Abstract
Background
Gastric signet ring cell carcinoma (GSRCC) is a highly malignant subtype of gastric cancer. We tried to establish and validate a nomogram using common clinical variables to achieve more personalized management.
Methods
We analyzed patients with GSRCC in the Surveillance, Epidemiology, and End Results database between 2004 and 2017. The survival curve was calculated by the Kaplan–Meier method, and the difference in survival curve was tested by log-rank test. We used the cox proportional hazard model to evaluate independent factors of prognosis, and established a nomogram to predict 1-, 3- and 5- overall survival (OS). Harrell's consistency index and calibration curve were used to measure the discrimination and calibration of the nomogram. In addition, we used decision curve analysis (DCA) to compare the net clinical benefits of the nomogram and American Joint Committee on Cancer (AJCC) staging system.
Results
The prognosis nomogram predicting 1-, 3- and 5-years OS for patients with GSRCC is established for the first time. The C-index and AUC of nomogram were higher than that of the American Joint Committee on Cancer (AJCC) staging system in the training set. Our model also shows better performance than the AJCC staging system in the validation set, and importantly, DCA shows that our model has a better net benefit than the AJCC stage.
Conclusions
We have developed and validated a new nomogram and risk classification system, which is better than the AJCC staging system. It will help clinicians manage postoperative patients with GSRCC more accurately.
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Availability of data and materials
SEER Stat 8.39 software was used to extract our data online, and data in our study is available at SEER database: https://seer.cancer.gov/.
Abbreviations
- GSRCC:
-
Gastric signet ring cell carcinoma
- SEER:
-
Surveillance, Epidemiology, and End Results
- OS:
-
Overall survival
- RNE:
-
Regional nodes examined
- AJCC:
-
American Joint Committee on Cancer
- DCA:
-
Decision curve analysis
- NA:
-
Not available
- CI:
-
Confidence interval
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Acknowledgements
The authors would like to express their gratitude to SEER for providing free access to the database.
Funding
The study was supported by Key project of Hunan Provincial Health Commission (C202203108338), 2021 Hunan Clinical Medical Technology Innovation Guidance Project (2021SK51410), the scientific research fund of Guangdong EFONG Pharmaceutical Co., Ltd (2022YF10) and Graduate Student Innovation Project of Hunan University of Chinese Medicine (2022CX22).
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DR N and J L conceived and designed the study. DR N and GL A wrote the manuscript. DR N, H Z collected data and performed the statistical analysis. J L and DR N revised the manuscript. All authors read and approved the submitted version.
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Since the patient information in the SEER database is deidentified and publicly available, our study was exempt from Institutional Review Board approval. In addition, we declared all methods were carried out in accordance with relevant guidelines and regulations.
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Supplementary figure 1 The optimal cutoff values for age (A/B), number of regional lymph nodes examined (C/D), and tumor size (E/F) were shown by X-tile analysis
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Nie, D., Zheng, H., An, G. et al. Development and validation of a novel nomogram for postoperative overall survival of patients with primary gastric signet-ring cell carcinoma: a population study based on SEER database. J Cancer Res Clin Oncol 149, 8593–8603 (2023). https://doi.org/10.1007/s00432-023-04796-x
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DOI: https://doi.org/10.1007/s00432-023-04796-x