Development and validation of a nomogram to predict the survival and estimate surgical benefits for gastric cancer with liver metastasis receiving primary tumor resection

Rishun Su; Xuezeng Sun; Songyao Chen; Guofei Deng; Songcheng Yin; Yulong He; Tengfei Hao; Liang Gu; Changhua Zhang

doi:10.3389/fonc.2024.1418548

Development and validation of a nomogram to predict the survival and estimate surgical benefits for gastric cancer with liver metastasis receiving primary tumor resection

Front Oncol. 2024 Nov 8:14:1418548. doi: 10.3389/fonc.2024.1418548. eCollection 2024.

Authors

Rishun Su^#¹, Xuezeng Sun^#¹, Songyao Chen^#¹, Guofei Deng¹, Songcheng Yin^{1

2}, Yulong He^{1

2

3}, Tengfei Hao¹, Liang Gu^{1

2}, Changhua Zhang^{1

2}

Affiliations

¹ Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
² Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
³ Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Surgical treatment has been widely controversial for gastric cancer accompanied by liver metastasis (GCLM). This paper aims to develop and validate a nomogram to predict the survival and estimate surgical benefits for GCLM patients.

Methods: A total of 616 GCLM patients from the Surveillance, Epidemiology, and End Results Program (SEER) database and 74 GCLM patients receiving primary tumor resection (PTR) from the Chinese center were included in this study. Patients from the SEER database were divided into training set (with PTR) (n=493) and non-operative set (without PTR) (n=123). Patients undergoing PTR from China were included as external validation set. Independent risk factors associated with the overall survival of GCLM patients undergoing PTR were identified in the training set via log-rank test and Cox regression analysis. Afterwards, a comprehensive model and corresponding nomogram were constructed and validated by validation set.

Results: The survival of patients undergoing PTR (n=493) was longer than that without PTR (n=123) (log-rank test, p<0.0001) in SEER cohort. T stage (HR=1.40, 95% CI=1.14, 1.73), differentiation grade (HR=1.47, 95% CI=1.17, 1.85), non-hepatic metastases (HR=1.69, 95% CI=1.29, 2.21), and adjuvant therapy (HR=0.34, 95% CI= 0.28, 0.42) were closely related with the survival of GCLM with PTR, and thus, a four-factor nomogram was established. However, GCLM patients receiving PTR in the high-risk subgroup (n=255) screened out by the nomogram did not have better survival outcomes compared with patients without PTR (n=123) (log-rank test, p=0.25).

Conclusions: The nomogram could predict survival of GCLM patients receiving PTR with acceptable accuracy. In addition, although PTR did improve the survival of whole GCLM patients, patients in the high-risk subgroup were unable to benefit from PTR, which could assist clinicians to make decisions for the treatment of GCLM.

Keywords: gastric cancer; liver metastasis; nomogram; prognosis; surgery.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was funded by the Guangdong Provincial Key Laboratory of Digestive Cancer Research (No. 2021B1212040006), the Sanming Project of Medicine in Shenzhen (No. SZSM201911010), the Shenzhen Key Medical Discipline Construction Fund (No. SZXK016), Shenzhen Sustainable Project (KCXFZ20200201101059392), and the Guangdong–Hong Kong–Macau University Joint Laboratory of Digestive Cancer Research (2021LSYS003), and the Natural Science Foundation of Shenzhen (JCYJ20220530145012027).