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, 430022, China.
² Laboratory of Pediatric Hematology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
³ Department of Clinical Laboratory, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, China.
⁴ Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, 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 in the gastrointestinal tract (GI-SRCC).

Methods: Using the Surveillance Epidemiology and End Results (SEER) database, GI-SRCC patients who underwent surgery or received non-surgical 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 GI-SRCC patients. Nomogram was established to predict metastasis for GI-SRCC patients.

Results: The study enrolled a total of 9428 GI-SRCC patients, with 1689 patients in the non-surgery group and 7739 patients in the surgery group. Following 1:1 PSM, we analyzed 743 patients from each group. Our survival analyses revealed that surgery independently correlated with improved OS for GI-SRCC patients (HR = 0.37, 95% CI: 0.33-0.42, P < 0.001). Subgroup analysis further confirmed the positive impact of surgery on the prognosis of patients with non-metastatic GI-SRCC. Notably, distinct subsets of metastatic patients, particularly those originating from the upper GI (esophagus, proximal stomach, distal stomach) and left colon, demonstrated a significant improvement in OS post-surgery. However, no significant survival difference was observed for patients with metastatic right colon-SRCC and rectum-SRCC. Utilizing 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 (AUC) values of 0.829.

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

Keywords: SEER; Signet-ring cell carcinoma; overall survival; propensity score matching; surgery.