Development and validation of a nomogram to predict perioperative blood transfusion for gastric cancer surgery

Abstract Background This study aimed to construct and validate a nomogram composed of preoperative variables to predict perioperative blood transfusion for gastric cancer surgery. Methods 600 gastric cancer patients undergoing gastrectomy between January 2010 and December 2015 were selected as primary cohort. 399 patients from January 2016 to June 2019 were collected as validation cohort. In the primary cohort, univariate and multivariate analyses were performed to identify independent risk factors for blood transfusion. Using Akaike information criterion, selected variables were incorporated to construct a nomogram. Validations of the nomogram were performed in the primary and validation cohort. Discrimination of the nomogram was assessed by the concordance index (C-index) and calibration of the nomogram was assessed by calibration curve and Hosmer–Lemeshow goodness-of-fit test. Results The following independent risk factors for transfusion were identified: Charlson comorbidity index score over 3 (odds ratio (OR) 2.15), tumor location (diffuse vs upper: OR 1.50), pTNM stage (III vs I: OR 3.17), type of gastrectomy (subtotal vs total gastrectomy: OR 0.58), extragastric organ resection (OR 2.03) and preoperative hemoglobin less than 80 g/l (vs over 120 g/l: OR 66.03). C-index was 0.863 and 0.901 in the primary and validation cohort, respectively, indicating good discrimination of the nomogram. Both calibration curves and Hosmer–Lemeshow goodness-of-fit tests (P-value 0.716 and 0.935) demonstrated high agreement between prediction and actual outcome. Conclusion A nomogram composed of preoperative variables to predict blood transfusion for gastric cancer surgery was developed and validated. This nomogram could be used to improve utilization of packed red blood cells.