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Conditional Probability of Survival Nomogram for 1-, 2-, and 3-Year Survivors After an R0 Resection for Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

The authors would like to thank Marianne Beninati and Elma Meershoek–Klein Kranenbarg for their contribution in data management. This research was funded in part by the “Prof. Michael van Vloten” Foundation, the Dutch Cancer Society (KWF Kankerbestrijding), the Dutch Digestive Foundation, and the “Jo Keur” Foundation.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Johan L. Dikken MD, PhD, Murray F. Brennan MD & Daniel G. Coit MD

  2. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Johan L. Dikken MD, PhD & Cornelis J. H. van de Velde MD, PhD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Raymond E. Baser MS & Mithat Gonen PhD

  4. Department of Quantative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Michael W. Kattan PhD

  5. Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Manish A. Shah MD

  6. Department of Radiotherapy, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Marcel Verheij MD, PhD

Authors
  1. Johan L. Dikken MD, PhD
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  2. Raymond E. Baser MS
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  3. Mithat Gonen PhD
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  4. Michael W. Kattan PhD
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  5. Manish A. Shah MD
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  6. Marcel Verheij MD, PhD
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  7. Cornelis J. H. van de Velde MD, PhD
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  8. Murray F. Brennan MD
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  9. Daniel G. Coit MD
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Corresponding author

Correspondence to Daniel G. Coit MD.

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Dikken, J.L., Baser, R.E., Gonen, M. et al. Conditional Probability of Survival Nomogram for 1-, 2-, and 3-Year Survivors After an R0 Resection for Gastric Cancer. Ann Surg Oncol 20, 1623–1630 (2013). https://doi.org/10.1245/s10434-012-2723-6

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  • DOI: https://doi.org/10.1245/s10434-012-2723-6

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