Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2023; 29(24): 3807-3824
Published online Jun 28, 2023. doi: 10.3748/wjg.v29.i24.3807
Prediction of lymph node metastasis in early gastric signet-ring cell carcinoma: A real-world retrospective cohort study
Jia-Jia Yang, Xiao-Yong Wang, Rui Ma, Mei-Hong Chen, Guo-Xin Zhang, Xuan Li
Jia-Jia Yang, Mei-Hong Chen, Guo-Xin Zhang, Xuan Li, Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Xiao-Yong Wang, Department of Gastroenterology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
Rui Ma, Department of Nursing, Jiangsu Health Vocational College, Nanjing 211800, Jiangsu Province, China
Author contributions: Yang JJ, Wang XY, Ma R and Chen MH contributed equally to this work; Yang JJ and Wang XY designed the research study and performed the research; Ma R and Chen MH contributed new reagents and analytic tools; Yang JJ, Wang XY, Ma R and Chen MH analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Supported by National Natural Science Foundation of China, No. 82200625 and No. 82100595; Youth Talent Development Program, No. YNRCQN0313; Young Scholar Fostering Fund of the First Affiliated Hospital of Nanjing Medical University, No. PY2021023; Top Talent of Changzhou “The 14th Five-Year Plan” High-Level Health Talents Training Project, No. 2022CZBJ051; and Natural Science Foundation of Jiangsu Province, China, No. BK20210958.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Nanjing Medical University and the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University (Approval No. 2021KY311-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Xuan Li, PhD, Attending Doctor, Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. lixuan20091225@163.com
Received: February 2, 2023
Peer-review started: February 2, 2023
First decision: March 20, 2023
Revised: March 30, 2023
Accepted: May 16, 2023
Article in press: May 16, 2023
Published online: June 28, 2023
ARTICLE HIGHLIGHTS
Research background

Signet-ring cell carcinoma (SRCC) has shown discriminative biological characteristics compared with adenocarcinoma, and the behavior of SRCC in gastric cancer is controversial. In this study, we recognize the risk of lymph node metastasis (LNM) in early gastric SRCC, which can aid in pre-surgical decision making of the best method of treatment for patients.

Research motivation

At present the predictive probability of LNM has not been clearly defined, and the clinical diagnosis of gastric LNM in early gastric cancer (EGC) and early gastric SRCC is still challenging. Quantitative predictive models are beneficial for both clinicians and patients in making more objective decisions regarding treatment options.

Research objectives

We aimed to establish models to predict LNM in EGC, including early gastric SRCC, which can aid in pre-surgical decision making of the best method of treatment for patients.

Research methods

We examined the retrospective large-sample clinical information of patients who had undergone surgery, by comparing the clinicopathological features of patients with non-signet ring cell carcinoma and SRCC. Variables that are significantly associated with LNM were identified as candidate variables for the artificial neural network (ANN) model and multivariate logistic regression.

Research results

Our ANN and nomogram may serve as effective tools for predicting the incidence of LNM in Chinese patients with EGC, including early gastric SRCC, which may lead to improved selection of appropriate treatments methods.

Research conclusions

With respect to the risk factors for LNM in SRCC, our findings demonstrated that patients with a mixed type, submucosal invasion, and higher LVI are more likely to experience LNM. At the same time, we found that the mixed type was the only independent risk factor for LNM in patients with SRCC limited to the mucosa, which is consistent with the multivariable analysis of LNM in patients with mixed SRCC.

Research perspectives

Further multicenter, large-sample clinical and randomized controlled studies that can help establish additional risk factors for LNM in EGC or early gastric SRCC are still necessary.