Validation of the Memorial Sloan Kettering gastric cancer post-resection survival nomogram: Does it stand the test of time? Journal Article


Authors: Nakauchi, M.; Court, C. M.; Tang, L. H.; Gönen, M.; Janjigian, Y. Y.; Maron, S. B.; Molena, D.; Coit, D. G.; Brennan, M. F.; Strong, V. E.
Article Title: Validation of the Memorial Sloan Kettering gastric cancer post-resection survival nomogram: Does it stand the test of time?
Abstract: BACKGROUND: The Memorial Sloan Kettering Cancer Center (MSK) nomogram combined both gastroesophageal junction (GEJ) and gastric cancer patients and was created in an era from patients who generally did not receive neoadjuvant chemotherapy. We sought to reevaluate the MSK nomogram in the era of multidisciplinary treatment for GEJ and gastric cancer. STUDY DESIGN: Using data on patients who underwent R0 resection for GEJ or gastric cancer between 2002 and 2016, the C-index of prediction for disease-specific survival (DSS) was compared between the MSK nomogram and the American Joint Committee on Cancer (AJCC) 8th edition staging system after segregating patients by tumor location (GEJ or gastric cancer) and neoadjuvant treatment. A new nomogram was created for the group for which both systems poorly predicted prognosis. RESULTS: During the study period, 886 patients (645 gastric and 241 GEJ cancer) underwent up-front surgery, and 999 patients (323 gastric and 676 GEJ) received neoadjuvant treatment. Compared with the AJCC staging system, the MSK nomogram demonstrated a comparable C-index in gastric cancer patients undergoing up-front surgery (0.786 vs 0.753) and a better C-index in gastric cancer patients receiving neoadjuvant treatment (0.796 vs 0.698). In GEJ cancer patients receiving neoadjuvant chemotherapy, neither the MSK nomogram nor the AJCC staging system performed well (C-indices 0.647 and 0.646). A new GEJ nomogram was created based on multivariable Cox regression analysis and was validated with a C-index of 0.718. CONCLUSIONS: The MSK gastric cancer nomogram's predictive accuracy remains high. We developed a new GEJ nomogram that can effectively predict DSS in patients receiving neoadjuvant treatment. Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
Keywords: neoadjuvant therapy; cancer staging; neoplasm staging; pathology; nomograms; stomach neoplasms; nomogram; stomach tumor; esophagogastric junction; gastroesophageal junction; humans; prognosis; human
Journal Title: Journal of the American College of Surgeons
Volume: 235
Issue: 2
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2022-08-01
Start Page: 294
End Page: 304
Language: English
DOI: 10.1097/xcs.0000000000000251
PUBMED: 35839406
PROVIDER: scopus
PMCID: PMC9298603
DOI/URL:
Notes: Article -- Export Date: 1 August 2022 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    1059 Brennan
  2. Mithat Gonen
    1034 Gonen
  3. Yelena Yuriy Janjigian
    400 Janjigian
  4. Laura Hong Tang
    448 Tang
  5. Vivian Strong
    268 Strong
  6. Daniel Coit
    542 Coit
  7. Daniela   Molena
    285 Molena
  8. Steven Maron
    108 Maron
  9. Colin Macdonald Court
    9 Court