CMS4 is an independent predictor of GAC overall survival. (A) CMS4 has the poorest overall survival of any CMS classification in the combined ACRG/STAD dataset, with a median OS of approximately 24.2 months, compared to 48.7 months for CMS2, 85.6 months for CMS3, and >120 months for CMS1 (p < 0.0001). (B) ROC analysis demonstrating moderate sensitivity and specificity for OS in the combined ACRG/STAD dataset at 1, 1.5, 3, and 5 years postdiagnosis (AUC: 0.625–0.649, p < 0.0001). (C) Multivariate Cox regression analysis demonstrating that CMS4 is an independent prognostic factor for OS in GAC (p = 0.030).