Defining nomograms for predicting the prognosis of early and late recurrence in gastric cancer patients after radical gastrectomy

Abstract Background : There are few studies on the predictive factors of early recurrence (ER) and late recurrence (LR) of advanced gastric cancer (GC) after curative surgery. Our study aims to explore the independent predictors influencing the prognosis between ER and LR in patients with advanced GC after curative intent surgery respectively. And we will further develop nomograms for prediction of post recurrence survival (PRS). Materials and Method : Data of patients with GC who received radical gastrectomy was retrospectively collected. Recurrence was classified into ER and LR according to the two years after surgery as the cut-off value. Multivariate Cox regression analyses were used to explore significant predictors in our analysis. Then these significant predictors were integrated to construct nomograms. Results : The 1-, 2- and 3-year probabilities of PRS in patients with ER were 30.00%, 16.36% and 11.82%, respectively. In contrast, the late group were 44.68%, 23.40%, and 23.30%, respectively. Low body mass index (HR=0.86, P =0.001), elevated monocytes count (HR=4.54, P =0.003) and neutrophil–lymphocyte ratio (HR=1.03, P =0.037) at the time of recurrence were risk factors of PRS after ER. Decreased hemoglobin (HR=0.97, P =0.008) and elavated neutrophil–lymphocyte ratio (HR=1.06, P =0.045) at the time of recurrence were risk factors of PRS after LR. The calibration curves for probability of 1-, 2- and 3-year PRS showed excellent predictive effect. Internal validation C-indexes of PRS were 0.722 and 0.671 for ER and LR respectively. Conclusion : In view of the different predictive factors of ER and LR of GC, the practical predictive model may help clinicians make reasonable decisions.