The effect of surgery and metastatic risk prediction in patients with gastrointestinal tract signet-ring cell carcinoma

Yanan Chu; Fei Long; Xueliang Ding; Shaobo Tian

doi:10.1016/j.gassur.2024.05.011

The effect of surgery and metastatic risk prediction in patients with gastrointestinal tract signet-ring cell carcinoma

J Gastrointest Surg. 2024 May 11:S1091-255X(24)00453-0. doi: 10.1016/j.gassur.2024.05.011. Online ahead of print.

Authors

Yanan Chu¹, Fei Long², Xueliang Ding³, Shaobo Tian⁴

Affiliations

¹ Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Laboratory of Pediatric Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department of Clinical Laboratory, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China.
⁴ Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: tianshaobogut@163.com.

PMID: 38740257
DOI: 10.1016/j.gassur.2024.05.011

Abstract

Purpose: This study aimed to assess the efficacy of surgery as a treatment option for patients with signet-ring cell carcinoma (SRCC) in the gastrointestinal tract (GI-SRCC).

Methods: Using the Surveillance, Epidemiology, and End Results database, patients with GI-SRCC who underwent surgery or received nonsurgical treatment were included. Propensity score matching (PSM) analysis was used to balance baseline characteristics and reduce bias. Overall survival (OS) was calculated in matching cohorts to estimate prognosis for patients with GI-SRCC. Nomogram was established to predict metastasis for patients with GI-SRCC.

Results: The study enrolled a total of 9428 patients with GI-SRCC, with 1689 patients in the nonsurgery group and 7739 patients in the surgery group. After 1:1 PSM, we analyzed 743 patients from each group. Our survival analyses revealed that surgery independently correlated with improved OS for patients with GI-SRCC (hazard ratio, 0.37; 95% CI, 0.33-0.42; P < .001). Subgroup analysis further confirmed the positive impact of surgery on the prognosis of patients with nonmetastatic GI-SRCC. Notably, distinct subsets of patients with metastasis, particularly those originating from the upper GI (esophagus, proximal stomach, and distal stomach) and left colon, demonstrated a significant improvement in OS after surgery. However, no significant survival difference was observed for patients with metastatic right colon and rectum SRCC. Using nomogram, we quantitatively assessed the risk of metastasis in patients with right colon and rectum SRCC, which exhibited robust predictive accuracy, with area under the curve values of 0.829.

Conclusion: Our study highlighted surgery's positive impact on prognosis for both patients with nonmetastatic and metastatic upper GI-SRCC and left colon SRCC. Hence, we recommend surgery as a treatment option for these groups. In addition, for patients with metastatic right colon and rectum SRCC ineligible for surgery, our predictive nomogram can offer a convenient tool to aid early intervention and improve prognosis.

Keywords: Overall survival; Propensity score matching; Signet-ring cell carcinoma; Surgery; Surveillance, Epidemiology, and End Results.