 0.75, respectively, and c-indices of 0.85, 0.54, and 0.76, respectively.

Discussion: The nomograms for GC prediction would be useful in identifying high-risk individuals, particularly for intestinal type. This would facilitate the implementation of personalized eradication and intensive screening strategies to target those at higher risk for GC.

Keywords: atrophy; diffuse type; gastric cancer; intestinal type.

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Conflict of interest statement

Guarantor of the article: Soo Jeong Cho, MD, PhD.

Specific author contributions: J.H.L. and S.J.C.: study conception and design, data analysis/interpretation. A.H. and S.H.: data analysis/interpretation. J.H.L.: manuscript drafting. S.H. and S.G.K.: critical revision of manuscript. All authors read and approved the final manuscript and the authorship list. All authors fulfill the ICMJE criteria for authorship.

Financial support: This research was supported by a grant (04-2022-0300) from the SNUH Research Fund and a grant (2022R1A2C101043711, 2022R1A2B5B01001430 and IRB # H-2104-165-1214) from the National Research Foundation of Korea, and the Korean Society of Gastrointestinal Endoscopy (2021). The work was independent of these fundings.

Potential competing interests: None to report.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Study flow diagram showing patient enrolment.
Figure 2.
Figure 2.
Group classification according to the ABC method.
Figure 3.
Figure 3.
Nomograms for gastric cancer probability. (a) Nomogram for intestinal type gastric cancer. (b) Nomogram for diffuse type gastric cancer. (c) Nomogram for overall gastric cancer. BMI, body mass index; Prob., probability.
Figure 3.
Figure 3.
Nomograms for gastric cancer probability. (a) Nomogram for intestinal type gastric cancer. (b) Nomogram for diffuse type gastric cancer. (c) Nomogram for overall gastric cancer. BMI, body mass index; Prob., probability.
Figure 4.
Figure 4.
AUC plot for 15-year prediction performance through 10-fold cross-validation for intestinal type gastric cancer (dotted line), diffuse type gastric cancer (dashed-dotted line), and overall gastric cancer (solid line). AUC, area under the curve.
Figure 5.
Figure 5.
The “ABC method” which discriminates the risk for gastric cancer according to the anti-H. pylori serology and the presence of atrophy. (a) Conventional “ABC method” (15). (b) Updated ABC method which subclassifies the risk according to the anti-H. pylori antibody titer (12). HR, hazard ratio.
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