• Chun Guang Guo, Yan Jia Chen, Hu Ren, Hong Zhou, Ju Fang Shi, Xing Hua Yuan, Ping Zhao, Dong Bing Zhao, and Gui Qi Wang.
• Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital Medical Statistics Office Program Office for Cancer Screening in Urban China Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
• Medicine (Baltimore). 2016 Nov 1; 95 (46): e5393e5393.

AbstractTreatment algorithm has not been established for early gastric cancer with signet ring cell carcinoma (SRC), which has a reported low rate of lymph node metastasis (LNM) similar to differentiated cancer. A cohort of 256 patients with early gastric SRC at our center between January 2002 and December 2015 were retrospectively reviewed. Multivariate logistic regression analysis was used to determine the independent factors of LNM. A nomogram for predicting LNM was constructed and internally validated. Additional external validation was performed using the database from Cancer Institute Ariake Hospital in Tokyo (n = 1273). Clinical performance of the model was assessed by decision analysis of curve. The overall LNM incidence was 12.9% (33/256). The multivariate logistic model identified sex, tumor size, and LVI as covariates associated with LNM. Subsequently, a nomogram consisted of sex, tumor size, and depth of invasion was established. The model showed qualified discrimination ability both in internal validation (area under curve, 0.801; 95% confidence interval [CI], 0.729-0.873) and in external dataset (area under curve, 0.707; 95% CI, 0.657-0.758). Based on the nomogram, treatment algorithm for early gastric SRC was proposed to assist clinicians in making better decisions. We developed a nomogram predicting risk of LNM for early gastric SRC, which should be helpful for patient counseling and surgical decision-making.

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