Nomogram-based prognostic stratification for resectable gastric signet-ring cell carcinoma and adenocarcinoma: A retrospective cohort study

doi:10.4251/wjgo.v17.i5.106244

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May 15, 2025 (publication date) through May 15, 2025

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Oncol. May 15, 2025; 17(5): 106244
Published online May 15, 2025. doi: 10.4251/wjgo.v17.i5.106244

Table 1 Patients and tumors’ clinical and pathological characteristics before and after propensity score matching, n (%)

Variable	All patients		P value	Matched patients		P value
Variable	GA (n = 2151)	GSRCC (n = 886)	P value	GA (n = 761)	GSRCC (n = 761)	P value
Age (year)			< 0.001			0.382
< 60	939 (43.65)	540 (60.95)		404 (53.09)	422 (55.45)
≥ 60	1212 (56.35)	346 (39.05)		357 (46.91)	339 (44.55)
Gender			< 0.001			0.510
Male	1717 (79.82)	576 (65.01)		524 (68.86)	511 (67.15)
Female	434 (20.18)	310 (34.99)		237 (31.14)	250 (32.85)
BMI (kg/m²)			0.347			0.644
< 24	1099 (51.09)	470 (53.05)		407 (53.48)	397 (52.17)
≥ 24	1052 (48.91)	416 (46.95)		354 (46.52)	364 (47.83)
Comorbidity (yes)	906 (42.12)	341 (38.49)	0.070	332 (43.63)	306 (40.21)	0.194
Smoking history (yes)	1099 (51.09)	369 (41.65)	< 0.001	342 (44.94)	322 (42.31)	0.326
Drinking history (yes)	1010 (46.95)	383 (43.23)	0.067	334 (43.89)	335 (44.02)	1.000
Tumor location			< 0.001			0.449
Upper	859 (39.93)	171 (19.30)		190 (24.97)	171 (22.47)
Middle	411 (19.11)	231 (26.07)		183 (24.05)	208 (27.33)
Lower	841 (39.10)	443 (50.00)		357 (46.91)	351 (46.12)
More than two position or total	40 (1.86)	41 (4.63)		31 (4.07)	31 (4.07)
Differentiation			< 0.001			0.932
Poor	784 (36.45)	717 (80.93)		598 (78.58)	592 (77.79)
Moderate	1228 (57.09)	167 (18.85)		161 (21.16)	167 (21.94)
Well	139 (6.46)	2 (0.23)		2 (0.26)	2 (0.26)
Size (cm)			< 0.001			0.196
1 < 4	904 (42.03)	435 (49.10)		319 (41.92)	345 (45.34)
2 ≥ 4	1247 (57.97)	451 (50.90)		442 (58.08)	416 (54.66)
Perineural invasion (yes)	1039 (48.30)	424 (47.86)	0.854	418 (54.93)	412 (54.14)	0.797
Vascular invasion (yes)	867 (40.31)	328 (37.02)	0.100	335 (44.02)	315 (41.39)	0.325
pT stage			< 0.001			0.955
T1	510 (23.71)	303 (34.20)		198 (26.02)	198 (26.02)
T2	309 (14.37)	107 (12.08)		99 (13.01)	100 (13.14)
T3	728 (33.84)	182 (20.54)		173 (22.73)	181 (23.78)
T4a/4b	604 (28.08)	294 (33.18)		291 (38.24)	282 (37.06)
pN stage			< 0.001			0.723
N0	848 (39.42)	377 (42.55)		264 (34.69)	275 (36.14)
N1	367 (17.06)	100 (11.29)		86 (11.30)	96 (12.61)
N2	375 (17.43)	145 (16.37)		144 (18.92)	136 (17.87)
N3	561 (26.08)	264 (29.80)		267 (35.09)	254 (33.38)
pTNM stage			< 0.001			0.115
I	632 (29.38)	317 (35.78)		219 (28.78)	213 (27.99)
II	558 (25.94)	175 (19.75)		135 (17.74)	167 (21.94)
III	961 (44.68)	394 (44.47)		407 (53.48)	381 (50.07)
Adjuvant chemotherapy (yes)	747 (34.73)	304 (34.31)	0.859	310 (40.74)	291 (38.24)	0.345

BMI: Body mass index; GA: Gastric adenocarcinoma; GSRCC: Gastric signet ring cell carcinoma; pTNM: Post-treatment nodal margin.

Table 2 Univariate and multivariate analysis of overall survival after propensity score matching

Variable	Univariate analyses			Multivariate analysis
Variable	HR	95%CI	P value	HR	95%CI	P value
Subtype
GA	Ref.			Ref.
GSRCC	1.601	0.973-2.635	0.064	1.112	0.916-1.349	0.282
Age (year)
< 60	Ref.			Ref.
≥ 60	1.391	1.148-1.685	0.001	1.330	1.094-1.617	0.004
Gender
Male	Ref.
Female	0.94	0.764-1.156	0.556
BMI (kg/m²)
< 24	Ref.
≥ 24	0.715	0.733-1.078	0.232
Smoking history
Yes	Ref.
No	0.938	0.733-1.137	0.514
Drinking history
Yes	Ref.
No	1.039	0.856-1.261	0.698
Tumor location
Upper	Ref.
Middle	0.559	0.427-0.732	< 0.001
Lower	0.585	0.464-0.737	< 0.001
More than two position or total	1.964	1.363-2.83	< 0.001
Poor differentiation
Yes	Ref.			Ref.
No	0.628	0.482-0.818	0.001	0.766	0.584-0.999	0.049
Size (cm)
< 4	Ref.			Ref.
≥ 4	2.714	2.172-3.390	< 0.001	1.376	1.088-1.739	0.008
Perineural invasion
Yes	Ref.
No	0.441	0.358-0.542	< 0.001
Vascular invasion
Yes	Ref.			Ref.
No	0.402	0.330-0.489	< 0.001	0.744	0.606-0.915	0.005
pTNM stage
I	Ref.		< 0.001	Ref.
II	2.805	1.701-4.628		2.498	1.499-4.164	< 0.001
III	10.631	6.97-16.215		8.004	5.065-12.648	< 0.001
Adjuvant chemotherapy
Yes	Ref.			Ref.
No	1.169	1.022-1.338	0.023	1.123	0.922-1.368	0.250

BMI: Body mass index; GA: Gastric adenocarcinoma; GSRCC: Gastric signet ring cell carcinoma; pTNM: Post-treatment nodal margin; HR: Hazard ratio; CI: Confidence interval.

Table 3 Coefficients for least absolute shrinkage and selection operator survival regression with lambda values

Variable	Lambda
Subtype	0.0609
Age	0.2521
Poor differentiation	-0.2036
Size	0.2898
Vascular invasion	-0.2725
pTNM stage	0.9118
Adjuvant chemotherapy	0.0756
Perineural invasion	0
Tumor location	0

pTNM: Post-treatment nodal margin.

Citation: 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
URL: https://www.wjgnet.com/1948-5204/full/v17/i5/106244.htm
DOI: https://dx.doi.org/10.4251/wjgo.v17.i5.106244