Purpose

Considering the poor prognosis and high lymph node (LN) involvement rate of colorectal signet ring cell carcinoma (SRCC), this study aimed to construct a prognostic nomogram to predict overall survival (OS) with satisfactory accuracy and utility, based on LN status indicators with superior predictability.

Methods

Using the Surveillance, Epidemiology, and End Results (SEER) database, we obtained cases of colorectal SRCC patients and employed univariate and multivariate Cox analyses to determine independent prognostic factors. Kaplan–Meier curves were utilized to visualize survival differences among these factors. Receiver operating characteristic curves were generated to assess predictive performances of models incorporating various LN status indicators. A novel nomogram, containing optimal LN status indicators and other prognostic factors, was developed to predict OS, whose discriminatory ability and accuracy were evaluated using calibration curves and decision curve analysis.

Results

A total of 1663 SRCC patients were screened from SEER database. Older patients and those with grades III–IV, tumor sizes > 39 mm, T3/T4 stage, N1/N2 stage, M1 stage, and higher log odds of positive lymph nodes (LODDS) values exhibited poorer prognoses. Age, grade, tumor size, TNM stage, and LODDS were independent prognostic factors. The model containing N stage and LODDS outperformed the one relying solely on N stage as LN status indicator, resulting in a validated nomogram for accurately predicting OS in SRCC patients.

Conclusion

The integration of LODDS, N stage, and other risk factors into a nomogram offered precise OS predictions, enhancing therapeutic decision-making and tailored follow-up management for colorectal SRCC patients.

中文翻译：

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用于预测结直肠印戒细胞癌患者总生存期的基于阳性淋巴结列线图的新对数赔率：一项基于 SEER 人群的研究

目的

考虑到结直肠印戒细胞癌（SRCC）的预后不良和淋巴结（LN）受累率高，本研究旨在基于LN状态指标和优越的可预测性。

方法

利用监测、流行病学和最终结果 (SEER) 数据库，我们获得了结直肠 SRCC 患者的病例，并采用单变量和多变量 Cox 分析来确定独立的预后因素。卡普兰-迈耶曲线用于可视化这些因素之间的生存差异。生成接受者操作特征曲线以评估包含各种 LN 状态指标的模型的预测性能。开发了一种包含最佳 LN 状态指标和其他预后因素的新型列线图来预测 OS，并使用校准曲线和决策曲线分析评估其区分能力和准确性。

结果

从 SEER 数据库中筛选出 1663 名 SRCC 患者。老年患者和 III-IV 级、肿瘤大小 > 39 mm、T3/T4 分期、N1/N2 分期、M1 分期以及阳性淋巴结对数比值 (LODDS) 值较高的患者预后较差。年龄、分级、肿瘤大小、TNM 分期和 LODDS 是独立的预后因素。包含 N 分期和 LODDS 的模型优于仅依赖 N 分期作为 LN 状态指标的模型，从而生成了经过验证的列线图，可准确预测 SRCC 患者的 OS。

结论

将 LODDS、N 分期和其他危险因素整合到列线图中可以提供精确的 OS 预测，从而增强结直肠 SRCC 患者的治疗决策和定制的后续管理。