Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
Department of Gastroenterology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China.
World J Gastroenterol. 2023 Jun 28;29(24):3807-3824. doi: 10.3748/wjg.v29.i24.3807.
Signet-ring cell carcinoma (SRCC) was previously thought to have a worse prognosis than other differentiated gastric cancer (GC), however, recent studies have shown that the prognosis of SRCC is related to pathological type. We hypothesize that patients with SRCC and with different SRCC pathological components have different probability of lymph node metastasis (LNM).
To establish models to predict LNM in early GC (EGC), including early gastric SRCC.
Clinical data from EGC patients who had undergone gastrectomy at the First Affiliated Hospital of Nanjing Medical University from January 2012 to March 2022 were reviewed. The patients were divided into three groups based on type: Pure SRCC, mixed SRCC, and non-signet ring cell carcinoma (NSRC). The risk factors were identified through statistical tests using SPSS 23.0, R, and Em-powerStats software.
A total of 1922 subjects with EGC were enrolled in this study, and included 249 SRCC patients and 1673 NSRC patients, while 278 of the patients (14.46%) presented with LNM. Multivariable analysis showed that gender, tumor size, depth of invasion, lymphovascular invasion, ulceration, and histological subtype were independent risk factors for LNM in EGC. Establishment and analysis using prediction models of EGC showed that the artificial neural network model was better than the logistic regression model in terms of sensitivity and accuracy (98.0% 58.1%, = 0.034; 88.4% 86.8%, < 0.001, respectively). Among the 249 SRCC patients, LNM was more common in mixed (35.06%) rather than in pure SRCC (8.42%, < 0.001). The area under the ROC curve of the logistic regression model for LNM in SRCC was 0.760 (95%CI: 0.682-0.843), while the area under the operating characteristic curve of the internal validation set was 0.734 (95%CI: 0.643-0.826). The subgroups analysis of pure types showed that LNM was more common in patients with a tumor size > 2 cm (OR = 5.422, = 0.038).
A validated prediction model was developed to recognize the risk of LNM in EGC and early gastric SRCC, which can aid in pre-surgical decision making of the best method of treatment for patients.
先前认为印戒细胞癌 (SRCC) 的预后比其他分化型胃癌 (GC) 差，但最近的研究表明，SRCC 的预后与病理类型有关。我们假设 SRCC 患者和具有不同 SRCC 病理成分的患者具有不同的淋巴结转移 (LNM) 概率。
建立预测早期胃癌 (EGC) 中 LNM 的模型，包括早期胃 SRCC。
回顾 2012 年 1 月至 2022 年 3 月在南京医科大学第一附属医院接受胃切除术的 EGC 患者的临床资料。根据类型将患者分为三组：纯 SRCC、混合 SRCC 和非印戒细胞癌 (NSRC)。使用 SPSS 23.0、R 和 Em-powerStats 软件通过统计检验识别危险因素。
本研究共纳入 1922 例 EGC 患者，其中 249 例为 SRCC 患者，1673 例为 NSRC 患者，278 例患者 (14.46%) 存在 LNM。多变量分析显示，性别、肿瘤大小、浸润深度、脉管侵犯、溃疡和组织学亚型是 EGC 中 LNM 的独立危险因素。建立和分析 EGC 的预测模型显示，在敏感性和准确性方面，人工神经网络模型优于逻辑回归模型（98.0% vs 58.1%，=0.034；88.4% vs 86.8%，<0.001）。在 249 例 SRCC 患者中，混合性（35.06%）比纯 SRCC（8.42%，<0.001）更常见 LNM。SRCC 中 LNM 的逻辑回归模型的 ROC 曲线下面积为 0.760（95%CI：0.682-0.843），内部验证集的工作特征曲线下面积为 0.734（95%CI：0.643-0.826）。纯型亚组分析显示，肿瘤大小>2cm 的患者 LNM 更常见（OR=5.422，=0.038）。
验证了一种预测模型，用于识别 EGC 和早期胃 SRCC 中 LNM 的风险，这有助于为患者制定最佳治疗方法的术前决策。
