Epidemiology and prognostic nomogram for locally advanced gastric signet ring cell carcinoma: A population-based study

Figure 1 Steps involved in developing the models and a flowchart outlining the study procedure. GSRC: Gastric signet ring cell carcinoma; LAGSRC: Locally advanced gastric signet ring cell carcinoma; AUC: Area under the receiver operating characteristic curve; DCA: Decision curve analysis.

Figure 2 Joinpoint analysis of the incidence of gastric signet ring cell carcinoma and gastric adenocarcinoma. A: Overall gastric signet ring cell carcinoma (GSRC); B: Overall gastric adenocarcinoma (GA); C: GSRC by sex; D: GA by sex. ¹Indicates that the annual percentage change (APC) is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 2 Joinpoints. ²Indicates that the APC is significantly different from zero at the alpha = 0.05 level. Final Selected Model: Male -2 Joinpoints, Female - 2 Joinpoints. Rejected Parallelism. APC: Annual percentage change.

Figure 3 Joinpoint analysis of the incidence of gastric signet ring cell carcinoma and gastric adenocarcinoma by age. A: Age < 60 years with gastric signet ring cell carcinoma (GSRC); B: Age < 60 years with gastric adenocarcinoma (GA); C: Age 60-69 years with GSRC; D: Age 60-69 years with GA; E: Age > 70 years with GSRC; F: Age > 70 years with GA. ¹Indicates that the annual percentage change (APC) is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 2 Joinpoints. ²Indicates that the APC is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 1 Joinpoints. APC: Annual percentage change.

Figure 4 Joinpoint analysis of the incidence-based mortality of gastric signet ring cell carcinoma and gastric adenocarcinoma. A: Overall gastric signet ring cell carcinoma (GSRC); B: Overall gastric adenocarcinoma (GA); C: GSRC by sex; D: GA by sex. ¹Indicates that the annual percentage change (APC) is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 2 Joinpoints. ²Indicates that the APC is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 3 Joinpoints. ³Indicates that the APC is significantly different from zero at the alpha = 0.05 level. Final Selected Model: Male - 2 Joinpoints, Female - 2 Joinpoints, failed to reject Parallelism. APC: Annual percentage change.

Figure 5 Joinpoint analysis of the incidence-based mortality of gastric signet ring cell carcinoma and gastric adenocarcinoma by age. A: Age < 60 years with GSRC; B: Age < 60 years with GA; C: Age 60-69 years with gastric signet ring cell carcinoma (GSRC); D: Age 60-69 years with GA; E: Age > 70 years with GSRC; F: Age > 70 years with GA. ¹Indicates that the annual percentage change (APC) is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 1 Joinpoints. ²Indicates that the APC is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 3 Joinpoints. ³Indicates that the APC is significantly different from zero at the alpha = 0.05 level. Final Selected Model: 2 Joinpoints. APC: Annual percentage change.

Figure 6 Kaplan-Meier estimate of cancer-specific survival by pathologic stage. A: Overall; B: Stage I; C: Stage II; D: Stage III.

Figure 7 Kaplan-Meier estimate of overall survival by pathologic stage. A: Overall; B: Stage I; C: Stage II; D: Stage III.

Figure 8 Multivariable-adjusted adjuvant chemotherapy hazard ratio trend for gastric signet ring cell carcinoma by year of diagnosis. A: Cancer-specific survival; B: Overall survival. HR: Hazard ratios; 95%CI: 95% confidence interval.

Figure 9 Forest plot for subgroup analysis of the impact of adjuvant chemotherapy. A: Cancer-specific survival; B: Overall survival. HR: Hazard ratios; 95%CI: 95% confidence interval.

Figure 10  Nomogram for 1-, 3-, and 5-year overall survival of patients with locally advanced gastric signet ring cell carcinoma. ¹P < 0.05; ²P < 0.01; ³P < 0.001.

Figure 11  Validation of the nomogram's training set. A: Receiver operating characteristic curves for 1-, 3- and 5-year overall survival (OS) in the training set; B: Calibration curves for 1-, 3- and 5-year OS in the training set; C: Decision curves of the nomogram for predicting 1-, 3- and 5-year OS in the training set. AUC: Area under the receiver operating characteristic curve; OS: Overall survival; TP: True positive rate; FP: False positive rate.

Figure 12  Validation of the nomogram's test set. A: Receiver operating characteristic curves for 1-, 3- and 5-year overall survival (OS) in the test set; B: Calibration curves for 1-, 3- and 5-year OS in the test set; C: Decision curves of the nomogram for predicting 1-, 3- and 5-year OS in the test set. AUC: Area under the receiver operating characteristic curve; OS: Overall survival; TP: True positive rate; FP: False positive rate.

Figure 13  Comparison of area under the receiver operating characteristic curves for the nomogram and pathological staging using time-dependent receiver operating characteristic curves. A: In the training set; B: In the test set. Kaplan–Meier survival curves of the high-risk, middle-risk and low-risk groups; C: In the training set; D: In the test set.

Figure 14  Kaplan-Meier survival curves of patients in the high-risk, middle-risk and low-risk locally advanced gastric signet ring cell carcinoma groups diagnosed between 2018 and 2019.