Department of Oncology, The First Hospital of Hunan University of Chinese Medicine, Changsha, China.
First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
BMC Gastroenterol. 2023 Mar 9;23(1):62. doi: 10.1186/s12876-023-02650-5.
This study aimed to compare the incidence, clinicopathological characteristics and survival results of pancreatic signet ring cell carcinoma (PSRCC) and pancreatic adenocarcinomas (PDAC), as well as to analyze the clinical characteristics related to the overall survival (OS) of PSRCC, and to establish an effective prognostic nomogram to predict the risks associated with patient outcomes.
A total of 85,288 eligible patients including 425 PSRCC and 84,863 PDAC cases were retrieved from the Surveillance, Epidemiology, and End Results database. The survival curve was calculated using the Kaplan-Meier method and differences in them were measured by Log-rank tests. The Cox proportional hazards regression model was used to identify independent predictors of OS in patients with PSRCC. A nomogram was constructed to predict 1-, 3-, and 5-year OS. The performance of the nomogram was measured by C-index, receiver operating characteristic (ROC) curve, decision curve analysis (DCA).
The incidence of PSRCC is much lower than that of PDAC (10.798 V.S. 0.349 per millions). PSRCC is an independent predictor of pancreatic cancer with a poorer histological grade, a higher rate of lymph node and distant metastasis, and a poorer prognosis. We identified four independent prognostic factors including grade, American Joint Committee on Cancer Tumor-Node-Metastasis (TNM) stage, surgery and chemotherapy based on the Cox regression model. The C-index and DCA curves showed better performance of the nomogram than TNM stage. ROC curve analysis also showed that the nomogram had good discrimination, with an area under the curve of 0.840, 0.896, and 0.923 for 1-, 3-, and 5-year survival. The calibration curves showed good agreement between the prediction by the nomogram and actual observations.
PSRCC is a rare but fatal subtype of pancreatic cancer. The constructed nomogram in this study accurately predicted the prognosis of PSRCC, performed better than the TNM stage.
本研究旨在比较胰腺印戒细胞癌（PSRCC）和胰腺腺癌（PDAC）的发病率、临床病理特征和生存结果，分析与 PSRCC 总生存（OS）相关的临床特征，并建立有效的预后列线图来预测与患者结局相关的风险。
从监测、流行病学和最终结果（SEER）数据库中总共检索到 85288 名符合条件的患者，包括 425 例 PSRCC 和 84863 例 PDAC 病例。使用 Kaplan-Meier 方法计算生存曲线，对数秩检验测量它们之间的差异。使用 Cox 比例风险回归模型来确定 PSRCC 患者 OS 的独立预测因素。构建列线图来预测 1 年、3 年和 5 年 OS。通过 C 指数、受试者工作特征（ROC）曲线、决策曲线分析（DCA）来衡量列线图的性能。
PSRCC 的发病率远低于 PDAC（每百万人 10.798 例 VS. 0.349 例）。PSRCC 是胰腺癌症的独立预测因素，具有较差的组织学分级、更高的淋巴结和远处转移率以及更差的预后。我们根据 Cox 回归模型确定了四个独立的预后因素，包括分级、美国癌症联合委员会肿瘤-淋巴结-转移（TNM）分期、手术和化疗。C 指数和 DCA 曲线表明，该列线图的性能优于 TNM 分期。ROC 曲线分析也表明，该列线图具有良好的区分能力，1 年、3 年和 5 年生存率的曲线下面积分别为 0.840、0.896 和 0.923。校准曲线表明，该列线图的预测与实际观察之间具有良好的一致性。
PSRCC 是一种罕见但致命的胰腺癌症亚型。本研究构建的列线图准确预测了 PSRCC 的预后，性能优于 TNM 分期。
