A Nomogram Model and Therapeutic Efficacy Assessment for Geriatric Patient with Gastric Cancer: A SEER Database and External validation Study

Abstract

Abstract Purpose This research has delineated an all-encompassing survival prognostication model for geriatric patients afflicted by gastric cancer, elucidating the influence of diverse therapeutic modalities on the patient's prognosis. The primary aim herein is to aid clinical practitioners in the discernment of patient states and the judicious selection of apt therapeutic interventions. Methods In this investigation, the esteemed SEER database served as the foundation. We employed Cox regression analysis to identify pivotal risk factors governing overall survival (OS) in the venerable cohort afflicted by gastric cancer. Subsequently, we crafted a meticulous Nomogram model, subjecting it to the crucible of external validation data, with unwavering attention to the metrics of predictive accuracy, notably the concordance index (c-index), and the calibration curve. Lastly, we delved into the impact of diverse therapeutic modalities on patient OS, intimately scrutinizing the results through the lens of Kaplan-Meier curves. Results A total of 9,222 patients from the SEER database, alongside 209 validation cases from Liaoning Cancer Hospital, constituted our cohort. Cox regression analysis revealed several favorable independent prognostic factors, including being female, younger age at initial diagnosis, lower tumor grade, undergoing surgery, receiving chemotherapy, and having a single primary malignancy. The Nomogram's C-index garnered 0.723 from the SEER modeling data and 0.719 from the external validation data, with the calibration curve attesting to the commendable congruence between the predicted and observed survival rates of overall survival (OS). Through the discerning lens of Kaplan-Meier analysis, surgery emerged as the preeminent single treatment modality, generously benefitting patients across various tumor stages. Meanwhile, the elegant interplay of surgery and chemotherapy assumed the mantle of the most efficacious combined therapeutic approach. Indeed, this amalgamation exhibited superior efficacy, outperforming the solitary pursuit of surgery alone. Conclusion We established an OS nomogram prediction model for geriatric patients with gastric cancer, which may assist physicians in evaluating patient conditions. Surgery plus chemotherapy may be the most recommended form of treatment.