Table 1_Development and validation of a novel prognostic model for gastric signet ring cell carcinoma based on inflammation-nutrition indicators.docx

BackgroundGastric signet-ring cell carcinoma (GSRCC) is a highly aggressive subtype of gastric cancer with poor prognosis. Existing prognostic models lack integrated analysis of systemic inflammation and nutritional status. This study aimed to develop and validate a prognostic model incorporating inflammatory and nutritional indicators to enhance individualized clinical management in GSRCC patients.
MethodsA total of 604 GSRCC patients who underwent curative surgery between 2014 and 2018 were retrospectively analyzed and divided into training (n = 368) and validation (n = 236) cohorts. Prognostic factors were selected using univariate analysis, multivariate Cox regression, and least absolute shrinkage and selection operator (LASSO) regression. A nomogram integrating clinicopathological features and inflammation-nutrition indicators was constructed and evaluated using calibration curves, time-dependent ROC (t-ROC) analysis, and decision curve analysis (DCA).
ResultsX-tile analysis determined optimal cut-off values for inflammation and nutrition markers. Multivariate analysis identified age ≥60 years, upper tumor location, T4 stage, N2–N3 stage, lymphocyte-to-CRP ratio (LCR) ≥ 8,785.7, and geriatric nutritional risk index (GNRI) ≥ 112.9 as independent predictors of overall survival (all p < 0.05). The combined LCR_GNRI score showed strong prognostic discrimination (p < 0.001). The nomogram achieved a concordance index (C-index) of 0.831, with good calibration and substantial clinical benefit confirmed by DCA.
ConclusionsThis study developed and validated a novel GSRCC prognostic nomogram integrating inflammatory and nutritional indicators, offering improved discrimination and clinical utility. It provides a practical tool for precise risk stratification and personalized management of GSRCC patients.