A Nomogram Integrating HOXA9 Expression and Clinicopathological Factors for Predicting Postoperative Recurrence in Gastric Cancer: A Single-Center Retrospective Study

Jianze Weng,1 Jingwen Ying,1 Minming Xia,2 Yijie Xie3 1Department of Pharmacy, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China; 2Department of Gastrointestinal Minimally Invasive Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China; 3Department of Dermatology, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of ChinaCorrespondence: Jianze Weng, Department of Pharmacy, The Affiliated People’s Hospital of Ningbo University, No. 251 Baizhang East Road, Yinzhou District, Ningbo, Zhejiang, 315000, People’s Republic of China, Email wengjianze2022@163.comObjective: To develop a nomogram integrating HOXA9 expression with clinicopathological indicators for predicting postoperative recurrence risk in gastric cancer.Methods: This single-center retrospective study enrolled 152 gastric cancer patients who underwent radical surgery (June 2023–March 2024) with 18-month follow-up. Patients were divided into recurrence (n=58) and non-recurrence (n=94) groups. HOXA9 expression was assessed by immunohistochemistry. Clinicopathological parameters including age, gender, tumor size, location, differentiation, invasion depth, lymph node metastasis, TNM stage, vascular invasion, and perineural invasion were collected. Univariate and multivariate Cox regression and ROC analyses were used to identify independent risk factors and evaluate predictive value.Results: The recurrence rate was 38.16%. The recurrence group had significantly larger tumor size, higher proportions of poor differentiation, lymph node metastasis, TNM stage III, vascular invasion, perineural invasion, and high HOXA9 expression (all P< 0.05). Multivariate Cox regression identified lymph node metastasis [HR=1.206 (1.042– 1.397)], TNM stage III [HR=1.598 (1.096– 2.328)], vascular invasion [HR=1.863 (1.093– 3.176)], and high HOXA9 expression [HR=2.076 (1.222– 3.525)] as independent risk factors (P< 0.05). The combined AUC was 0.798, significantly higher than each factor alone (Z=3.472– 3.305, all P< 0.01).Conclusion: The model combining HOXA9 expression with TNM stage, lymph node metastasis, and vascular invasion demonstrates good performance in assessing postoperative recurrence risk and may serve as a practical tool for clinical risk stratification.