School of Life Science and Technology, Harbin Institute of Technology, Harbin, China.
Department of Oncology, Heilongjiang Provincial Hospital, Harbin, China.
BMC Gastroenterol. 2023 Aug 16;23(1):284. doi: 10.1186/s12876-023-02915-z.
The TNM staging system cannot accurately predict the prognosis of postoperative gastric signet ring cell carcinoma (GSRC) given its unique biological behavior, epidemiological features, and various prognostic factors. Therefore, a reliable postoperative prognostic evaluation system for GSRC is required. This study aimed to establish a nomogram to predict the overall survival (OS) rate of postoperative patients with GSRC and validate it in the real world.
Clinical data of postoperative patients with GSRC from 2002 to 2014 were collected from the Surveillance, Epidemiology, and End Results database and randomly assigned to training and internal validation sets at a 7:3 ratio. The external validation set used data from 124 postoperative patients with GSRC who were admitted to the Affiliated Tumor Hospital of Harbin Medical University between 2002 and 2014. The independent risk factors affecting OS were screened using univariate and multivariate analyses to construct a nomogram. The performance of the model was evaluated using the C-index, receiver operating characteristic curve (ROC), calibration curve, decision analysis (DCA) curve, and adjuvant chemotherapy decision analysis.
Univariate/multivariate analysis indicated that age, stage, T, M, regional nodes optimized (RNE), and lymph node metastasis rate (LNMR) were independent risk factors affecting prognosis. The C-indices of the training, internal validation, and external validation sets are 0.741, 0.741, and 0.786, respectively. The ROC curves for the first, third, and fifth years in three sets had higher areas under the curves, (training set, 0.782, 0.864, 0.883; internal validation set, 0.781, 0.863, 0.877; external validation set, 0.819, 0.863, 0.835). The calibration curve showed high consistency between the nomogram-predicted 1-, 3-, and 5-year OS and the actual OS in the three queues. The DCA curve indicated that applying the nomogram enhanced the net clinical benefits. The nomogram effectively distinguished patients in each subgroup into high- and low-risk groups. Adjuvant chemotherapy can significantly improve OS in high-risk group (P = 0.034), while the presence or absence of adjuvant chemotherapy in low-risk group has no significant impact on OS (P = 0.192).
The nomogram can effectively predict the OS of patients with GSRC and may help doctors make personalized prognostic judgments and clinical treatment decisions.
由于胃印戒细胞癌（GSRC）具有独特的生物学行为、流行病学特征和各种预后因素，TNM 分期系统无法准确预测其术后预后。因此，需要建立一种可靠的 GSRC 术后预后评估系统。本研究旨在建立一个预测 GSRC 术后患者总生存率（OS）的列线图，并在真实世界中进行验证。
从 2002 年至 2014 年，从监测、流行病学和最终结果（SEER）数据库中收集了 GSRC 术后患者的临床数据，并按 7:3 的比例随机分配到训练集和内部验证集中。外部验证集使用了 2002 年至 2014 年期间哈尔滨医科大学附属肿瘤医院收治的 124 例 GSRC 术后患者的数据。使用单因素和多因素分析筛选影响 OS 的独立危险因素，构建列线图。通过 C 指数、接受者操作特征曲线（ROC）、校准曲线、决策分析（DCA）曲线和辅助化疗决策分析评估模型的性能。
单因素/多因素分析表明，年龄、分期、T、M、区域淋巴结优化（RNE）和淋巴结转移率（LNMR）是影响预后的独立危险因素。训练集、内部验证集和外部验证集的 C 指数分别为 0.741、0.741 和 0.786。三组的 ROC 曲线在第一年、第三年和第五年的曲线下面积更高，（训练集，0.782、0.864、0.883；内部验证集，0.781、0.863、0.877；外部验证集，0.819、0.863、0.835）。校准曲线显示，列线图预测的 1 年、3 年和 5 年 OS 与三个队列中的实际 OS 具有较高的一致性。DCA 曲线表明应用列线图可显著提高净临床效益。列线图能够有效地将每个亚组的患者分为高风险组和低风险组。辅助化疗可显著提高高危组的 OS（P=0.034），而低危组是否接受辅助化疗对 OS 无显著影响（P=0.192）。
该列线图可有效预测 GSRC 患者的 OS，有助于医生做出个性化的预后判断和临床治疗决策。
