Yu Chengqing, Yang Jian, Li Haoran, Wang Jie, Jin Kanghui, Li Yifan, Zhang Zixiang, Zhou Jian, Tang Yuchen
Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.
Front Oncol. 2024 Oct 21;14:1473798. doi: 10.3389/fonc.2024.1473798. eCollection 2024.
In recent years, the overall incidence of gastric cancer has decreased. However, the incidence of gastric signet ring cell carcinoma (SRCC) is still increasing year by year. Compared with other subtypes (non-SRCC) such as adenocarcinoma, SRCC usually exhibits a more aggressive biological behavior. Therefore, studying the prognostic differences and factors associated with SRCC is essential to improve the accuracy of diagnosis and prognosis. The purpose of this study was to investigate the prognostic factors influencing the prognosis of patients with SRCC and to develop personalized treatments for different subgroups of patients.
The data on gastric SRCC patients and gastric adenocarcinoma (AC) patients from 1992 to 2020 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The data of gastric SRCC as the external validation group was reviewed from the First Affiliated Hospital of Soochow University. The overall survival (OS) and cancer specific survival (CSS) at 1 and 2 years were predicted for SRCC patients by constructing prognostic nomograms. A series of validation methods, including Akaike information criterion (AIC), decision curve analysis (DCA), calibration curve analysis, the concordance index (C-index) and the area under the receiver operating characteristic (AUC) curve, were used to verify the accuracy and reliability of the models.
In all, 549 patients with SRCC were included after propensity score matching (PSM). Multivariate Cox regression analysis showed that T stage, N stage, M stage and surgical approach were independent risk factors affecting the prognosis of SRCC patients. A prognostic nomogram was constructed and validated as an accurate model for SRCC patients after scoring by receiver operating characteristic curve (ROC) curves and calibration plots. The patients were further divided into high-risk and low-risk groups, and the Kaplan-Meier curves showed that SRCC patients in the low-risk group could receive only surgery without chemotherapy, while chemotherapy plus surgery was a better option for SRCC patients in the high-risk group.
The prognosis for SRCC was less favorable than that of AC in terms of CSS. The nomograms were developed and validated to predict OS and CSS in patients with SRCC, helping in developing appropriate individualized treatment schedules.
近年来，胃癌的总体发病率有所下降。然而，胃印戒细胞癌（SRCC）的发病率仍在逐年上升。与腺癌等其他亚型（非SRCC）相比，SRCC通常表现出更具侵袭性的生物学行为。因此，研究与SRCC相关的预后差异和因素对于提高诊断和预后的准确性至关重要。本研究的目的是探讨影响SRCC患者预后的因素，并为不同亚组患者制定个性化治疗方案。
从监测、流行病学和最终结果（SEER）数据库中获取1992年至2020年胃SRCC患者和胃腺癌（AC）患者的数据。从苏州大学附属第一医院回顾性分析胃SRCC数据作为外部验证组。通过构建预后列线图预测SRCC患者1年和2年的总生存期（OS）和癌症特异性生存期（CSS）。采用一系列验证方法，包括赤池信息准则（AIC）、决策曲线分析（DCA）、校准曲线分析、一致性指数（C-index）和受试者操作特征（AUC）曲线下面积，以验证模型的准确性和可靠性。
经过倾向评分匹配（PSM）后，共纳入549例SRCC患者。多因素Cox回归分析显示，T分期、N分期、M分期和手术方式是影响SRCC患者预后的独立危险因素。构建了预后列线图，并通过受试者操作特征曲线（ROC）曲线和校准图评分后验证为SRCC患者的准确模型。患者进一步分为高风险组和低风险组，Kaplan-Meier曲线显示，低风险组的SRCC患者仅接受手术无需化疗，而高风险组的SRCC患者化疗加手术是更好的选择。
就CSS而言，SRCC的预后不如AC。开发并验证了列线图以预测SRCC患者的OS和CSS，有助于制定适当的个体化治疗方案。
