Hu HT, Wang P, Jiang YJ, Wang HK, Shao XX, Tian YT. Nomogram-based prognostic stratification for resectable gastric signet-ring cell carcinoma and adenocarcinoma: A retrospective cohort study. World J Gastrointest Oncol 2025; 17(5): 106244 [DOI: 10.4251/wjgo.v17.i5.106244]
Corresponding Author of This Article
Yan-Tao Tian, PhD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tyt67@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hai-Tao Hu, Peng Wang, Yu-Juan Jiang, Hai-Kuo Wang, Xin-Xin Shao, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Co-first authors: Hai-Tao Hu and Peng Wang.
Author contributions: Hu HT collected data and drafted the manuscript; Wang P performed the data analysis and revised the manuscript; Wang HK helped perform the analysis with constructive discussions; Jiang YJ and Shao XX contributed to manuscript preparation data for the work; Tian YT conceived the work that led to the submission and approved the final version; Hu HT and Wang P contribute equally to this work as co-first authors; All authors issued final approval for the version to be submitted.
Supported by the National Natural Science Foundation of China, No. 82473285; and Beijing Hope Run Special Fund of Cancer Foundation of China, No. LC2022B02.
Institutional review board statement: The Institutional Review Board of the Cancer Hospital, Chinese Academy of Medical Sciences (No. 14-067/857) granted ethical approval.
Informed consent statement: The Institutional Review Board waived the need for informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, PhD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tyt67@163.com
Received: February 20, 2025 Revised: March 2, 2025 Accepted: March 11, 2025 Published online: May 15, 2025 Processing time: 84 Days and 9.5 Hours
Abstract
BACKGROUND
Gastric signet-ring cell carcinoma (GSRCC) is a more aggressive subtype of gastric cancer compared to gastric adenocarcinoma (GA), with an increasing incidence. However, the prognostic differences between these subtypes, particularly in resectable cases, remain unclear.
AIM
To evaluate prognostic factors and develop a predictive model for GA and GSRCC patients undergoing curative resection.
METHODS
This retrospective cohort study included patients with GA and GSRCC who underwent curative surgery at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, from 2011 to 2018. Propensity score matching (PSM) (1:1) balanced the baseline characteristics. Prognostic factors were identified using univariate and multivariate Cox and least absolute shrinkage and selection operator (LASSO) regression analyses. Model performance was evaluated through calibration curves, decision curve analysis (DCA), and time-dependent receiver operating characteristic curves. Subgroup analysis and Kaplan-Meier survival curves were generated.
RESULTS
In a cohort of 3027 patients, the GSRCC group was characterized by a significantly higher prevalence of individuals under 60 years of age, females, cases with poor differentiation, and early-stage (stage I) disease (all P < 0.001). After PSM, the baseline was balanced and 761 patients were retained in each group. Variables identified through univariate Cox regression were included in the LASSO regression analysis. Multivariate Cox regression analysis identified age, tumor differentiation, tumor size, vascular invasion, and post-treatment nodal margin staging as independent prognostic factors. Subgroup analysis indicated a notably poorer prognosis for GSRCC in patients aged 60 and above (hazard ratio = 1.36, P = 0.025). The nomogram (C-index = 0.755) exhibited greater predictive accuracy than tumor node metastasis (TNM) staging for 1-, 3-, and 5-year overall survival (all P < 0.001), and provided a higher clinical net benefit according to DCA.
CONCLUSION
This study systematically compared resectable GA and GSRCC, revealing no overall survival difference. However, GSRCC demonstrated a significantly elevated mortality risk in subgroups stratified by age and tumor size. Multivariate analysis identified age, differentiation, tumor size, vascular invasion, and TNM stage as independent prognostic factors. The nomogram integrates clinicopathological features for precise risk stratification, surpassing traditional TNM staging.
Core Tip: This large-scale, retrospective cohort study compared prognostic outcomes of gastric adenocarcinoma and gastric signet-ring cell carcinoma (GSRCC) and revealed heterogeneous survival risks. While no overall survival difference was observed, GSRCC demonstrated significantly worse prognosis in age ≥ 60 years, size ≥ 4 cm, and poor differentiation. A new nomogram incorporating seven clinicopathological variables demonstrated greater accuracy than traditional tumor node metastasis staging in predicting 1-, 3-, and 5-year overall survival (P < 0.001). Key innovations include the application of least absolute shrinkage and selection operator regression to address multicollinearity and propensity score matching to minimize baseline bias. Integration of the model into clinical workflows could enable real-time risk stratification and guide personalized therapy for resectable gastric cancer.
