Introduction: The objective of our study was to develop a nomogram to predict overall survival (OS) and cancer-specific survival (CSS) in patients with gastric signet ring cell carcinoma (GSRCC). Methods: A total of 3,408 GSRCC patients between 1975 and 2017 were screened from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation cohorts. Univariate and multivariate Cox analyses were conducted to identify independent prognostic factors for the construction of a nomogram. The performance of the model was then assessed by the concordance index (C-index), calibration plot, and area under the receiver operating characteristic curve (AUC). Then, the novel nomogram was further assessed by 64 GSRCC patients from our hospital as the external cohort. Results: We identified age, tumor lymph node metastasis (TNM) staging system, surgery, and chemotherapy as significant independent elements of prognosis. On this basis, a nomogram was constructed, with a C-index of OS in the training and validation cohorts of 0.763 (95% CI: 0.751–0.774) and 0.766 (95% CI: 0.748–0.784) and a C-index of CSS of 0.765 (95% CI: 0.753–0.777) and 0.773 (95% CI: 0.755–0.791), respectively. The AUCs of the nomogram for predicting 2- and 5-year OS were 0.848 and 0.885, respectively, and those for predicting CSS were 0.854 and 0.899, respectively, demonstrating the excellent predictive value of the constructed nomogram compared to the traditional AJCC staging system. Similar results were also observed in both the internal and external validation sets. Conclusion: The nomogram provided an accurate tool to predict OS and CSS in patients with GSRCC, which can assist clinicians in making predictions about individual patient survival.

1.
Chen
W
,
Zheng
R
,
Baade
PD
,
Zhang
S
,
Zeng
H
,
Bray
F
, et al
.
Cancer statistics in China, 2015
.
CA Cancer J Clin
.
2016
;
66
(
2
):
115
32
. .
2.
Siegel
RL
,
Miller
KD
,
Jemal
A
.
Cancer statistics, 2019
.
CA Cancer J Clin
.
2019
;
69
(
1
):
7
34
. .
3.
Piessen
G
,
Messager
M
,
Leteurtre
E
,
Jean-Pierre
T
,
Mariette
C
.
Signet ring cell histology is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of tumoral clinical presentation
.
Ann Surg
.
2009
;
250
(
6
):
878
87
. .
4.
Son
T
,
Sun
J
,
Choi
S
,
Cho
M
,
Kwon
IG
,
Kim
HI
, et al
.
Multi-institutional validation of the 8th AJCC TNM staging system for gastric cancer: analysis of survival data from high-volume Eastern centers and the SEER database
.
J Surg Oncol
.
2019
;
120
(
4
):
676
84
. .
5.
Chon
HJ
,
Hyung
WJ
,
Kim
C
,
Park
S
,
Kim
JH
,
Park
CH
, et al
.
Differential prognostic implications of gastric signet ring cell carcinoma: stage adjusted analysis from a single high-volume center in Asia
.
Ann Surg
.
2017
;
265
(
5
):
946
53
. .
6.
Bamboat
ZM
,
Tang
LH
,
Vinuela
E
,
Kuk
D
,
Gonen
M
,
Shah
MA
, et al
.
Stage-stratified prognosis of signet ring cell histology in patients undergoing curative resection for gastric adenocarcinoma
.
Ann Surg Oncol
.
2014
;
21
(
5
):
1678
85
. .
7.
Guo
J
,
Yu
J
,
Xu
Z
,
Sun
X
,
Zheng
J
.
The role of surgery in patients aged 85 years or older with resectable gastric cancer: a propensity score matching analysis of the SEER database
.
Scand J Gastroenterol
.
2020
;
55
(
6
):
694
700
. .
8.
Zhang
S
,
Liu
Y
,
Jiao
Z
,
Li
Z
,
Wang
J
,
Li
C
, et al
.
Development and validation of a prognostic nomogram for gastric signet ring cell carcinoma: a multicenter population-based study
.
Front Oncol
.
2021
;
11
:
603031
. .
9.
Smyth
EC
,
Nilsson
M
,
Grabsch
HI
,
van Grieken
NC
,
Lordick
F
.
Gastric cancer
.
Lancet
.
2020
;
396
(
10251
):
635
48
. .
10.
Zhang
C
,
Liu
R
,
Zhang
WH
,
Chen
XZ
,
Liu
K
,
Yang
K
, et al
.
Difference between signet ring cell gastric cancers and non-signet ring cell gastric cancers: a systematic review and meta-analysis
.
Front Oncol
.
2021
;
11
:
618477
. .
11.
Li
C
,
Kim
S
,
Lai
JF
,
Hyung
WJ
,
Choi
WH
,
Choi
SH
, et al
.
Advanced gastric carcinoma with signet ring cell histology
.
Oncology
.
2007
;
72
(
1–2
):
64
8
. .
12.
Kim
HW
,
Kim
JH
,
Lim
BJ
,
Kim
H
,
Kim
H
,
Park
JJ
, et al
.
Sex disparity in gastric cancer: female sex is a poor prognostic factor for advanced gastric cancer
.
Ann Surg Oncol
.
2016
;
23
(
13
):
4344
51
. .
13.
Guo
Q
,
Wang
Y
,
An
J
,
Wang
S
,
Dong
X
,
Zhao
H
.
A prognostic model for patients with gastric signet ring cell carcinoma
.
Technol Cancer Res Treat
.
2021
;
20
:
15330338211027912
. .
14.
Wei
Q
,
Gao
Y
,
Qi
C
,
Yuan
X
,
Li
J
,
Xu
Q
, et al
.
Clinicopathological characteristics and prognosis of signet ring gastric cancer: a population-based study
.
Front Oncol
.
2021
;
11
:
580545
. .
15.
Kao
YC
,
Fang
WL
,
Wang
RF
,
Li
AFY
,
Yang
MH
,
Wu
CW
, et al
.
Clinicopathological differences in signet ring cell adenocarcinoma between early and advanced gastric cancer
.
Gastric Cancer
.
2019
;
22
(
2
):
255
63
. .
16.
Wang
H
,
Peng
Y
,
Huang
Q
,
Wu
J
,
Zhang
M
.
Prognostic nomograms for nonelderly adults with gastric signet ring cell carcinoma
.
Biomed Res Int
.
2021
;
2021
:
1274527
. .
17.
Chen
L
,
Shi
Y
,
Yuan
J
,
Wu
Q
,
Han
Y
,
Qin
R
, et al
.
Evaluation of docetaxel- and oxaliplatin-based adjuvant chemotherapy in postgastrectomy gastric cancer patients reveals obvious survival benefits in docetaxel-treated mixed signet ring cell carcinoma patients
.
Med Oncol
.
2014
;
31
(
9
):
159
. .
18.
Shu
Y
,
Zhang
W
,
Hou
Q
,
Zhao
L
,
Zhang
S
,
Zhou
J
, et al
.
Prognostic significance of frequent CLDN18-ARHGAP26/6 fusion in gastric signet-ring cell cancer
.
Nat Commun
.
2018
;
9
(
1
):
2447
. .
19.
Li
Y
,
Ma
FH
,
Xue
LY
,
Tian
YT
.
Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: a retrospective, propensity score-matched study
.
World J Gastroenterol
.
2020
;
26
(
8
):
818
27
. .
20.
Heger
U
,
Sisic
L
,
Nienhuser
H
,
Blank
S
,
Hinz
U
,
Haag
GM
, et al
.
Neoadjuvant therapy improves outcomes in locally advanced signet-ring-cell containing esophagogastric adenocarcinomas
.
Ann Surg Oncol
.
2018
;
25
(
8
):
2418
27
. .
21.
Park
SH
,
Sohn
TS
,
Lee
J
,
Lim
DH
,
Hong
ME
,
Kim
KM
, et al
.
Phase III trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses
.
J Clin Oncol
.
2015
;
33
(
28
):
3130
6
. .
22.
Wei
F
,
Lyu
H
,
Wang
S
,
Chu
Y
,
Chen
F
.
Postoperative radiotherapy improves survival in gastric signet-ring cell carcinoma: a SEER database analysis
.
J Gastric Cancer
.
2019
;
19
(
4
):
393
407
. .
23.
Chen
CL
,
Xue
DX
,
Chen
HH
,
Liang
MZ
,
Lin
DZ
,
Yu
M
, et al
.
Nomograms to predict overall and cancer-specific survival in gastric signet-ring cell carcinoma
.
J Surg Res
.
2021
;
266
:
13
26
. .
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