印戒细胞（SRC）的比例影响晚期胃癌根治术后的预后。
The percentages of signet-ring cells (SRCs) affects the prognosis after radical gastrectomy for advanced gastric cancer.
机构信息
The Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, 310053, Hangzhou, China.
Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Zhejiang, 310022, Hangzhou, China.
出版信息
Langenbecks Arch Surg. 2023 Sep 25;408(1):376. doi: 10.1007/s00423-023-03114-w.
PURPOSE
Only recently has the percentage of signet-ring cells (SRCs) been shown to affect the prognosis following gastric cancer surgery. It is uncertain whether the SRC percentage has a role in tumour biology or prognosis of gastric signet-ring cell carcinoma (GSRCC). For this research, we assessed the effect of the SRC percentage on the clinicopathological and prognostic characteristics of gastric cancer (GC) tumours and created and verified a prognostic nomogram to assess the overall survival (OS) of GSRCC patients.
METHODS
In our study, 1100 GC patients with signet-ring cell carcinoma (SRCC) at Zhejiang Cancer Hospital from December 2013 to December 2018 who underwent curative gastric cancer resection were retrospectively analysed. The patients were separated into two groups: those with SRCC (SRC percentage >50%; n = 157) and those with partial signet-ring cell carcinoma (PSRCC) (SRC percentage ≤50%; n = 943). We compared the clinicopathological characteristics of both groups. To estimate OS and determine correlations with the SRC percentage, the Kaplan-Meier method and log-rank test were used. To develop the prognostic nomogram, independent prognostic indicators for OS were identified using Cox regression analyses. Predictions were assessed using the calibration curve and C-index.
RESULTS
Our research showed that there was no discernible difference in OS between the two groups. The preoperative CA242 level, pT stage, pN stage, age, nerve invasion, neoadjuvant chemotherapy, postoperative chemotherapy, and maximum tumour diameter were independent prognostic risk factors for OS for GC (all p < 0.05). However, for advanced GC, the SRC percentage (HR = 1.571, 95% CI 1.072-2.302, p = 0.020) was an independent prognostic factor of OS. Other independent prognostic risk factors were age, pT stage, pN stage, nerve invasion, tumour location, neoadjuvant chemotherapy, postoperative chemotherapy, preoperative CA50 level, and preoperative CEA level (all p < 0.05). On these bases, nomograms were constructed for GC and advanced GC, with C-indexes of 0.806 (95%CI 0.782-0.830) and 0.728 (95%CI 0.697-0.759), respectively.
CONCLUSIONS
In cases of advanced gastric cancer, the SRC percentage served as a standalone prognostic indicator for OS. An effective tool for assessing the prognosis of GSRCC was offered by the nomogram.
目的
只有最近的研究表明，胃癌手术后的预后与印戒细胞（SRC）的百分比有关。目前还不确定 SRC 百分比是否在胃印戒细胞癌（GSRCC）的肿瘤生物学或预后中起作用。为此，我们评估了 SRC 百分比对胃癌（GC）肿瘤的临床病理和预后特征的影响，并建立和验证了一个预测总生存期（OS）的列线图，以评估 GSRCC 患者的整体生存率。
方法
本研究回顾性分析了 2013 年 12 月至 2018 年 12 月在浙江省肿瘤医院接受根治性胃癌切除术的 1100 例胃印戒细胞癌（SRCC）患者的临床资料。患者被分为两组：印戒细胞癌组（SRC 百分比＞50%；n=157）和部分印戒细胞癌组（SRC 百分比≤50%；n=943）。我们比较了两组的临床病理特征。使用 Kaplan-Meier 方法和对数秩检验比较 OS，并使用 Cox 回归分析确定与 SRC 百分比相关的独立预后因素。使用校准曲线和 C 指数评估预后列线图的预测能力。
结果
我们的研究表明，两组之间的 OS 无明显差异。术前 CA242 水平、pT 分期、pN 分期、年龄、神经侵犯、新辅助化疗、术后化疗和最大肿瘤直径是 GC 的独立预后危险因素（均 p＜0.05）。然而，对于晚期 GC，SRC 百分比（HR=1.571，95%CI 1.072-2.302，p=0.020）是 OS 的独立预后因素。其他独立的预后危险因素是年龄、pT 分期、pN 分期、神经侵犯、肿瘤位置、新辅助化疗、术后化疗、术前 CA50 水平和术前 CEA 水平（均 p＜0.05）。在此基础上，构建了 GC 和晚期 GC 的列线图，C 指数分别为 0.806（95%CI 0.782-0.830）和 0.728（95%CI 0.697-0.759）。
结论
在晚期胃癌中，SRC 百分比是 OS 的独立预后指标。该列线图为评估 GSRCC 患者的预后提供了一种有效工具。
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