Wang Cenzhu, Fang Ying, Zhang Yuhan, Feng Shuhan, Hou Rui, Fan Hanfang, Wang Zeyu, Liu Lei, Ding Junli, Xu Junying
Department of Oncology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China.
Department of Chemotherapy, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China.
Front Mol Biosci. 2025 May 14;12:1600626. doi: 10.3389/fmolb.2025.1600626. eCollection 2025.
Gastric cancer is a serious human chronic disease. The gastric signet ring cell carcinoma (GSRCC) is the most-dangerous subtype with several acute complications, including gastrointestinal hemorrhage, gastric perforation, pyloric obstruction and so on. This study aimed to compare the predictive efficiency of positive lymph nodes (PLN) and log odds of positive lymph nodes (LODDS) for survival and to establish a LODDS-based nomogram model in stage III-IV GSRCC.
Stage III-IV GSRCC patients were acquired between 2015 and 2019 from SEER dataset and the affiliated Yixing hospital of jiangsu university, serving as training and validation datasets respectively. The X-tile software was used to identify cut-off values while their relationship with clinical features was explored by chi-square test. The Kaplan-Meier analysis was applied for survival curve while cox regression analysis was performed for independent risk factors. The nomogram model was built with ROC and calibration curves for verification.
A total of 585 stage III-IV GSRCC patients were included in this study with 536 patients for training and 49 patients for validation. The LODDS showed better predictive efficiency for overall survival (OS) and cancer-specific survival (CSS) than PLN. The LODDS, M stage and chemotherapy status were independent factors for both OS and CSS, with LODDS contribution accounting for 31.47% in OS and 30.39% in CSS. A LODDS-based nomogram was built with accurate efficiency in stage III-IV GSRCC. The 1-year, 2-year, 3-year OS area under curve (AUC) values were 0.755, 0.795, 0.759 for internal and 0.776, 0.756, 0.816 for external verification while 1-year, 2-year, 3-year CSS AUC values were 0.745, 0.803, 0.770 for internal and 0.796, 0.762, 0.820 for external verification.
LODDS is an independent risk factor in stage III-IV GSRCC. The LODDS-based nomogram model showed excellent predictive efficiency, providing a novel insight for early diagnosis and precise therapies of stage III-IV GSRCC.
胃癌是一种严重的人类慢性疾病。胃印戒细胞癌（GSRCC）是最危险的亚型，伴有多种急性并发症，包括胃肠道出血、胃穿孔、幽门梗阻等。本研究旨在比较阳性淋巴结（PLN）和阳性淋巴结对数比值（LODDS）对生存的预测效率，并在Ⅲ-Ⅳ期GSRCC中建立基于LODDS的列线图模型。
2015年至2019年期间从SEER数据集和江苏大学附属宜兴医院获取Ⅲ-Ⅳ期GSRCC患者，分别作为训练集和验证集。使用X-tile软件确定临界值，同时通过卡方检验探索其与临床特征的关系。采用Kaplan-Meier分析绘制生存曲线，通过Cox回归分析确定独立危险因素。使用ROC曲线和校准曲线构建列线图模型进行验证。
本研究共纳入585例Ⅲ-Ⅳ期GSRCC患者，其中536例用于训练，49例用于验证。与PLN相比，LODDS对总生存（OS）和癌症特异性生存（CSS）显示出更好的预测效率。LODDS、M分期和化疗状态是OS和CSS的独立因素，LODDS在OS中的贡献率为31.47%，在CSS中的贡献率为30.39%。在Ⅲ-Ⅳ期GSRCC中建立了基于LODDS的列线图，具有准确的预测效率。内部验证的1年、2年、3年OS曲线下面积（AUC）值分别为0.755、0.795、0.759，外部验证分别为0.776、0.756、0.816；内部验证的1年、2年、3年CSS AUC值分别为0.745、0.803、0.770，外部验证分别为0.796、0.762、0.820。
LODDS是Ⅲ-Ⅳ期GSRCC的独立危险因素。基于LODDS的列线图模型显示出优异的预测效率，为Ⅲ-Ⅳ期GSRCC的早期诊断和精准治疗提供了新的见解。
