Abstract
ObjectiveOur aims were to establish novel nomogram models, which directly targeted patients with signet ring cell carcinoma (SRC), for individualized prediction of overall survival (OS) rate and cancer-specific survival (CSS).MethodsWe selected 1,365 SRC patients diagnosed from 2010 to 2015 from Surveillance, Epidemiology and End Results (SEER) database, and then randomly partitioned them into a training cohort and a validation cohort. Independent predicted indicators, which were identified by using univariate testing and multivariate analyses, were used to construct our prognostic nomogram models. Three methods, Harrell concordance index (C-index), receiver operating characteristics (ROC) curve and calibration curve, were used to assess the ability of discrimination and predictive accuracy. Integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision curve analysis (DCA) were used to assess clinical utility of our nomogram models.ResultsSix independent predicted indicators, age, race, log odds of positive lymph nodes (LODDS), T stage, M stage and tumor size, were associated with OS rate. Nevertheless, only five independent predicted indicators were associated with CSS except race. The developed nomograms based on those independent predicted factors showed reliable discrimination. C-index of our nomogram for OS and CSS was 0.760 and 0.763, which were higher than American Joint Committee on Cancer (AJCC) 8th edition tumor-node-metastasis (TNM) staging system (0.734 and 0.741, respectively). C-index of validation cohort for OS was 0.757 and for CSS was 0.773. The calibration curves also performed good consistency. IDI, NRI and DCA showed the nomograms for both OS and CSS had a comparable clinical utility than the TNM staging system.ConclusionsThe novel nomogram models based on LODDS provided satisfying predictive ability of SRC both in OS and CSS than AJCC 8th edition TNM staging system alone.
Highlights
Gastric cancer (GC) is a severe threat to human health, ranking fifth for most commonly diagnosed cancers and third for cancer mortality worldwide
The morbidity of GC has declined in recent years, some western studies demonstrated the morbidity of signet ring cell (SRC) carcinoma was still high [2]
Staging [0.741, P
Summary
Gastric cancer (GC) is a severe threat to human health, ranking fifth for most commonly diagnosed cancers and third for cancer mortality worldwide. East Asia, whereas a generally low incidence was observed in Northern America and North Europe [1]. The morbidity of GC has declined in recent years, some western studies demonstrated the morbidity of signet ring cell (SRC) carcinoma was still high [2]. According to the definition of World Health Organization (WHO), SRC was characterized as isolated or small groups of malignant www.cjcrcn.org. Chinese Journal of Cancer Research, Vol 32, No 6 December 2020 non-cohesive cells [3]. SRC was defined as an undifferentiated carcinoma by the Japanese Gastric Cancer Association and as a diffuse type by Lauren [4]
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