# Prognostic value of positive lymph node ratio, tumor deposit, and perineural invasion in advanced colorectal signet-ring cell carcinoma

## TL;DR

This study shows that combining lymph node ratio, tumor deposits, and perineural invasion improves survival prediction in advanced colorectal signet-ring cell carcinoma.

## Contribution

The combined analysis of LNR, TD, and PNI provides higher prognostic value than traditional staging factors in advanced SRCC.

## Key findings

- High LNR, TD-positive, and PNI-positive were linked to worse cancer-specific and overall survival.
- A nomogram model incorporating LNR, TD, and PNI showed excellent predictive accuracy and calibration.
- The combined variable of LNR, TD, and PNI contributed more to survival prediction than T and M stages.

## Abstract

The aim of this study was to assess the prognostic significance of positive lymph node ratio (LNR), tumor deposits (TD), and perineural invasion (PNI) in advanced colorectal signet-ring cell carcinoma (SRCC).

A multicenter retrospective cohort analysis was conducted involving 677 patients with advanced colorectal SRCC. The associations of variables with CSS and OS were analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards models. A nomogram model was developed to predict outcomes.

High-LNR, TD-positive, and PNI-positive were associated with poorer CSS and OS in both the training and validation cohorts. Multivariate Cox analysis identified T stage, M stage, TD, CEA, chemotherapy, and LNR as independent prognostic factors. A prognostic nomogram model incorporating these variables demonstrated excellent calibration and satisfactory predictive accuracy. Survival curves generated from individualized nomogram scores effectively discriminated prognostic outcomes (P < 0.001). The combined variable of LNR, TD, and PNI significantly enhanced the predictive performance. Specifically, the combined variable exhibited the highest relative contribution to OS at 23.4%, surpassing that of T and M stages. For CSS, its relative contribution was 21.4%, ranking second only to T and M stages.

LNR, TD, and PNI served as prognostic factors for advanced colorectal SRCC. The combined analysis demonstrated a higher prognostic predictive value.