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Nomograms for predicting survival in patients with metastatic gastric adenocarcinoma who undergo palliative gastrectomy

Ma, Tai, Wu, Zhi-jun, Xu, Hui, Wu, Chang-hao, Xu, Jing, Peng, Wan-ren, Fan, Lu-lu and Sun, Guo-ping (2019) Nomograms for predicting survival in patients with metastatic gastric adenocarcinoma who undergo palliative gastrectomy BMC Cancer, 19, 852. pp. 1-11.

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Recently, evidence has emerged that palliative gastrectomy in patients with stage IV gastric cancer may offer some survival benefits. However, the decision whether to perform primary tumor surgery remains challenging for surgeons, and investigations into models that are predictive of prognosis are scarce. Current study aimed to develop and validate prognostic nomograms for patients with metastatic gastric adenocarcinoma treated with palliative gastrectomy.


The development dataset comprised 1186 patients from the Surveillance, Epidemiology, and End Results Program who were diagnosed with metastatic gastric adenocarcinoma in 2004–2011, while the validation dataset included 407 patients diagnosed in 2012–2015. Variables were incorporated into a Cox proportional hazards model to identify independent risk factors for survival. Both pre- and postoperative nomograms for predicting 1- or 2-year survival probabilities were constructed using the development dataset. The concordance index (c-index) and calibration curves were plotted to determine the accuracy of the nomogram models. Finally, the cut-off value of the calculated total scores based on preoperative nomograms was set and validated by comparing survival with contemporary cases without primary tumor surgery.


Age, tumor size, location, grade, T stage, N stage, metastatic site, scope of gastrectomy, number of examined lymph node(s), chemotherapy and radiotherapy were risk factors of survival and were included as variables in the postoperative nomogram; the c-indices of the development and validation datasets were 0.701 (95% confidence interval [CI]: 0.693–0.710) and 0.699 (95% CI: 0.682–0.716), respectively. The preoperative nomogram incorporated age, tumor size, location, grade, depth of invasion, regional lymph node(s) status, and metastatic site. The c-indices for the internal (bootstrap) and external validation sets were 0.629 (95% CI: 0.620–0.639) and 0.607 (95% CI: 0.588–0.626), respectively. Based on the preoperative nomogram, patients with preoperative total score ˃ 28 showed no survival benefit with gastrectomy compared to no primary tumor surgery.


Our survival nomograms for patients with metastatic gastric adenocarcinoma undergoing palliative gastrectomy can assist surgeons in treatment decision-making and prognostication.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Ma, Tai
Wu, Zhi-jun
Xu, Hui
Xu, Jing
Peng, Wan-ren
Fan, Lu-lu
Sun, Guo-ping
Date : 28 August 2019
DOI : 10.1186/s12885-019-6075-5
Copyright Disclaimer : © The Author(s). 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Uncontrolled Keywords : Gastric adenocarcinoma; Palliative gastrectomy; Nomogram; Prognosis
Depositing User : Clive Harris
Date Deposited : 12 Sep 2019 14:05
Last Modified : 12 Sep 2019 14:05

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