Hui Xin, Zhou Guangbo, Zheng Ya, Wang Yuping, Guo Qinghong
The First Clinical Medical College, Lanzhou University, Lanzhou, China.
Department of Gastroenterology, The First Hospital of Lanzhou University, No.1, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China.
Updates Surg. 2024 Dec;76(8):2813-2824. doi: 10.1007/s13304-024-02020-0. Epub 2024 Nov 4.
Gastric signet ring cell carcinoma (GSRC) is a rare malignancy without a commonly acknowledged prognostic assessment and treatment system. This study aimed to determine the optimal cut-off value of tumor size (TS), and construct a prognostic nomogram in combination with other independent prognostic factors (PFs) to predict 3 year and 5 year overall survival (OS) in GSRC patients. From the Surveillance, Epidemiology, and End Results (SEER) database, this study collected 4744 patients diagnosed with GSRC. These patients were randomized into a training cohort (n = 2320,) and a validation cohort (n = 1142). A restricted cubic spline (RCS) was used to determine the cut-off value for TS, and univariate and multivariate Cox regression analyses were performed in the training cohort to identified significant predictors. A prognostic nomogram was constructed to predict OS at 3 and 5 years. Concordance index (C index), receiver operating characteristics curve (ROC curve), area under curve (AUC), and calibration curve were used to test the predictive accuracy of the model. A non-linear relationship was observed between TS and the risk of OS in GSRC, with TS thresholds at 4.4 cm and 9.6 cm. Survival was significantly lower in GSRC patients with TS > 4.4 cm. Age, marriage, chemotherapy, surgery, TS, SEER stage, regional lymph node status, and total number were independent predictors of OS. The C index in the training cohort was 0.748, and the AUC values for both 3- and 5-year OS were higher than 0.80. Similar results were observed in the validation cohort. In addition, the calibration curves showed good agreement between the predicted 3 year and 5 year OS and the actual OS. TS is a key prognostic factor for patients with GSRC, and patients with a TS of 4.4-9.6 cm and > 9.6 cm may have a poorer prognosis than those with a TS of < 4.4 cm. The TS-stratified nomogram we constructed and validated has favorable accuracy and calibration precision, and may be helpful in predicting the survival rate of patients.
胃印戒细胞癌（GSRC）是一种罕见的恶性肿瘤，目前尚无公认的预后评估和治疗体系。本研究旨在确定肿瘤大小（TS）的最佳截断值，并结合其他独立预后因素（PFs）构建预后列线图，以预测GSRC患者的3年和5年总生存期（OS）。本研究从监测、流行病学和最终结果（SEER）数据库中收集了4744例诊断为GSRC的患者。这些患者被随机分为训练队列（n = 2320）和验证队列（n = 1142）。采用限制性立方样条（RCS）确定TS的截断值，并在训练队列中进行单因素和多因素Cox回归分析以识别显著预测因素。构建了一个预后列线图来预测3年和5年的OS。一致性指数（C指数）、受试者工作特征曲线（ROC曲线）、曲线下面积（AUC）和校准曲线用于检验模型的预测准确性。在GSRC中观察到TS与OS风险之间存在非线性关系，TS阈值分别为4.4 cm和9.6 cm。TS＞4.4 cm的GSRC患者生存率显著较低。年龄、婚姻状况、化疗、手术、TS、SEER分期、区域淋巴结状态和总数是OS的独立预测因素。训练队列中的C指数为0.748，3年和5年OS的AUC值均高于0.80。在验证队列中观察到类似结果。此外，校准曲线显示预测的3年和5年OS与实际OS之间具有良好的一致性。TS是GSRC患者的关键预后因素，TS为4.4 - 9.6 cm和＞9.6 cm的患者预后可能比TS＜4.4 cm的患者更差。我们构建并验证的TS分层列线图具有良好的准确性和校准精度，可能有助于预测患者的生存率。
