A clinical model to predict distant metastasis in patients with superficial gastric cancer with negative lymph node metastasis and a survival analysis for patients with metastasis

Abstract

Background: Distant metastasis (DM) is relatively rare in superficial gastric cancer (SGC), especially in patients without lymph node metastasis. This study aimed to explore the main clinical risk factors for DM in patients with superficial gastric cancer-no lymph node metastasis (SGC-NLNM) and the prognostic factors for patients with DM.

Methods: Records of patients with SGC-NLNM between 2004 and 2015 were collected from the public Surveillance, Epidemiology, and End Results (SEER) database. Both univariate and multivariate logistic regressions were performed to analyze the clinical risk factors for DM. The Kaplan-Meier method and Cox regression model were used to identify prognostic factors for patients with DM. A nomogram was built based on multivariate logistic regression and evaluated by the C-index, the calibration, and the area under the receiver operating characteristic curve (AUC).

Results: We developed and validated a nomogram to predict DM in patients with SGC-NLNM, showing that race, age, primary site, depth, size, and grade were independent risk factors. The built nomogram had a good discriminatory performance, with a C-index of 0.836 (95% confidence interval [CI]: 0.813-0.859). Calibration plots showed that the predicted DM probability was identical to the actual observations in both the training and validation sets. AUC was 0.846 (95% CI: 0.820-0.871) and 0.801 (95% CI: 0.751-0.850) in the training and validation sets, respectively. The results of the survival analysis revealed that surgery (hazard ratio [HR] = 0.249; 95% CI, 0.125-0.495), chemotherapy (HR = 0.473; 95% CI, 0.353-0.633), and grade (HR = 1.374; 95% CI, 1.018-1.854) were independent prognostic factors associated with cancer-specific survival (CSS), but radiotherapy was not (log-rank test, p = 0.676).

Conclusions: We constructed a sensitive and discriminative nomogram to identify high-risk patients with SGC-NLNM who may harbor dissemination at initial diagnosis. The tumor size and primary site were the largest contributors to DM prediction. Compared with radiotherapy, aggressive surgery, and chemotherapy may be better options for patients with DM.

Keywords: SEER Program; distant metastasis; nomogram; superficial gastric cancer.

Conflict of interest statement

None declared.

© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

FIGURE 1

Forest plot for the potential risk factors for distant metastasis in patients with superficial gastric cancer‐no lymph node metastasis

FIGURE 2

Nomogram for predicting the probability of distant metastasis. Age: 1, >60; 2, ≤60. Primary site: 1, antrum/pylorus; 2, body; 3, cardia; 4, fundus; 5, lesser curvature; 6, greater curvature; 7, overlapping/not otherwise specified. Grade: 1, well/moderate; 2, poorly/undifferentiated. Tumor size: 1, ≤2 cm; 2, ≤3 cm; 3, ≤5 cm; 4, >5 cm; 5, unknown/diffuse. Depth: 1, T1a; 2, T1b

FIGURE 3

Nomogram validation. (A) Receiver operating characteristic (ROC) curve of the nomogram from the training set. The AUC is 0.846 and 95% CI 0.820–0.871. (B) ROC curve of the nomogram from the validation set. The AUC is 0.801 and 95% CI 0.751–0.850. (C) Calibration plot of the nomogram from the training set. (D) Calibration plot of the nomogram from the validation set

FIGURE 4

Kaplan–Meier survival curve for cancer‐specific survival in patients with metastatic superficial gastric cancer‐no lymph node metastasis, stratified by (A) surgery, (B) chemotherapy, (C) radiotherapy, and (D) grade