A Practical Nomogram for Predicting the Prognosis of Elderly Patients with Gastric Adenocarcinoma After Gastrectomy

Figures & data

Table 1 Patient Characteristics for 3-Year and 5-Year OS and GCSS of Elderly Patients with Gastric Adenocarcinoma After Gastrectomy

Characteristics	n	Percentage	OS (%)		GCSS (%)
Total	8401	100	3-Year	5-Year	3-Year	5-Year
Sex
Male	5113	60.9	48.1±0.7	37.1±0.7	55.1± 0.7	47.0±0.8
Female	3288	39.1	51.1±0.9	41.1±0.9	56.9±0.9	50.6±1.0
Age
65–74	4294	51.1	52.6±0.8	43.6±0.8	57.8±0.8	50.8±0.8
75–84	3251	38.7	48.0±0.9	36.0±0.9	54.9±0.9	46.5±1.0
>85	856	10.2	37.7±1.7	24.8±1.6	49.7±1.9	44.0±1.9
Race
White	5515	65.6	46.9±0.7	35.9±0.7	53.6±0.7	45.7±0.8
Black	921	11.0	46.3±1.7	36.6±1.7	55.0±1.8	47.7±1.9
Other	1965	23.4	57.5±1.2	47.9±1.2	62.6±1.2	56.3±1.2
Marital status
Married	5164	61.5	51.5±0.7	40.8±0.7	57.3±0.7	49.4±0.8
Divorced	657	7.8	46.5±2.0	37.9±2.1	55.3±2.1	49.0±2.2
Other	2580	30.7	45.6±1.0	34.6±1.0	53.1±1.1	46.4±1.1
Site
Cardia	2014	23.9	44.4±1.2	33.3±1.2	50.3±1.2	41.1±1.3
Fundus	275	3.2	45.1±3.1	36.6±3.1	52.4±3.2	46.8±3.3
Body	858	10.2	54.9±1.8	44.1±1.9	61.5±1.8	53.8±1.9
Antrum	2705	32.2	51.3±1.0	41.6±1.0	58.6±1.0	52.7±1.1
Pylorus	381	4.5	44.6±2.6	34.6±2.6	51.3±2.7	43.6±2.8
Lesser curvature	1099	13.1	54.5±1.6	43.3±1.6	61.5±1.6	53.5±1.7
Greater curvature	456	5.4	52.5±2.4	42.1±2.5	58.4±2.8	52.1±2.6
Overlapping lesion	613	7.5	40.9±2.1	29.3±2.0	45.7± 2.1	37.7±2.2
Size
≤2 cm	1659	19.7	71.6±1.2	60.9±1.3	79.2±1.1	74.2±1.2
>2, ≤5 cm	3753	44.7	48.9±0.8	37.1±0.9	56.2±0.9	47.3±0.9
>5 cm	2989	35.6	37.5±0.9	28.6±0.9	42.5±1.0	35.7±1.0
Differentiation
Well	488	5.8	69.5±2.2	61.8±2.4	79.3±1.9	74.0±2.2
Moderate	2656	31.6	58.1±1.0	45.7±1.1	69.4±0.9	57.8±1.1
Poor	5090	60.6	43.1±0.7	33.1±0.7	52.2±0.7	41.6±0.8
Undifferentiated	167	2.0	38.8±4.0	28.8±4.0	42.4±4.1	34.0±4.3
T stage
T1	2003	23.8	77±1.0	66.3±1.2	86.1±0.8	80.8±1.0
T2	4034	48.0	48.7±0.8	36.7±0.8	55.6±0.8	46.7±0.9
T3	1839	21.9	28.6±1.1	20.6±1.0	32.6±1.2	25.7±1.2
T4	525	6.3	19.5±1.8	12.7±1.5	22.7±1.9	16.4±1.8
N stage
N0	3547	42.2	69.9±0.8	57.9±0.9	78.6±0.7	72.3±0.8
N1	3144	37.4	42.3±0.9	32.0±0.9	48.1±1.0	39.7±1.0
N2	1233	14.7	22.0±1.2	13.1±1.1	25.5±1.4	16.8±1.3
N3	477	5.7	12.6±1.6	5.0±1.2	14.1±1.8	7.2±1.5
M stage
M0	7724	91.9	52.5±0.6	41.4±0.6	59.5±0.6	51.8±0.6
M1	677	8.1	12.7±1.3	8.0±1.2	14.6±1.5	9.8±1.3
Radiation
No	6105	72.7	49.7±0.7	39.4±0.7	57.0±0.7	50.2±0.7
Yes	2296	27.3	48.1±1.1	36.9±1.1	53.0±1.1	44.2±1.2
Chemotherapy
No	4973	59.2	51.0±0.7	40.8±0.7	59.5±0.7	53.2±0.8
Yes	3428	40.8	46.7±0.9	35.5±0.9	50.7±0.9	41.7±1.0

Abbreviations: OS, overall survival; GCSS, gastric cancer-specific survival.

Figure 1 The flow diagram of the selection process for elderly patients with gastric adenocarcinoma undergoing radical gastrectomy.

Figure 2 OS and GCSS curves of all elderly patients with gastric adenocarcinoma undergoing radical gastrectomy.

Abbreviations: OS, overall survival; GCSS, gastric cancer-specific survival.

Table 2 Univariate and Multivariate Cox Regression Analyses Estimating the Risk Factors for OS of Elderly Patients with Gastric Adenocarcinoma After Gastrectomy

Characteristics	Univariate			Multivariate
	HR	95% CI	P	HR	95% CI	P
Sex			0.080
Male	Ref
Female	0.952	0.901–1.006	0.081
Age			<0.001			<0.001
65–74	Ref			Ref
75–84	1.290	1.218–1.366	<0.001	1.425	1.343–1.511	0.030
>85	1.769	1.625–1.926	<0.001	2.088	1.909–2.284	0.046
Race			<0.001			<0.001
White	Ref			Ref
Black	1.003	0.922–1.092	<0.939	1.034	0.948–1.129	<0.001
Other	0.738	0.690–0.790	<0.001	0.779	0.727–0.836	<0.001
Marital status			<0.001			<0.001
Married	Ref			Ref
Divorced	1.112	1.004–1.232	<0.041	1.172	1.057–1.299	<0.001
Other	1.235	1.165–1.308	<0.001	1.152	1.084–1.224	0.785
Site			<0.001			<0.001
Cardia	Ref			Ref
Fundus	0.994	0.854–1.157	0.936	0.870	0.747–1.014	<0.001
Body	0.801	0.723–0.887	<0.001	0.719	0.648–0.798	0.169
Antrum	0.859	0.800–0.923	<0.001	0.750	0.695–0.809	0.288
Pylorus	0.998	0.874–1.140	0.977	0.802	0.700–0.919	0.601
Lesser curvature	0.816	0.744–0.895	<0.001	0.702	0.638–0.773	0.631
Greater curvature	0.824	0.725–0.937	0.003	0.770	0.676–0.877	0.133
Overlapping lesion	1.161	1.042–1.294	0.007	0.772	0.689–0.864	0.980
Size			<0.001			0.024
≤2 cm	Ref			Ref
>2, ≤5 cm	1.845	1.699–2.004	<0.001	1.132	1.034–1.238	0.007
>5 cm	2.395	2.203–2.605	<0.001	1.117	1.014–1.230	0.025
Differentiation			<0.001			<0.001
Well	Ref			Ref
Moderate	1.398	1.216–1.607	<0.001	0.975	0.846–1.125	0.073
Poor	1.989	1.738–2.276	<0.001	1.148	0.998–1.320	0.053
Undifferentiated	2.245	1.791–2.814	<0.001	1.251	0.994–1.573	0.056
T stage			<0.001			<0.001
T1	Ref			Ref
T2	2.199	2.032–2.380	<0.001	1.576	1.440–1.724	<0.001
T3	3.596	3.296–3.923	<0.001	2.029	1.831–2.250	<0.001
T4	4.881	4.347–5.479	<0.001	2.660	2.332–3.034	<0.001
N stage			<0.001			<0.001
N0	Ref			Ref
N1	1.964	1.843–2.093	<0.001	1.507	1.406–1.615	<0.001
N2	3.438	3.179–3.718	<0.001	2.465	2.259–2.691	<0.001
N3	4.717	4.236–5.253	<0.001	3.180	2.825–3.581	<0.001
M stage			<0.001			<0.001
M0	Ref			Ref
M1	2.912	2.673–3.171	<0.001	1.915	1.753–2.092	<0.001
Radiation			0.200
No	Ref
Yes	0.962	0.906–1.021	0.200
Chemotherapy			0.245
No	Ref
Yes	1.033	0.978–1.091	0.244

Abbreviations: OS, overall survival; GCSS, gastric cancer-specific survival; Ref, reference.

Table 3 Univariate and Multivariate Cox Regression Analyses Estimating the Risk Factors for GCSS of Elderly Patients with Gastric Adenocarcinoma After Gastrectomy

Characteristics	Univariate			Multivariate
	HR	95% CI	P	HR	95% CI	P
Sex			0.219
Male	Ref
Female	0.961	0.901–1.024	0.219
Age			<0.001			<0.001
65–74	Ref			Ref
75–84	1.156	1.082–1.235	<0.001	1.202	1.122–1.288	<0.001
>85	1.345	1.212–1.493	<0.001	1.428	1.278–1.596	<0.001
Race			<0.001			<0.001
White	Ref			Ref
Black	0.949	0.858–1.050	0.307	1.037	0.936–1.150	0.486
Other	0.750	0.694–0.812	<0.001	0.798	0.736–0.865	<0.001
Marital status			0.001			0.052
Married	Ref			Ref
Divorced	1.038	0.920–1.170	0.544	1.075	0.953-1.214	0.240
Other	1.142	1.067–1.223	<0.001	1.088	1.013-1.168	0.021
Site			<0.001			<0.001
Cardia	Ref			Ref
Fundus	0.900	0.752–1.077	0.249	0.770	0.643–0.923	<0.005
Body	0.749	0.665–0.843	<0.001	0.651	0.577–0.735	<0.001
Antrum	0.770	0.709–0.837	<0.001	0.666	0.609–0.727	<0.001
Pylorus	0.982	0.844–1.143	0.813	0.765	0.656–0.893	0.001
Lesser curvature	0.730	0.655–0.814	<0.001	0.604	0.540–0.676	<0.001
Greater curvature	0.800	0.690–0.927	0.003	701.000	0.603–0.814	<0.001
Overlapping lesion	1.146	1.014–1.294	0.029	0.689	0.607–0.783	<0.001
Size			<0.001			0.002
≤2 cm	Ref			Ref
>2, ≤5 cm	2.388	2.143–2.661	<0.001	1.214	1.082–1.363	0.001
>5 cm	3.418	3.067–3.810	<0.001	1.235	1.094–1.395	0.001
Differentiation			<0.001			<0.001
Well	Ref			Ref
Moderate	1.672	1.386–2.018	<0.001	1.017	0.840–1.230	0.865
Poor	2.792	2.329–3.348	<0.001	1.336	1.109–1.609	0.002
Undifferentiated	3.417	2.617–4.462	<0.001	1.590	1.213–2.084	0.001
T stage			<0.001			<0.001
T1	Ref			Ref
T2	3.493	3.120–3.910	<0.001	2.306	2.034–2.615	<0.001
T3	6.434	5.717–7.241	<0.001	3.243	2.828–3.720	<0.001
T4	8.929	7.741–10.299	<0.001	4.251	3.614–5.000	<0.001
N stage			<0.001			<0.001
N0	Ref			Ref
N1	2.799	2.584–3.033	<0.001	2.133	1.953–2.331	<0.001
N2	5.183	4.725–5.686	<0.001	3.554	3.201–3.947	<0.001
N3	7.262	6.447–8.181	<0.001	4.534	3.967–5.183	<0.001
M stage			<0.001			<0.001
M0	Ref			Ref
M1	3.457	3.159–3.784	<0.001	1.969	1.791–2.166	<0.001
Radiation			0.024			<0.001
No	Ref			Ref
Yes	1.082	1.011–1.158	0.024	0.855	0.784–0.933	<0.001
Chemotherapy			<0.001			<0.001
No	Ref			Ref
Yes	1.243	1.167–1.323	<0.001	0.693	0.638–0.752	<0.001

Abbreviations: OS, overall survival; GCSS, gastric cancer-specific survival; Ref, reference.

Table 4 Comparison of AUC Between the Nomogram and TNM Stage

Characteristics	OS			GCSS
	AUC	95% CI	P	AUC	95% CI	P
Nomogram	0.752	0.743–0.761	<0.001	0.782	0.773–0.791	<0.001
TNM stage	0.715	0.705–0.725		0.767	0.758–0.776

Abbreviations: AUC, area under the curve; OS, overall survival; GCSS, gastric cancer-specific survival.

Figure 3 (A) Nomogram for predicting the 3-year and 5-year OS rates of elderly patients undergoing radical gastrectomy. (B) Nomogram for predicting the 3-year and 5-year GCSS rates of elderly patients undergoing radical gastrectomy.

Abbreviations: GC, great curvature; LC, lesser curvature; OL, overlapping lesion; OS, overall survival; GCSS, gastric cancer-specific survival.

Figure 4 (A) Calibration curve of the nomogram for predicting the 3-year OS rates of elderly patients undergoing radical gastrectomy. (B) Calibration curve of the nomogram for predicting the 5-year OS rates of elderly patients undergoing radical gastrectomy.

Abbreviation: OS, overall survival.

Figure 5 (A) Calibration curve of the nomogram for predicting the 3-year GCSS rates of elderly patients undergoing radical gastrectomy. (B) Calibration curve of the nomogram for predicting the 5-year GCSS rates of elderly patients undergoing radical gastrectomy.

Abbreviation: GCSS, gastric cancer-specific survival.

Figure 6 Decision curve analysis (DCA) curves of the two nomograms for elderly patients undergoing radical gastrectomy. (A) DCA for overall OS; (B) DCA for GCSS.

Figure 7 Receiver operating characteristic (ROC) curves of the two nomograms for elderly patients undergoing radical gastrectomy. (A) ROC curve for OS; (B) ROC curve for GCSS.