Wang Xijuan, Ke Xiurong, Min Junxia
Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Orthopedic Surgery, The Third Hospital Affiliated to Wenzhou Medical University, Rui'an, China.
Ann Transl Med. 2021 Apr;9(7):525. doi: 10.21037/atm-20-6280.
Primary ovarian signet-ring cell carcinoma (POSRCC) is a rare subtype of ovarian carcinoma that is characterized by abundant mucin accumulation. POSRCC is aggressive, and the prognostic factors associated with its clinical outcome remain poorly defined. This study aimed to elucidate the clinical characteristics and survival of patients with POSRCC, and to establish an effective prognostic nomogram and risk stratification model to predict the risks associated with patient outcomes.
Data of patients with POSRCC from the period 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Univariable and multivariable analyses of demographic factors, clinicopathological characteristics, and treatments were conducted to identify significant prognostic parameters. The identified independent variables were integrated to develop a nomogram and risk stratification model. The discrimination and calibration of the nomogram were assessed with the concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration curves.
A total of 172 patients were identified as being eligible to participate in this study. The median overall survival (OS) time was 7 months [95% confidence interval (CI), 4.6-9.4 months]. The 1-, 3-, and 5-year OS rates were 35.5%, 15.3%, and 6%, respectively. A multivariable analysis of the primary patients identified the independent predictors for survival as age at diagnosis, race, marital status, T (primary tumor size) stage, and chemotherapy, which were all incorporated into the nomogram. The C-index was 0.70 (95% CI, 0.66-0.75), which was statistically higher than that of the International Federation of Gynecology and Obstetrics (FIGO) staging system (0.58; 95% CI, 0.53-0.63). ROC curve analysis also showed that the nomogram had good discrimination, with an area under the curve (AUC) of 0.74, 0.62, and 0.71 for 1-, 3-, and 5-year survival, respectively. The calibration curves showed good agreement between the prediction by the nomogram and actual observations. A risk stratification model was further used to classify patients into a low-risk or high-risk group. The median OS time for the low- and high-risk groups was 13.0 months (95% CI, 9.33-16.67) and 2.0 months (95% CI, 1.12-2.89), respectively. Surgery did not significantly prolong survival in either group [low-risk group: hazard ratio (HR), 0.69; 95% CI, 0.45-1.07; P=0.09; high-risk group: HR, 0.55; 95% CI, 0.46-0.67; P=0.18].
The proposed nomogram and risk stratification model showed accurate prognostic prediction for POSRCC. These methods could improve individualized evaluations of survival and therapeutic decisions for patients with POSRCC.
原发性卵巢印戒细胞癌（POSRCC）是卵巢癌的一种罕见亚型，其特征是有大量黏液积聚。POSRCC具有侵袭性，与其临床结局相关的预后因素仍不清楚。本研究旨在阐明POSRCC患者的临床特征和生存情况，并建立有效的预后列线图和风险分层模型，以预测与患者结局相关的风险。
收集1975年至2016年期间来自监测、流行病学和最终结果（SEER）数据库的POSRCC患者数据。对人口统计学因素、临床病理特征和治疗方法进行单变量和多变量分析，以确定显著的预后参数。将确定的独立变量整合起来，建立列线图和风险分层模型。用一致性指数（C指数）、受试者工作特征（ROC）曲线和校准曲线评估列线图的辨别力和校准情况。
共确定172例患者符合本研究的纳入标准。中位总生存（OS）时间为7个月[95%置信区间（CI），4.6 - 9.4个月]。1年、3年和5年的OS率分别为35.5%、15.3%和6%。对初治患者进行多变量分析，确定生存的独立预测因素为诊断时年龄、种族、婚姻状况、T（原发肿瘤大小）分期和化疗，这些因素均纳入列线图。C指数为0.70（95%CI，0.66 - 0.75），在统计学上高于国际妇产科联盟（FIGO）分期系统（0.58；95%CI，0.53 - 0.63）。ROC曲线分析还显示，列线图具有良好的辨别力，1年、3年和5年生存的曲线下面积（AUC）分别为0.74、0.62和0.71。校准曲线显示列线图预测与实际观察结果之间具有良好的一致性。进一步使用风险分层模型将患者分为低风险或高风险组。低风险组和高风险组的中位OS时间分别为13.0个月（95%CI，9.33 - 16.67）和2.0个月（95%CI，1.12 - 2.89）。手术在两组中均未显著延长生存期[低风险组：风险比（HR），0.69；95%CI，0.45 - 1.07；P = 0.09；高风险组：HR，0.55；95%CI，0.46 - 0.67；P = 0.18]。
所提出的列线图和风险分层模型对POSRCC显示出准确的预后预测。这些方法可改善对POSRCC患者生存的个体化评估和治疗决策。
