Method Article

Comparison of Predictive Performance of Three Lymph Node Staging Systems in Colorectal Signet Ring Cell Carcinoma Based on Machine Learning Model

DOI:

10.3791/67941

April 18th, 2025

In This Article

Summary

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This study evaluates prognostic systems for colorectal signet-ring cell carcinoma patients using machine learning models and competing risk analyses. It identifies log odds of positive lymph nodes as a superior predictor compared to pN staging, demonstrating strong predictive performance and aiding clinical decision-making through robust survival prediction tools.

Abstract

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Lymph node status is a critical prognostic predictor for patients; however, the prognosis of colorectal signet-ring cell carcinoma (SRCC) has garnered limited attention. This study investigates the prognostic predictive capacity of the log odds of positive lymph nodes (LODDS), lymph node ratio (LNR), and pN staging in SRCC patients using machine learning models (Random Forest, XGBoost, and Neural Network) alongside competing risk models. Relevant data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. For the machine learning models, prognostic factors for cancer-specific survival (CSS) were identified through univariate and multivariate Cox regression analyses, followed by the application of three machine learning methods-XGBoost, RF, and NN-to ascertain the optimal lymph node staging system. In the competing risk model, univariate and multivariate competing risk analyses were employed to identify prognostic factors, and a nomogram was constructed to predict the prognosis of SRCC patients. The area under the receiver operating characteristic curve (AUC-ROC) and calibration curves were utilized to assess the model's performance. A total of 2,409 SRCC patients were included in this study. To validate the effectiveness of the model, an additional cohort of 15,122 colorectal cancer patients, excluding SRCC cases, was included for external validation. Both the machine learning models and the competing risk nomogram exhibited strong performance in predicting survival outcomes. Compared to pN staging, the LODDS staging systems demonstrated superior prognostic capability. Upon evaluation, machine learning models and competing risk models achieved excellent predictive performance characterized by good discrimination, calibration, and interpretability. Our findings may assist in informing clinical decision-making for patients.

Introduction

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Colorectal cancer (CRC) ranks as the third most prevalent malignant tumor globally1,2,3. Signet ring cell carcinoma (SRCC), a rare subtype of CRC, comprises approximately 1% of cases and is characterized by abundant intracellular mucin displacing the cell nucleus1,2,4. SRCC is often associated with younger patients, has a higher prevalence in females, and has advanced tumor stages at diagnosis. Compared to colorectal adenocarcinoma, SRCC shows poorer differentiation, a higher risk of....

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Protocol

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This study does not refer to ethical approval and consent to participate. The data used in this study was obtained from databases. We included patients diagnosed with colorectal signet-ring cell carcinoma from 2004 to 2015, as well as other types of colorectal cancer. Exclusion criteria included patients with a survival time of less than one month, those with incomplete clinicopathological information, and cases where the cause of death was unclear or unspecified.

1. Data acquisition

  1. Download SEER. Obtain statistics 8.4.3 software from the SEER database website (http://seer.cancer.gov/about/overview.html). After....

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Results

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Patients characteristics
This study focused on patients diagnosed with colorectal SRCC, using data from the SEER database spanning 2004 to 2015. Exclusion criteria included patients with a survival time of less than one month, those with incomplete clinicopathological information, and cases where the cause of death was unclear or unspecified. A total of 2409 colorectal SRCC patients who met the inclusion criteria were randomly divided into a training cohort (N = 1686) and a validation cohort (N = 723.......

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Discussion

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Colorectal cancer (CRC) SRCC is a rare and special subtype of colorectal cancer with a poor prognosis. Therefore, greater attention needs to be paid to the prognosis of SRCC patients. Accurate survival prediction for SRCC patients is crucial for determining their prognosis and making individualized treatment decisions. In this study, we explored the relationship between clinical features and prognosis in SRCC patients and identified the optimal LN staging system for SRCC patients from the SEER database. To our knowledge,.......

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Disclosures

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The authors have no financial conflicts of interest to disclose.

Materials

List of materials used in this article
NameCompanyCatalog NumberComments
SEER databaseNational Cancer institiute at NIH
X-tile softwareYale school of medicine
R-studioPosit

References

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  1. Siegel, R. L., Giaquinto, A. N., Jemal, A. Cancer statistics, 2024. CA Cancer J Clin. 74 (1), 12-49 (2024).
  2. Korphaisarn, K., et al. Signet ring cell colorectal cancer: Genomic insights into a rare subpopulation of colorectal adenocarcinoma. Br J Cancer.

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Tags

Lymph Node StagingSignet Ring Cell CarcinomaMachine Learning ModelsCancer Survival PredictionLODDS ClassificationLymph Node RatioRandom ForestXGBoost ModelNeural Network ModelCompeting Risk Model

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