Research Paper Volume 12, Issue 13 pp 13160—13171

A validated survival nomogram for early-onset diffuse gastric cancer

Fei Liao1, *, , Xufeng Guo2, *, , Xiaohong Lu1, , Weiguo Dong1, ,

  • 1 Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430061, Hubei Province, China
  • 2 Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430061, Hubei Province, China
* Equal contribution

Received: February 10, 2020       Accepted: May 25, 2020       Published: July 8, 2020
How to Cite

Copyright © 2020 Liao et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


This study aimed to establish and independently validate a prognostic nomogram for individual risk prediction in patients with early-onset diffuse gastric cancer (EODGC). Data for 794 patients with EODGC from the SEER database were randomly assigned to training (N=558) and internal validation (N=236) sets, and data for 82 patients from the Renmin Hospital of Wuhan University (RMHWHU) were used as an independent validation cohort. Our LASSO regression analyses of the training set yielded five clinicopathological features (race, AJCC stage, surgery for primary site, chemotherapy and tumor size), which were used to create a survival nomogram. Our survival nomogram achieved better predictive performance than the AJCC staging system, the current standard. Additionally, the calibration curves of the prognostic nomogram revealed good agreement between the predicted survival probabilities and the ground truth values. Indeed, our nomogram, which estimates individualized survival probabilities for patients with EODGC, shows good predictive accuracy and calibration ability for both the SEER and RMHWHU cohorts. These results suggest that a survival nomogram may be better at predicting OS for EODGC patients than the AJCC staging system.


GC: Gastric cancer; EODGC: Early-onset diffuse gastric cancer; SEER: Surveillance, Epidemiology, and End Results; LASSO: Least absolute shrinkage and selection operator; EMT: Epithelial stromal transformation; AJCC: American Joint Committee on Cancer; OS: Overall survival; C-index: Concordance index; PLR: positive likelihood ratio; NLR: negative likelihood ratio; PPV: positive predictive value; NPV: negative predictive value.