Scientometrics
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2021; 9(11): 2503-2518
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2503
Prognostic nomograms for predicting overall survival and cause-specific survival of signet ring cell carcinoma in colorectal cancer patients
Fu-Rong Kou, Yang-Zi Zhang, Wei-Ran Xu
Fu-Rong Kou, Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
Yang-Zi Zhang, Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
Wei-Ran Xu, Department of Oncology, Peking University International Hospital, Beijing 102206, China
Author contributions: Kou FR contributed to research design, data collection, interpretation, and analysis, and manuscript drafting; Zhang YZ contributed to data collection, interpretation, and analysis; Xu WR contributed to study design, data analysis, result interpretation, and critical revision of the manuscript; all authors approved the final version and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Ran Xu, MD, Doctor, Department of Oncology, Peking University International Hospital, Life Science Park of Zhongguancun, Changping District, Beijing 102206, China. xiaoyao444444@126.com
Received: December 7, 2020
Peer-review started: December 7, 2020
First decision: January 25, 2021
Revised: January 28, 2021
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: April 16, 2021
Processing time: 116 Days and 11.3 Hours
Abstract
BACKGROUND

Signet ring cell carcinoma (SRCC) is an uncommon subtype in colorectal cancer (CRC), with a short survival time. Therefore, it is imperative to establish a useful prognostic model. As a simple visual predictive tool, nomograms combining a quantification of all proven prognostic factors have been widely used for predicting the outcomes of patients with different cancers in recent years. Until now, there has been no nomogram to predict the outcome of CRC patients with SRCC.

AIM

To build effective nomograms for predicting overall survival (OS) and cause-specific survival (CSS) of CRC patients with SRCC.

METHODS

Data were extracted from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Multivariate Cox regression analyses were used to identify independent variables for both OS and CSS to construct the nomograms. Performance of the nomograms was assessed by concordance index, calibration curves, and receiver operating characteristic (ROC) curves. ROC curves were also utilized to compare benefits between the nomograms and the tumor-node-metastasis (TNM) staging system. Patients were classified as high-risk, moderate-risk, and low-risk groups using the novel nomograms. Kaplan-Meier curves were plotted to compare survival differences.

RESULTS

In total, 1230 patients were included. The concordance index of the nomograms for OS and CSS were 0.737 (95% confidence interval: 0.728-0.747) and 0.758 (95% confidence interval: 0.738-0.778), respectively. The calibration curves and ROC curves demonstrated good predictive accuracy. The 1-, 3-, and 5-year area under the curve values of the nomogram for predicting OS were 0.796, 0.825 and 0.819, in comparison to 0.743, 0.798, and 0.803 for the TNM staging system. In addition, the 1-, 3-, and 5-year area under the curve values of the nomogram for predicting CSS were 0.805, 0.847 and 0.863, in comparison to 0.740, 0.794, and 0.800 for the TNM staging system. Based on the novel nomograms, stratified analysis showed that the 5-year probability of survival in the high-risk, moderate-risk, and low-risk groups was 6.8%, 37.7%, and 67.0% for OS (P < 0.001), as well as 9.6%, 38.5%, and 67.6% for CSS (P < 0.001), respectively.

CONCLUSION

Convenient and visual nomograms were built and validated to accurately predict the OS and CSS rates for CRC patients with SRCC, which are superior to the conventional TNM staging system.

Keywords: Colorectal carcinoma; Signet ring cell carcinoma; Nomogram; Overall survival; Cause-specific survival; Prognosis

Core Tip: Using data from the Surveillance, Epidemiology, and End Results database between 2004 and 2015, convenient and visual nomograms were built and validated to accurately predict 1-, 3-, and 5-year overall survival and cause-specific survival rates for signet ring cell carcinoma in colorectal cancer patients for the first time. The novel nomograms stratified patients into high-risk, moderate-risk, and low-risk groups with 5-year probability survival of 6.8%, 37.7%, and 67.0% for overall survival (P < 0.001), as well as 9.6%, 38.5%, and 67.6% for cause-specific survival (P < 0.001), respectively. Besides, these nomograms were proved to be superior to the conventional tumor-node-metastasis staging system.