Using nomograms to predict prognostic factors in young colorectal mucinous and signet-ring cell adenocarcinoma patients

Abstract Due to insufficient quantitative evaluation of the clinic-pathological features and prognosis of young colorectal cancer (CRC) with mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRC), the aim of our study was to develop a nomogram to identify the prognostic predictors for overall survival (OS) in this patient population. We retrospectively evaluated the patient records of MAC and SRC patients aged ≤ 40 years. Kaplan–Meier analysis and log-rank testing were performed to estimate OS. A nomogram predicting OS was created for risk quantitation and decision tree analysis was performed for patient grouping. With a median follow-up of 36.5 months, we included a total of 90 young CRC patients for analysis. The overall cumulate 5-year OS rate was 57.7% (95% confidence interval (CI): 45.1–68.5%). The estimated 5-year OS was 62.9% (95% CI: 48.5–74.3%) for MAC and 37.3% (95% CI: 14.4–61.2%) for SRC (P=0.021). The recurrence rate was significantly greater in the SRC group compared with the mucinous group (52.4 compared with 26.1%, P=0.047). In the multivariate Cox regression model, preoperative carcinoembryonic antigen (CEA) levels and cycles of adjuvant chemotherapy (CT) were found to be an independent prognostic factor for OS (hazard ratio (HR): 2.43; 95% CI: 1.13–5.62, P=0.024; HR: 0.21; 95% CI: 0.083–0.57, P=0.002, respectively). Nomograms predicting 3- and 5-year OS were established that performed well (concordance index (c-indexes) of 0.636, 95% CI: 0.549–723) for OS. For MAC and SRC disease, a greater proportion of young patients present with advanced disease, and the prognosis for young SRC patients is poorer than MAC. Furthermore, preoperative CEA levels and cycles of adjuvant CT seem to independently affect the OS in this patient population.

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Primary Signet-Ring Cell Carcinoma of the Urinary Bladder Successfully Managed with Radical Cystectomy in a Young Patient

Case Reports in Urology ◽

10.1155/2017/9121078 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Farzad Allameh ◽

Morteza Fallah Karkan ◽

Yalda Nilipour ◽

Azadeh Rakhshan

Keyword(s):

Radical Cystectomy ◽

Gastrointestinal Endoscopy ◽

Signet Ring Cell Carcinoma ◽

Pelvic Lymphadenectomy ◽

Signet Ring Cell ◽

Signet Ring Cell Adenocarcinoma ◽

Signet Ring ◽

Poorly Differentiated ◽

Ring Cell

Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using “W” ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence.

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A Prognostic Model for Patients With Gastric Signet Ring Cell Carcinoma

Technology in Cancer Research & Treatment ◽

10.1177/15330338211027912 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110279

Author(s):

Qinping Guo ◽

Yinquan Wang ◽

Jie An ◽

Siben Wang ◽

Xiushan Dong ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Cox Regression ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Training Set ◽

Cox Regression Analysis ◽

Signet Ring ◽

Ring Cell ◽

Independent Risk Factors

Background: The aim of our study was to develop a nomogram model to predict overall survival (OS) and cancer-specific survival (CSS) in patients with gastric signet ring cell carcinoma (GSRC). Methods: GSRC patients from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to the training and validation sets. Multivariate Cox regression analyses screened for OS and CSS independent risk factors and nomograms were constructed. Results: A total of 7,149 eligible GSRC patients were identified, including 4,766 in the training set and 2,383 in the validation set. Multivariate Cox regression analysis showed that gender, marital status, race, AJCC stage, TNM stage, surgery and chemotherapy were independent risk factors for both OS and CSS. Based on the results of the multivariate Cox regression analysis, prognostic nomograms were constructed for OS and CSS. In the training set, the C-index was 0.754 (95% CI = 0.746-0.762) for the OS nomogram and 0.762 (95% CI: 0.753-0.771) for the CSS nomogram. In the internal validation, the C-index for the OS nomogram was 0.758 (95% CI: 0.746-0.770), while the C-index for the CSS nomogram was 0.762 (95% CI: 0.749-0.775). Compared with TNM stage and SEER stage, the nomogram had better predictive ability. In addition, the calibration curves also showed good consistency between the predicted and actual 3-year and 5-year OS and CSS. Conclusion: The nomogram can effectively predict OS and CSS in patients with GSRC, which may help clinicians to personalize prognostic assessments and clinical decisions.

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Anatomic Subsites and Prognosis of Gastric Signet Ring Cell Carcinoma: A SEER Population-based 1:1 Propensity-matched Study

10.21203/rs.3.rs-403278/v1 ◽

2021 ◽

Author(s):

Yangyang Xie ◽

Xue Song ◽

Haimin Jin ◽

Zhongkai Ni ◽

Xiaowen Li ◽

...

Keyword(s):

Cell Carcinoma ◽

Mortality Risk ◽

Cox Regression ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Survival Prediction ◽

Cancer Specific Survival ◽

Dismal Prognosis ◽

Signet Ring ◽

Ring Cell

Abstract Background: The dismal prognosis of gastric signet ring cell carcinoma (GSRC) is a global problem. The current study is conducted to comprehensively evaluate clinicopathological features and survival outcomes in GSRC patients stratified by anatomic subsites. Then predictive nomograms are constructed and validated to improve the effectiveness of personalized management.Method: The patients diagnosed with GSRC were recruited from the online SEER database. The influence of anatomic subsites on overall survival (OS) and cancer-specific survival (CSS) was evaluated using multivariate Cox regression and Kaplan-Meier analysis. Then we employed propensity score matching (PSM) technique to decrease selection bias and balance patients’ epidemiological factors. Predictive nomograms were constructed and validated.Results: Multivariate Cox regression demonstrated that the patients with overlapping gastric cancer (OGC) suffered the highest mortality risk for OS (HR, 1.29; 95%CI, 1.23-1.36; P<0.001) and CSS (HR, 1.33; 95%CI, 1.28-1.37; P<0.001). Age, TNM stage, tumor localization, tumor size, surgery and chemotherapy presented a highly significant relationship with OS and CSS. Following subgroup and PSM analysis, OGC patients were confirmed to have the worst OS and CSS. Then nomograms predicting 6 months, 12 months and 36 months OS and CSS were constructed. The calibration curves and reveiver operating characteristic curves demonstrated the great performance of the nomograms.Conclusion: We identified anatomic subsites as a predictor of survival in those with GSRC. Patients with OGC suffered the highest mortality risk. The proposed nomograms allowed a relatively accurate survival prediction for GSRC patients.

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Signet-ring Cell Carcinoma Derived from a Main Duct-type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Case Report with Long-term Follow-up

Internal Medicine ◽

10.2169/internalmedicine.9743-17 ◽

2018 ◽

Vol 57 (8) ◽

pp. 1093-1099 ◽

Cited By ~ 2

Author(s):

Toshitaka Sakai ◽

Shinsuke Koshita ◽

Kei Ito ◽

Yoshihide Kanno ◽

Takahisa Ogawa ◽

...

Keyword(s):

Case Report ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Main Duct ◽

Mucinous Neoplasm ◽

Signet Ring ◽

Long Term Follow Up ◽

Ring Cell

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A case of gastric signet-ring cell carcinoma with a long-term retrospective follow-up of 17 years

Clinical Journal of Gastroenterology ◽

10.1007/s12328-021-01443-1 ◽

2021 ◽

Author(s):

Junichi Muraishi ◽

Masaki Miyaoka ◽

Kentaro Imamura ◽

Kensei Ohtsu ◽

Takao Kanemitsu ◽

...

Keyword(s):

Cell Carcinoma ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Signet Ring ◽

Ring Cell

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Development and Validation of a Prognostic Nomogram for Gastric Signet Ring Cell Carcinoma: A Multicenter Population-Based Study

Frontiers in Oncology ◽

10.3389/fonc.2021.603031 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shuairan Zhang ◽

Yang Liu ◽

Zihan Jiao ◽

Zenan Li ◽

Jin Wang ◽

...

Keyword(s):

Prognostic Factors ◽

Staging System ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Seer Database ◽

Kaplan Meier ◽

Signet Ring ◽

Ajcc Staging System ◽

Ring Cell ◽

Ajcc Staging

BackgroundGastric signet ring cell carcinoma (GSRCC) is a rare disease associated with poor prognosis. A prognostic nomogram was developed and validated in this study to assess GSRCC patients’ overall survival (OS).MethodsPatients diagnosed with GSRCC from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016) and the First Hospital of China Medical University (CMU1h) were enrolled in this retrospective cohort study. Univariate and multivariate COX analysis was used to determine independent prognostic factors to construct the prognostic nomogram. Predictions were evaluated by the C-index and calibration curve. In addition, the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and Kaplan-Meier analysis were employed to assess the clinical utility of the survival prediction model.ResultsPatients were classified into two cohorts. We randomly divided patients in the SEER database and CMU1h cohort into a training group (n=3068, 80%) and a validation group (n=764, 20%). Age, race, T stage, N stage, M stage, therapy, and tumor size were significantly associated with the prognosis of GSRCC patients. On this basis, a nomogram was constructed, with a C-index in the training and the validation cohorts at 0.772 (95% CI: 0.762–0.782) and 0.774 (95% CI: 0.752–0.796), respectively. The accuracy of the generated nomogram was verified through calibration plots. Similarly, compared with the traditional AJCC staging system, the results of the area under curve (AUC) calculated by ROC, DCA, and Kaplan-Meier curves, demonstrated a good predictive value of the constructed nomogram, compared to the traditional AJCC staging system.ConclusionIn the present study, seven independent prognostic factors of GSRCC were screened out. The established nomogram models based on seven variables provided a visualization of each prognostic factor’s risk and assisted clinicians in predicting the 1-, 3-, and 5-year OS of GSRCC.

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Prognostic Nomograms for Nonelderly Adults with Gastric Signet Ring Cell Carcinoma

BioMed Research International ◽

10.1155/2021/1274527 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Hui Wang ◽

Yao Peng ◽

Qi Huang ◽

Jingjing Wu ◽

Mingjun Zhang

Keyword(s):

Cell Carcinoma ◽

Cox Regression ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Assessment Model ◽

Survival Prediction ◽

Cox Regression Analysis ◽

Calibration Curves ◽

Signet Ring ◽

Ring Cell

Background. Nomograms were established to predict the survival for gastric signet ring cell carcinoma (GSRC) in young and middle-aged adults. Material and Methods. Eligible patients with GSRC from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and then divided into a training and a testing cohort in proportion. Independent prognostic factors were picked by univariate and multivariate Cox regression analysis to set up nomograms. The predictive effect and clinical value of nomograms were evaluated by the concordance index (C-index), calibration curves, and receiver operating characteristic curve (ROC). Results. A total of 1686 GSRC patients were subsumed into this case for analysis, including a training ( n = 1180 ) and a testing cohort ( n = 506 ). Independent risk factors related to overall survival (OS) and cancer-specific survival (CSS) comprised of race, TNM stage, tumor size, number of positive lymph nodes (PLNE), and chemotherapy. For OS, the C-indexes of the training and testing cohorts were 0.737 and 0.752, while for CSS, C-indexes were, respectively, 0.749 and 0.751. These revealed that nomograms accurately predicted OS and CSS. Calibration curves and ROC demonstrated the apparent superiority of nomograms. Conclusion. We built a well-understood and comprehensive prognostic assessment model for GSRC, which provided an individualized survival prediction in the form of a quantitative score that can be considered for clinical practice.

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Primary colorectal signet-ring cell carcinoma in young patients: report of 3 cases

Pathology ◽

10.3109/00313028509063720 ◽

1985 ◽

Vol 17 (1) ◽

pp. 31-35 ◽

Cited By ~ 20

Author(s):

Irene O.L. Lui ◽

I.T.M. Kung ◽

J.M.H. Lee ◽

J.H. Boey

Keyword(s):

Cell Carcinoma ◽

Young Patients ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Signet Ring ◽

Ring Cell

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Signet Ring Cell Carcinoma of the Ampulla of Vater: A Rare Histopathological Variant

Case Reports in Gastroenterology ◽

10.1159/000488903 ◽

2018 ◽

Vol 12 (1) ◽

pp. 194-201 ◽

Cited By ~ 3

Author(s):

Guus W. de Klein ◽

Joop van Baarlen ◽

Leonie J. Mekenkamp ◽

Mike S.L. Liem ◽

Joost M. Klaase

Keyword(s):

Cell Carcinoma ◽

Immunohistochemical Staining ◽

Mixed Type ◽

Ampulla Of Vater ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Endoscopic Retrograde ◽

Signet Ring ◽

Ring Cell

Signet ring cell carcinoma (SRCC) of the ampulla of Vater is an extremely rare tumor. Our case describes a 45-year-old female presenting with jaundice and pruritus. Computed tomography, endoscopy, and endoscopic retrograde cholangiopancreatography showed a tumor of the ampulla of Vater without distant metastasis. Histological biopsy confirmed a malignant tumor with SRCC characteristics and immunohistochemical staining revealed a mixed type profile (both intestinal and pancreatobiliary characteristics). A pylorus-preserving pancreatoduodenectomy was performed and the patient recovered without complications. Pathology results concluded a pT2N0 ampullary SRCC. SRCC of the ampulla of Vater is known to be highly malignant. After 13 months of follow-up, our patient showed no signs of recurrence.

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Primary Signet-Ring Cell Adenocarcinoma of the Urinary Bladder Treated with Partial Cystectomy: A Case Report and Review of the Literature

Case Reports in Urology ◽

10.1155/2017/6829692 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Umesh Jayarajah ◽

D. M. Hilary Fernando ◽

Kasun Bandara Herath ◽

M. V. Chandu de Silva ◽

S. A. S. Goonewardena

Keyword(s):

Cell Carcinoma ◽

General Condition ◽

Bladder Tumour ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Partial Cystectomy ◽

Poor General Condition ◽

Signet Ring ◽

Ring Cell

Primary signet-ring cell carcinoma is a variant of adenocarcinoma which is extremely rare, associated with poor prognosis and generally found to be resistant to chemotherapy and radiotherapy. We report a case of primary signet-ring cell carcinoma of the bladder which was successfully treated with partial cystectomy. A 71-year-old female with a history of type 2 diabetes, hypertension, and ischaemic heart disease presented with painless haematuria for 2 months’ duration. The abdominal ultrasonography showed a localised polypoidal vesical growth arising from the bladder dome. Cystoscopy revealed an exophytic solid tumour in the anterior fundal wall. A deep transurethral resection of bladder tumour was done and histology revealed an adenocarcinoma composed of mucinous and signet-ring cell components. Later, considering the patient’s age and the poor general condition, a partial cystectomy was done. Follow-up cystoscopy and ultrasonography were done at 12 months and there was no evidence of tumour recurrence and the patient is currently symptom-free. Partial cystectomy may be considered in patients with localised tumour without evidence of metastasis and poor general condition. Regular cystoscopies and ultrasound imaging are necessary for follow-up and early identification of recurrences.

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