{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:58:42Z","timestamp":1781647122491,"version":"3.54.5"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The Surveillance, Epidemiology, and End Results (SEER) database is widely used to develop machine learning prognostic models for gastric cancer, yet data limitations restrict their clinical utility. We critically appraise the recent multicenter machine learning study by Guan et al., which reported superior prognostication compared with TNM staging, and identify eight methodological concerns: chemotherapy sensitivity of only 68% with systematic under capture of one-third of treated patients; complete loss of regimen-specific information that prevents distinction between curative perioperative therapy and palliative regimens; absence of performance status data despite it being the strongest predictor of outcome; missing molecular biomarkers (HER2, MSI-H, TMB, TCGA subtype) increasingly essential for precision oncology; unknown surgical technique quality metrics; and substantial cohort heterogeneity (surgery rates 26.6% vs 59.8%). These limitations collectively prevent individual treatment selection at the bedside. We conclude that SEER-based machine learning models should remain complementary to\u2014rather than substitutes for\u2014guideline-based decision-making, and future progress requires integration of regimen-specific treatment data, documented performance status, comorbidity indices, and molecular biomarkers.<\/jats:p>","DOI":"10.1007\/s00423-026-04014-5","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T09:58:48Z","timestamp":1775642328000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine learning nomograms for gastric cancer: addressing data limitations in SEER-based models"],"prefix":"10.1007","volume":"411","author":[{"given":"Amirhosein","family":"Naseri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Hossein","family":"Antikchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Neamatzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"4014_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s00423-025-03883-6","volume":"411","author":"X Guan","year":"2025","unstructured":"Guan X, Liu J, Xu L, Wang C (2025) Development and validation of a machine learning\u2013based prognostic model for gastric cancer: a multicenter retrospective study. Langenbecks Arch Surg 411:15. https:\/\/doi.org\/10.1007\/s00423-025-03883-6","journal-title":"Langenbecks Arch Surg"},{"key":"4014_CR2","unstructured":"National Cancer Institute. SEER Treatment Data Limitations (2024) Available at: https:\/\/seer.cancer.gov\/data\/treatment.html [Accessed January 3, 2026]"},{"key":"4014_CR3","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa055531","volume":"355","author":"D Cunningham","year":"2006","unstructured":"Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11\u201320. https:\/\/doi.org\/10.1056\/NEJMoa055531","journal-title":"N Engl J Med"},{"key":"4014_CR4","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1056\/NEJMoa010187","volume":"345","author":"JS Macdonald","year":"2001","unstructured":"Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725\u2013730. https:\/\/doi.org\/10.1056\/NEJMoa010187","journal-title":"N Engl J Med"},{"issue":"15 suppl","key":"4014_CR5","doi-asserted-by":"publisher","first-page":"4515","DOI":"10.1200\/jco.2009.27.15_suppl.4515","volume":"27","author":"JS Macdonald","year":"2009","unstructured":"Macdonald JS, Benedetti J, Smalley SR, Haller DG, Hundahl SA, Jessup JM et al (2009) Chemoradiation of resected gastric cancer: a 10-year follow-up of the phase III trial INT0116 (SWOG 9008). J Clin Oncol 27(15 suppl):4515. https:\/\/doi.org\/10.1200\/jco.2009.27.15_suppl.4515","journal-title":"J Clin Oncol"},{"key":"4014_CR6","doi-asserted-by":"publisher","first-page":"4991","DOI":"10.1200\/JCO.2006.06.8429","volume":"24","author":"E Van Cutsem","year":"2006","unstructured":"Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C et al (2006) Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 24:4991\u20134997. https:\/\/doi.org\/10.1200\/JCO.2006.06.8429","journal-title":"J Clin Oncol"},{"key":"4014_CR7","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1634\/theoncologist.2015-0314","volume":"21","author":"D Tougeron","year":"2016","unstructured":"Tougeron D, Hamidou H, Volet J, Taieb J (2016) Management of gastric cancer in elderly patients: an age-stratified treatment approach. Oncologist 21:450\u2013464. https:\/\/doi.org\/10.1634\/theoncologist.2015-0314","journal-title":"Oncologist"},{"key":"4014_CR8","doi-asserted-by":"publisher","first-page":"167","DOI":"10.6004\/jnccn.2022.0008","volume":"20","author":"JA Ajani","year":"2022","unstructured":"Ajani JA, D\u2019Amico TA, Bentrem DJ, Chao J, Das P, Denlinger CS et al (2022) Gastric cancer, version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 20:167\u2013192. https:\/\/doi.org\/10.6004\/jnccn.2022.0008","journal-title":"J Natl Compr Canc Netw"},{"key":"4014_CR9","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1038\/nature13480","volume":"513","author":"Cancer Genome Atlas Research Network","year":"2014","unstructured":"Cancer Genome Atlas Research Network (2014) Comprehensive molecular characterization of gastric adenocarcinoma. 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Lancet 376(9742):687\u2013697. https:\/\/doi.org\/10.1016\/S0140-6736(10)61121-X","journal-title":"Lancet"},{"key":"4014_CR11","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/S0140-6736(18)31257-4","volume":"392","author":"K Shitara","year":"2018","unstructured":"Shitara K, \u00d6zg\u00fcro\u011flu M, Bang YJ, Di Bartolomeo M, Mandal\u00e0 M, Ryu MH et al (2018) Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesophageal junction cancer (KEYNOTE-061): a randomised, open-label, controlled, phase 3 trial. Lancet 392:123\u2013133. https:\/\/doi.org\/10.1016\/S0140-6736(18)31257-4","journal-title":"Lancet"},{"key":"4014_CR12","doi-asserted-by":"publisher","first-page":"167","DOI":"10.6004\/jnccn.2022.0008","volume":"20","author":"JA Ajani","year":"2022","unstructured":"Ajani JA, Barthel JS, Bekaii-Saab T, Bentrem DJ, D\u2019Amico TA, Das P et al (2022) Gastric cancer, version 2.2022, NCCN Clinical Practice Guidelines in Oncology. 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This commentary analyzes published literature without human or animal subjects.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors consent to publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical Trial Registration"}}],"article-number":"117"}}