A nomogram based on Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) ratio after surgery to predict the prognostic value in patients with gastric cancer

Abstract Background This study aimed to develop an effective nomogram for predicting overall survival (OS) in surgically treated gastric cancer. Methods We retrospectively evaluated 190 gastric cancer in this study. Cox regression analyses were performed to identify significant prognostic factors for OS in patients with resectable gastric cancer. The predictive accuracy of nomogram was assessed by calibration plot, concordance index (C-index) and decision curve, and then were compared with the traditional TNM staging system. Based on the total points (TPS) by nomogram, we further divided patients into different risk groups. Results On multivariate analysis of the 190 cohort, independent factors for survival were age, clinical stage and Aspartate Aminotransferase/Alanine Aminotransferase (SLR), which were entered into the nomogram. The calibration curve for the probability of OS showed that the nomogram-based predictions were in good agreement with actual observations. And the C-index of the established nomogram for predicting OS had a superior discrimination power compared with the TNM staging system [0.768 (95% CI: 0.725-0.810) vs 0.730 (95% CI: 0.688-0.772), p < 0.05]. Decision curve also demonstrated that the nomogram was better than TNM staging system. Based on the TPS of the nomogram, we further subdivided the study cohort into 3 groups: low risk (TPS ≤ 158), middle risk (158 < TPS ≤ 188), high risk (TPS > 188), the differences of OS rate were significant in the groups. Conclusions The established nomogram resulted in more accurate prognostic prediction for individual patient with resectable gastric cancer.