Prediction of lymph node metastasis in early gastric signet-ring cell carcinoma:A real-world retrospective cohort study

BACKGROUND Signet-ring cell carcinoma(SRCC)was previously thought to have a worse prognosis than other differentiated gastric cancer(GC),however,recent studies have shown that the prognosis of SRCC is related to pathological type.We hypothesize that patients with SRCC and with different SRCC pathological components have different probability of lymph node metastasis(LNM).AIM To establish models to predict LNM in early GC(EGC),including early gastric SRCC.METHODS Clinical data from EGC patients who had undergone gastrectomy at the First Affiliated Hospital of Nanjing Medical University from January 2012 to March 2022 were reviewed.The patients were divided into three groups based on type:Pure SRCC,mixed SRCC,and non-signet ring cell carcinoma(NSRC).The risk factors were identified through statistical tests using SPSS 23.0,R,and EmpowerStats software.RESULTS A total of 1922 subjects with EGC were enrolled in this study,and included 249 SRCC patients and 1673 NSRC patients,while 278 of the patients(14.46%)presented with LNM.Multivariable analysis showed that gender,tumor size,depth of invasion,lymphovascular invasion,ulceration,and histological subtype were independent risk factors for LNM in EGC.Establishment and analysis using prediction models of EGC showed that the artificial neural network model was better than the logistic regression model in terms of sensitivity and accuracy(98.0%vs 58.1%,P=0.034;88.4%vs 86.8%,P<0.001,respectively).Among the 249 SRCC patients,LNM was more common in mixed(35.06%)rather than in pure SRCC(8.42%,P<0.001).The area under the ROC curve of the logistic regression model for LNM in SRCC was 0.760(95%CI:0.682-0.843),while the area under the operating characteristic curve of the internal validation set was 0.734(95%CI:0.643-0.826).The subgroups analysis of pure types showed that LNM was more common in patients with a tumor size>2 cm(OR=5.422,P=0.038).CONCLUSION A validated prediction model was developed to recognize the risk of LNM in EGC and early gastric SRCC,which can aid in pre-surgical decision making of the best method of treatment for patients.

Establishment and internal validation of preoperative nomograms for predicting the possibility of testicular salvage in patients with testicular torsion

This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage(TS)in patients with testicular torsion.The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital(Xi'an,China)between August 2008 and November 2019 were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS.Based on multivariate regression coefficients,nomograms to predict possibility of TS were established.The predictive ability of the nomograms was internally validated by receiver operating characteristic(ROC)curves and calibration plots.The duration of symptoms ranged from 2 h to 1 month,with a median of 3.5 days.Thirty(14.7%)patients underwent surgical reduction and contralateral orchiopexy,while the remaining 174(85.3%)underwent orchiectomy and contralateral orchiopexy.Finally,long symptom duration was an independent risk predictor for TS,while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors.Internal validation showed that the nomograms,which were established by integrating these three predictive factors,had good discrimination ability in predicting the possibility of TS(areas under the ROC curves were 0.851 and 0.828,respectively).The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation.In conclusion,this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.