Prognostic Comparison Between Early Gastric Signet Ring Cell Carcinoma and Non-Signet Ring Cell Carcinoma: A Large-Sample Matched Study with External Single-Center Validation

Prognostic Comparison Between Early Gastric Signet Ring Cell Carcinoma and Non-Signet Ring Cell Carcinoma: A Large-Sample Matched Study with External Single-Center Validation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognostic Comparison Between Early Gastric Signet Ring Cell Carcinoma and Non-Signet Ring Cell Carcinoma: A Large-Sample Matched Study with External Single-Center Validation Baodong Liao, Xueyi Xue, Hao Zeng, Zhipeng Que, Dongbo Xu, Xiaojie Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7454580/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: While gastric signet ring cell carcinoma (SRCC) is traditionally considered aggressive, emerging evidence suggests a "prognostic paradox" wherein early-stage SRCC may exhibit favorable outcomes. The comparative prognosis between early gastric SRCC and non-SRCC (NSRCC) remains controversial and requires large-scale validation. Methods: This retrospective cohort study analyzed 6,758 stage I gastric cancer patients from the SEER database (2010–2019; SRCC: n = 645, NSRCC: n = 6,112). 1:1 propensity score matching (PSM) balanced baseline characteristics (age, gender, Grade classification, pathological T and N stages, number of regional lymph nodes removed, postoperative chemotherapy/radiotherapy status, tumor size, number of harvested lymph nodes, and marital status). Overall survival (OS) and cancer-specific survival (CSS) were compared using Kaplan-Meier/log-rank tests. Multivariable Cox regression identified independent prognostic factors. An external cohort (n = 52) was included for validation. Results: Before PSM, SRCC showed better OS than NSRCC ( P = 0.0035) but comparable CSS ( P = 0.26). After PSM, no significant differences existed in OS (log-rank P = 0.71) or CSS (P = 0.50). External validation confirmed no survival difference ( P > 0.05). Multivariable analysis identified independent risk factors: age ≥ 65 years (HR 2.360, 95%CI 2.038 - 2.734, P < 0.001), male gender (HR 1.567, 95%CI 1.365 - 1.798, P < 0.001), Grade II (HR 1.569, 95%CI 1.205 - 2.043, P = 0.001), Grade III (HR 2.193, 95%CI 1.689 - 2.847, P < 0.001), Grade IV (HR 3.047, 95%CI 1.772 - 5.239, P < 0.001), AJCC_NN1 (HR 1.382, 95%CI 1.107 - 1.724, P = 0.004), no regional lymph node dissection (HR 2.107, 95%CI 1.508 - 2.945, P < 0.001), postoperative radiotherapy (HR 2.062, 95%CI 1.691 - 2.515, P 10 mm (HR 4.261, 95%CI 3.451 - 5.262, P < 0.001), and marital status (HR 1.385, 95%CI 1.219 - 1.572, P < 0.001) . The number of retrieved lymph nodes ≥ 12 LNS was protective (HR 0.747, 95%CI 0.618 - 0.903, P = 0.003). Conclusion: Early-stage SRCC and NSRCC have comparable long-term survival after confounding adjustment. Key prognostic factors include age ≥65, male sex, poor differentiation, large tumor size, lymph node metastasis, inadequate lymphadenectomy, and unmarried status. Adequate lymph node dissection (≥12 nodes) significantly improves survival, underscoring the critical role of standardized surgical quality in early gastric cancer management. Early gastric cancer Signet ring cell carcinoma (SRCC) Prognosis SEER database Propensity score matching Lymph node dissection Figures Figure 1 Figure 2 Figure 3 1. Introduction Gastric cancer ranks as the fifth most prevalent malignant neoplasm worldwide, with a notably more favorable prognosis for early gastric cancer (EGC) compared to advanced-stage gastric cancer [1] . Signet Ring Cell Carcinoma (SRCC), a distinctive subtype, is pathologically characterized by the intracellular mucus accumulation that gives rise to a "signet-ring" appearance (as per WHO classification) [2] . Recent epidemiological investigations have revealed a noteworthy increase in the incidence of SRCC, despite an overall decline in gastric cancer rates. This rise is particularly prominent among young women, with rates ranging from 5–10% in East Asia and 20–40% in Europe and the United States [3–5] . The prognosis of SRCC exhibits a distinct stage-dependent pattern. While advanced SRCC is highly invasive, progresses rapidly, and has a poor survival rate, early-stage SRCC presents more favorable prognostic features [6–8] . This phenomenon, known as the "prognosis paradox," has garnered significant attention in the academic community. Emerging evidence suggests that the survival outcomes of early-stage SRCC may even surpass those of non-signet-ring cell carcinoma (Non-SRCC, NSRCC) [7][9] . However, the underlying biological behavior and prognostic factors of early-stage SRCC remain understudied. Importantly, the clinicopathological differences and survival outcomes between early-stage SRCC and NSRCC warrant further investigation through large-scale studies [8] . This study leveraged the extensive the Surveillance, Epidemiology, and End Results (SEER) database (2010–2019) and employed 1:1 propensity score matching (PSM) to balance baseline confounding factors across a large cohort. It systematically compared long-term survival outcomes, including overall survival (OS) and cancer-specific survival (CSS), between early-stage SRCC and NSRCC. The findings were further validated using an independent cohort from the authors' institution. The aim was to elucidate the unique clinicopathological features of early-stage gastric cancer, thereby informing the development of personalized diagnostic and therapeutic strategies. 2. Materials and Methods 2.1 Included participants This retrospective cohort study utilized data from the SEER cancer database of the US National Cancer Institute (2010–2019), covering gastric cancer patients from 18 registries (only patients with a single primary tumor were included). Version 8.4.3 of the SEER*Stat software was used to screen and download patient data. Inclusion criteria were as follows: (1) The tumor site was defined as gastric cancer according to the third edition of the International Classification of Diseases for Oncology (ICD - O − 3). (2) The diagnosis date was between 2010 and 2019. (3) Patients were diagnosed with stage Ⅰ gastric cancer according to the 8th edition of the AJCC guidelines [10] . (4) There were follow - up data, and the cause of death was clear for deceased patients. Exclusion criteria were: (1) Non - primary tumor cases. (2) Patients with distant metastasis of the tumor found during preoperative examination or intraoperative exploration who did not undergo radical surgery. (3) Patients with two or more concurrent malignant tumors found during preoperative or postoperative follow - up. (4) Cases with unclear pathological diagnosis or invalid follow - up data. (5) Unclear information on postoperative radiotherapy/chemotherapy, tumor size, number of detected lymph nodes, or N classification according to the 8th edition of the AJCC [10] . The following information was collected for each patient: age, gender, Grade classification, pathological T and N stages, number of regional lymph nodes removed, postoperative chemotherapy/radiotherapy status, tumor size, number of harvested lymph nodes, and marital status. This study analyzed data from 6,758 patients in the SEER cancer database (2010–2019) (Fig. 1 ). Additionally, clinicopathological data from 52 early-stage gastric cancer patients (9 with gastric signet-ring cell carcinoma and 43 with gastric non-signet-ring cell carcinoma) who underwent radical surgery at our center between December 2016 and February 2019 were collected for external validation. The last follow-up was on May 31, 2022. Tumor grading was classified as Grade I (well differentiated), Grade II (moderately differentiated), Grade III (poorly differentiated), and Grade IV (undifferentiated; anaplastic). Marital status was categorized as married or unmarried (including single, widowed, divorced, and separated). This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Approval was obtained from the hospital’s Ethics Committee, with the approval number: (2020) Ethics Review Scientific Research No. (071). 2.2 Statistical Survival outcomes were assessed for each patient as follows: (1) Overall survival (OS), defined from diagnosis to death from any cause; (2) Cancer-specific survival (CSS), defined from diagnosis to cancer metastasis, recurrence, cancer-related death, or end of follow-up. CSS was the primary endpoint, with OS as the secondary. Categorical variables were compared via Fisher's exact test, and continuous variables via the t-test. Kaplan-Meier survival curves estimated OS and CSS, with the log-rank test evaluating group differences. To address baseline data imbalance, 1:1 PSM was conducted using logistic regression, considering variables such as age, gender, Grade classification, pathological T and N stages, number of regional lymph nodes removed, postoperative chemotherapy/radiotherapy status, tumor size, number of harvested lymph nodes, and marital status. Prognostic factors for OS and CSS in EGC patients were analyzed using univariate and multivariate Cox proportional hazards models. A P -value < 0.05 indicated statistical significance. Analyses were performed with R version 4.3.1. 3. Results 3.1 Basic characteristics of the patients This study retrospectively analyzed 6758 gastric cancer patients in the SEER database, including 645 cases of SRCC and 6112 cases of NSRCC. The baseline characteristics of the two groups of patients are shown in Table 1 . The results showed that compared with the NSRCC group, the proportions of patients in the SRCC group with age < 65 years, female gender, pathological Grade III - IV, T1a stage, undergoing regional lymph node dissection, obtaining ≥ 12 lymph nodes (LNS), and receiving postoperative chemotherapy were all higher than those in the NSRCC group (all P 0.05). The baseline characteristics after PSM are shown in Table 2 . The results showed that the baseline characteristics of SRCC patients and NSRCC patients were balanced after PSM, with no significant differences (all P > 0.05). 3.2 Survival analysis and conditional survival analysis The Kaplan-Meier survival analysis prior to PSM revealed that patients with SRCC exhibited better OS compared to those with NSRCC ( P = 0.0035). However, there was no statistically significant difference in CSS between the two groups ( P = 0.26). After applying PSM, the Kaplan-Meier survival curves showed no significant differences in OS and CSS between SRCC and NSRCC patients ( Fig. 2 , P = 0.71 and P = 0.50, respectively). Furthermore, in the external validation cohort from our hospital center, there were no statistical differences in CSS and OS between early-stage SRCC and NSRCC patients ( P = 0.64 and P = 0.48, Fig. 3 ). The baseline characteristics of our institutional data are shown in Supplementary Table 1 . 3.3 Univariate and multivariate COX regression analyses of the prognosis of patients with early gastric cancer COX univariate analysis was performed with the prognosis of patients with EGC as the observation index. The results showed that age ≥ 65 years, male gender, Grade classification, AJCC_T stage, number of regional lymph nodes removed, postoperative radiotherapy, tumor size > 10 mm, and unmarried status were risk factors for prognosis (all P < 0.05). Number of harvested lymph nodes ≥ 12 LNS was a protective factor for prognosis ( P < 0.05). In the COX multivariate analysis, the results showed that age ≥ 65 years (HR 2.360, 95%CI 2.038–2.734, P < 0.001), male gender (HR 1.567, 95%CI 1.365–1.798, P < 0.001), Grade II (HR 1.569, 95%CI 1.205–2.043, P = 0.001), Grade III (HR 2.193, 95%CI 1.689–2.847, P < 0.001), Grade IV (HR 3.047, 95%CI 1.772–5.239, P < 0.001), AJCC_NN1 (HR 1.382, 95%CI 1.107–1.724, P = 0.004), no regional lymph node dissection (HR 2.107, 95%CI 1.508–2.945, P < 0.001), postoperative radiotherapy (HR 2.062, 95%CI 1.691–2.515, P 10 mm (HR 4.261, 95%CI 3.451–5.262, P < 0.001), and marital status (HR 1.385, 95%CI 1.219–1.572, P < 0.001) were independent risk factors for prognosis (all P < 0.05). The number of retrieved lymph nodes ≥ 12 LNS (HR 0.747, 95%CI 0.618–0.903, P = 0.003) was an independent protective factor for prognosis (see Table 3 for details). 4. Discussion Gastric cancer is a prevalent malignancy of the digestive system globally. While the incidence of gastric cancer is declining, the proportion of SRCC has shown a significant increasing trend in recent decades [11] . The prognostic significance of early-stage SRCC remains disputed. SRCC has traditionally been associated with poor OS in gastric cancer patients [5][12] . However, some studies have challenged this notion, finding that early-stage SRCC may not necessarily confer a worse prognosis compared to other gastric cancer subtypes [4] . A meta-analysis even suggested that the prognosis of early-stage SRCC patients may be better than that of non-SRCC (NSRCC) patients [7] . The results of the present study indicate no significant difference in long-term survival outcomes between early-stage SRCC and NSRCC. Multivariate Cox regression analysis identified age ≥ 65 as an independent prognostic risk factor in early-stage gastric cancer (HR 2.360, 95% CI 2.038–2.734, P < 0.001), aligning with previous studies [13–15] . Hua Xiao et al.'s retrospective analysis of 902 stage I gastric cancer patients confirmed age ≥ 65 as a risk factor for disease-free survival (HR 2.808, 95% CI 1.543–5.109, P < 0.001) [13] . This survival disparity is especially marked in early-stage patients, whereas in advanced gastric cancer, tumor aggressiveness typically dictates prognosis. In early-stage SRCC, age-related physiological decline and reduced treatment tolerance significantly influence outcomes. While stage I SRCC generally has a favorable prognosis (5-year survival rate: 96.3%), elderly patients often opt for palliative care due to limited tolerance for radical surgery or severe comorbidities, resulting in lower survival rates [15][16] . Do Dam Suh et al. found that there were no significant differences in recurrence-free survival (RFS) and OS between young male and female patients (≤ 55 years old) with EGC. In elderly patients (> 55 years old), however, males had worse OS and females had worse RFS, and male gender was an independent poor prognostic factor for OS in EGC patients [17] . This study also confirmed that male gender was an independent risk factor for the prognosis of EGC patients (adjusted HR = 1.567, 95% CI: 1.365–1.798, P < 0.001). This phenomenon may be related to the higher proportion of males and the majority of elderly patients in the cohort, leading to an overall increase in baseline risks (such as incidence and potential tumor invasiveness). Large-scale clinical trials are needed for further verification in the future. Regarding grade classification, this study showed that it had a significant impact on the prognosis of EGC. This is consistent with the conclusion of Simeng Zhang et al. [18] for middle-aged patients with EGC that histologic grade is an independent risk factor for prognosis; moreover, high-grade is independently associated with the risk of distant metastasis of gastric cancer [19] . The possible mechanism is that high-grade tumors are more likely to undergo lymph node metastasis, resulting in poor prognosis [20] . However, some studies did not find a significant association between grade and survival rate [21] . This difference may be due to the heterogeneity of the study population (e.g., including advanced cases may dilute the grading effect). The present study corroborates a fundamental tenet of radical gastrectomy: an adequate lymph node yield (LNY ≥ 12) is an independent positive prognostic factor for OS and CSS in EGC patients [22–24] . Conversely, lymph node metastasis and suboptimal regional lymph node dissection are independent negative prognostic factors. These findings underscore the principle that "the quality of surgical resection determines the accuracy of staging and, more importantly, the long-term prognosis." This study corroborates that retrieval of ≥ 12 lymph nodes is an independent protective factor for patients with early-stage gastric cancer, aligning with numerous prior investigations [25][26] . This finding further substantiates that comprehensive lymph node dissection can enhance the accuracy of pathological staging and confer therapeutic benefits by eliminating micrometastatic foci. Notably, this protective effect is consistently observed in both the SRCC and non-SRCC subgroups, underscoring that systematic lymph node dissection should serve as a fundamental indicator for surgical management of EGC, irrespective of histological type. Although early SRCC usually has a relatively shallow invasion and a low lymph node metastasis rate [27][28] , this study reveals that the absence of standardized regional lymph node dissection will significantly worsen its prognosis. This suggests that even for early SRCC patients pre - operatively evaluated as cN0, the risk of occult lymph node metastasis should still be vigilant. Therefore, it is recommended to prioritize D1 + or D2 lymph node dissection for early SRCC to avoid staging migration and undertreatment [29] . Standardized regional lymph node dissection is crucial for improving the survival outcomes of early SRCC. Even though its biological behavior is more invasive, effective control of regional lymph node metastatic foci remains a key link for survival benefits. Particular attention should be paid to the relatively high risks of occult and skip metastases in SRCC [30][31] , which pose stricter technical requirements for the thoroughness of dissection. Multiple studies have confirmed that tumor size affects the prognosis of EGC patients by influencing lymph node metastasis. Xiaoyuan Fan et al. demonstrated that tumor size is an independent predictor of lymph node metastasis in EGC ( P < 0.05) [32] . Similarly, Sridevi K Pokala et al. reported that tumor size ( P < 0.001) is a strong predictor of lymph node metastasis, particularly in T1a stage tumors [33] . For EGC with a tumor diameter less than 1 cm confined to the mucosal layer, the risks of lymph node metastasis and recurrence are relatively low, suggesting these patients may be suitable for more limited surgical intervention [34] . Furthermore, Jun Ho Lee et al. found that larger early gastric tumors are more likely to contain undifferentiated components, which significantly increase the risk of lymph node metastasis [35] . Consequently, larger tumors may necessitate more extensive lymph node dissection to ensure radical resection [36][37] , consistent with the findings of the present study. This study found that postoperative radiotherapy was an independent risk factor for the prognosis of patients with EGC, while the effect of postoperative chemotherapy did not reach statistical significance. Although postoperative radiotherapy is feasible in high-risk non-metastatic gastric cancer (such as T3-4, N1-3), EGC patients usually do not belong to this high-risk group [38][39] . Multiple randomized trials (such as INT0116) have confirmed that postoperative chemoradiotherapy can improve the survival benefit of patients with locally advanced gastric cancer (LAGC) [40–42] . However, due to the relatively low recurrence risk of EGC patients, the marginal benefit brought by adjuvant radiotherapy may be limited. Studies have indicated that in EGC patients, there is no significant difference in prognosis between SRCC and non-SRCC, and the overall effect of adjuvant therapy on improving the survival of EGC patients is limited [43] . For EGC patients who have undergone D2 lymph node dissection, Asian guidelines tend to recommend adjuvant chemotherapy rather than radiotherapy [44] . It is worth noting that in Western trials (such as INT0116), radiotherapy is often used to compensate for surgical deficiencies (such as D0/D1 dissection). However, EGC patients typically receive adequate surgical treatment, so the additional value of radiotherapy is limited [45] . Moreover, postoperative radiotherapy (especially when combined with chemotherapy) may cause acute toxic reactions, such as gastrointestinal and hematological toxicity [40] . Given the generally good postoperative prognosis of EGC patients, additional radiotherapy may increase the unnecessary toxic burden. Regarding postoperative chemotherapy, a study by Wang et al. showed that the prognosis of patients with pT1 (early-stage) gastric cancer mainly depends on tumor size and pN stage, and postoperative chemotherapy does not significantly improve the survival rate of patients with pT1-2 stage [46] . This may be because for T1 stage patients whose tumors do not invade the submucosa, surgery alone is usually sufficient to achieve a radical cure, so the role of postoperative chemotherapy is limited [47] . In addition, consistent with the results of most studies, marital status, as an indirect indicator of psychosocial support, was also confirmed as an independent prognostic risk factor in this study [21][48] . Rongping Zhou et al. found in their study that married patients showed better 5-year gastric CSS than unmarried patients (including those who had never married, divorced/separated, and widowed). Moreover, this difference remained significant in the stratified analysis of histological types and pathological differentiation degrees. Unmarried patients exhibited a higher risk of cancer death in gastric adenocarcinoma, signet-ring cell carcinoma, moderately differentiated, and poorly differentiated/undifferentiated carcinomas [49] . The significantly poorer prognosis of unmarried patients may be due to the indirect influence of marital status on prognosis through social support (such as emotional support and financial security from a spouse). Married patients may seek treatment earlier and adhere to medical advice more strictly, while widowed or divorced patients may experience treatment delays or interruptions due to loneliness or financial stress [50][51] . This suggests that during the treatment decision-making process, we should more comprehensively evaluate the psychosocial factors of patients to achieve more comprehensive humanistic care. This study has several limitations. First, the retrospective design may introduce selection bias, and key details are lacking in the SEER database (e.g., the standardization of surgical techniques, tumor grading, specific adjuvant treatment regimens, and molecular marker status). This limits the comprehensive analysis of prognostic factors. Second, the failure to distinguish between pure and mixed SRCC subtypes may obscure their potentially heterogeneous biological behaviors. Third, the sample size of the external validation cohort was relatively small, particularly for the SRCC subgroup (n = 9), reducing the statistical power of validation. Additionally, although PSM was used to mitigate baseline differences, the single-center external validation cohort from our institution comprised primarily East Asian patients, contrasting with the predominantly European and American populations in the SEER database. This significant racial disparity may limit the generalizability of our findings. Future prospective, multicenter studies incorporating molecular subtyping and detailed treatment data are warranted to further validate the prognostic features of early-stage SRCC. 5. Conclusion There was no statistically significant difference observed in the long-term survival rates between patients with early signet-ring cell carcinoma (SRCC) and those with non-signet-ring cell carcinoma (NSRCC). Factors such as age equal to or greater than 65 years, male gender, poor tumor differentiation, tumor size larger than 10 mm, presence of lymph node metastasis, non-standardized lymph node dissection, and being unmarried were identified as independent risk factors affecting the prognosis of EGC. Conversely, the dissection of 12 or more lymph nodes emerged as an independent protective factor influencing prognosis. The findings underscore the critical importance of standardized surgical procedures, particularly emphasizing the significance of lymph node dissection, in enhancing the prognosis of EGC. Declarations Acknowledgements We would like to thank Prof. Xiaojie Wang and Prof. Shuangming Lin for his help in data interpretation and Manuscript writing, which made this study possible. Author contributions Conception and design: BL, HZ, XW. Collection and assembly of data: BL, ZQ. Data analysis and interpretation: HZ, BL, XX. Manuscript writing: BL, HZ, XX. Final approval of manuscript: SL DX. Funding This work was supported by Natural Science Foundation of Fujian Province (2021J011442), Longyan City Joint Funding (2021LYF17042), Longyan City Joint Funding (2022LYF17094), Longyan City Joint Funding (2022LYF17033). Availability of data and materials The data used and/or analyzed during the current study are available from the corresponding author on reasonable request. Declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval Not applicable. Informed consent The SEER database is an open public database, and the release of data from the SEER database does not require informed patient consent. Research involving human participants and/or animals The research involving human participants in this study is based on the analysis of de-identified data from the Surveillance, Epidemiology, and End Results (SEER) database. As the SEER database contains information that is publicly available and de-identified, the study does not involve direct interaction with human participants, and ethical approval was not required for this specific analysis. This article does not contain any studies with human participants or animals performed by any of the authors. References Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. 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The effect of tumor size on lymph node metastasis in patients with early distal gastric cancer. Hepatogastroenterology. 2012 Oct;59(119):2045-9. doi: 10.5754/hge12243. PMID: 22687966. Wang JM, Zhou LY, Lin SR, Ding SG. [Characteristics and risk factors of lymphatic metastasis in early gastric cancer]. Zhonghua Nei Ke Za Zhi. 2010 Apr;49(4):297-300. Chinese. PMID: 20627034. Li P, Sheng LM, Deng QH, Zhu Y, Liu LY, Liu P, Lu K. Treatment of high-risk gastric cancer postoperatively using intensity-modulated radiotherapy: a single-institution experience. Hepatogastroenterology. 2012 Jan-Feb;59(113):159-63. doi: 10.5754/hge11280. PMID: 22260830. Badakhshi H, Gruen A, Graf R, Boehmer D, Budach V. Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study. Gastric Cancer. 2014;17(3):537-41. doi: 10.1007/s10120-013-0310-6. Epub 2013 Oct 11. PMID: 24122094. Ng K, Meyerhardt JA, Fuchs CS. Adjuvant and neoadjuvant approaches in gastric cancer. Cancer J. 2007 May-Jun;13(3):168-74. doi: 10.1097/PPO.0b013e318074e351. PMID: 17620766. Ho VKY, Jansen EPM, Wijnhoven BPL, Neelis KJ, van Sandick JW, Verhoeven RHA, Lemmens VEP, van Laarhoven HWM. Adjuvant Chemoradiotherapy for Non-Pretreated Gastric Cancer. Ann Surg Oncol. 2017 Nov;24(12):3647-3657. doi: 10.1245/s10434-017-6048-3. Epub 2017 Aug 22. PMID: 28831737. Briasoulis E, Liakakos T, Dova L, Fatouros M, Tsekeris P, Roukos DH, Kappas AM. Selecting a specific pre- or postoperative adjuvant therapy for individual patients with operable gastric cancer. Expert Rev Anticancer Ther. 2006 Jun;6(6):931-9. doi: 10.1586/14737140.6.6.931. PMID: 16761937. Tian HK, Zhang Z, Ning ZK, Liu J, Liu ZT, Huang HY, Zong Z, Li H. Clinicopathological characteristics and prognosis of gastric signet ring cell carcinoma. World J Clin Cases. 2022 Oct 16;10(29):10451-10466. doi: 10.12998/wjcc.v10.i29.10451. PMID: 36312481; PMCID: PMC9602248. Foo M, Leong T. Adjuvant therapy for gastric cancer: current and future directions. World J Gastroenterol. 2014 Oct 14;20(38):13718-27. doi: 10.3748/wjg.v20.i38.13718. PMID: 25320509; PMCID: PMC4194555. Falcone A. Future strategies and adjuvant treatment of gastric cancer. Ann Oncol. 2003;14 Suppl 2:ii45-7. doi: 10.1093/annonc/mdg729. PMID: 12810458. Wang J, Yu JC, Kang WM, Ma ZQ. Prognostic significance of intraoperative chemotherapy and extensive lymphadenectomy in patients with node-negative gastric cancer. J Surg Oncol. 2012 Mar 15;105(4):400-4. doi: 10.1002/jso.22089. Epub 2011 Aug 30. PMID: 22311818. Siegel JB, Mukherjee R, DeChamplain B, Sutton JM, Mahvi DM, Lancaster WP. Neoadjuvant Chemotherapy is Associated With Decreased Survival in Early-Stage Gastric Cancer. Am Surg. 2024 Jan;90(1):28-37. doi: 10.1177/00031348231191182. Epub 2023 Jul 30. PMID: 37518065. Li J, Cui T, Huang Z, Mu Y, Yao Y, Xu W, Chen K, Liu H, Wang W, Chen X. Analysis of risk factors for lymph node metastasis and prognosis study in patients with early gastric cancer: A SEER data-based study. Front Oncol. 2023 Mar 17;13:1062142. doi: 10.3389/fonc.2023.1062142. PMID: 37007147; PMCID: PMC10064290. Zhou R, Yan S, Li J. Influence of marital status on the survival of patients with gastric cancer. J Gastroenterol Hepatol. 2016 Apr;31(4):768-75. doi: 10.1111/jgh.13217. PMID: 26513206. Zhao H, Zhou Y, Che CC, Chong MC, Zheng Y, Hou Y, Chen C, Zhu Y. Marital Self-Disclosure Intervention for the Fear of Cancer Recurrence in Chinese Patients With Gastric Cancer: Protocol for a Quasiexperimental Study. JMIR Res Protoc. 2024 Apr 29;13:e55102. doi: 10.2196/55102. PMID: 38684089; PMCID: PMC11091802. Bowden MB, Walsh NJ, Jones AJ, Talukder AM, Lawson AG, Kruse EJ. Demographic and clinical factors associated with suicide in gastric cancer in the United States. J Gastrointest Oncol. 2017 Oct;8(5):897-901. doi: 10.21037/jgo.2017.08.02. PMID: 29184695; PMCID: PMC5674247. Tables Table. 1 Baseline characteristics. Characteristic NSRCC SRCC P value Age <0.001 =65 years 3683 (60.26%) 304 (47.13%) Gender <0.001 Female 2675 (43.77%) 346 (53.64%) Male 3437 (56.23%) 299 (46.36%) Grade <0.001 Grade I 793 (12.97%) 0 (0.00%) Grade II 1030 (16.85%) 18 (2.79%) Grade III 757 (12.39%) 334 (51.78%) Grade IV 36 (0.59%) 13 (2.02%) Unknown/Blank 3496 (57.20%) 280 (43.41%) AJCC_T <0.001 T1a 1438 (23.53%) 275 (42.64%) T1b 1584 (25.92%) 175 (27.13%) T1NOS 1635 (26.75%) 48 (7.44%) T2 1455 (23.81%) 147 (22.79%) AJCC_N 0.974 N0 5712 (93.46%) 603 (93.49%) N1 400 (6.54%) 42 (6.51%) Regional lymph nodes removed <0.001 1 to 3 regional lymph nodes removed 210 (3.44%) 29 (4.50%) 4 or more regional lymph nodes removed 2771 (45.34%) 467 (72.40%) None 3131 (51.23%) 149 (23.10%) Radiation 0.568 None/Unknown 5383 (88.07%) 573 (88.84%) Yes 729 (11.93%) 72 (11.16%) Chemotherapy <0.001 No/Unknown 4910 (80.33%) 464 (71.94%) Yes 1202 (19.67%) 181 (28.06%) Tumor_Size <0.001 10mm 3779 (61.83%) 443 (68.68%) Number of harvested lymph nodes <0.001 =12 2008 (32.85%) 351 (54.42%) Marital_status 0.993 Married 3505 (57.35%) 370 (57.36%) Unmarried/Unkonw 2607 (42.65%) 275 (42.64%) Table. 2 Baseline characteristics after propensity score matching. Characteristic NSRCC SRCC P value Age 0.249 =65 years 311 (51.66%) 291 (48.34%) Gender 0.454 Female 298 (49.50%) 311 (51.66%) Male 304 (50.50%) 291 (48.34%) Grade 1.000 Grade II 18 (2.99%) 18 (2.99%) Grade III 303 (50.33%) 303 (50.33%) Grade IV 8 (1.33%) 8 (1.33%) Unknown/Blank 273 (45.35%) 273 (45.35%) AJCC_T 0.892 T1a 229 (38.04%) 238 (39.53%) T1b 181 (30.07%) 172 (28.57%) T1NOS 52 (8.64%) 48 (7.97%) T2 140 (23.26%) 144 (23.92%) AJCC_N 0.724 N0 565 (93.85%) 562 (93.36%) N1 37 (6.15%) 40 (6.64%) Regional lymph nodes removed 0.350 1 to 3 regional lymph nodes removed 31 (5.15%) 21 (3.49%) 4 or more regional lymph nodes removed 429 (71.26%) 432 (71.76%) None 142 (23.59%) 149 (24.75%) Radiation 0.431 None/Unknown 523 (86.88%) 532 (88.37%) Yes 79 (13.12%) 70 (11.63%) Chemotherapy 1.000 No/Unknown 433 (71.93%) 433 (71.93%) Yes 169 (28.07%) 169 (28.07%) Tumor_Size 0.092 10mm 451 (74.92%) 425 (70.60%) Number of harvested lymph nodes 0.603 =12 327 (54.32%) 318 (52.82%) Marital_status 0.908 Married 337 (55.98%) 335 (55.65%) Unmarried/Unkonw 265 (44.02%) 267 (44.35%) Table. 3 Univariate and multivariable analysis of factors associated with cancer-specific survival. Variable Univariate analysis Multivariate analysis H R 95% CI P -value H R 95% CI P -value Age =65 years 2.72 2.35 3.14 <0.001 2.360 2.038 2.734 <0.001 Gender Female Reference Male 1.75 1.54 1.99 <0.001 1.567 1.365 1.798 <0.001 Grade Grade I Reference Reference Grade II 2.25 1.74 2.9 <0.001 1.569 1.205 2.043 0.001 Grade III 2.76 2.15 3.53 <0.001 2.193 1.689 2.847 <0.001 Grade IV 3.60 2.11 6.15 <0.001 3.047 1.772 5.239 <0.001 Unknown/Blank 2.25 1.77 2.86 <0.001 1.515 1.182 1.94 0.001 Histological type NSRCC Reference SRCC 1.12 0.92 1.35 0.256 AJCC_T T1a Reference Reference T1b 1.42 1.2 1.68 <0.001 1.146 0.964 1.364 0.123 T1NOS 0.88 0.72 1.07 0.201 1.531 1.226 1.912 <0.001 T2 1.55 1.3 1.83 <0.001 1.025 0.857 1.227 0.785 AJCC_N N0 Reference N1 1.94 1.61 2.34 <0.001 1.382 1.107 1.724 0.004 R egional lymph nodes removed 1 to 3 regional lymph nodes removed Reference Reference 4 or more regional lymph nodes removed 0.92 0.66 1.28 0.614 0.960 0.675 1.365 0.819 None 1.40 1.01 1.94 0.046 2.107 1.508 2.945 <0.001 Radiation None/Unknown Reference Yes 3.54 3.09 4.04 <0.001 2.062 1.691 2.515 <0.001 Chemotherapy No/Unknown Reference Reference Yes 2.33 2.05 2.65 <0.001 1.018 0.838 1.236 0.856 Tumor_Size 10mm 4.09 3.43 4.87 <0.001 4.261 3.451 5.262 <0.001 Number of harvested lymph nodes =12 0.65 0.57 0.74 <0.001 0.747 0.618 0.903 0.003 Marital_status Married Reference Reference Unmarried/Unkonw 1.24 1.1 1.4 <0.001 1.385 1.219 1.572 <0.001 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7454580","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":507977696,"identity":"585c0a41-da49-4311-89d7-b99feb4215ad","order_by":0,"name":"Baodong Liao","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Baodong","middleName":"","lastName":"Liao","suffix":""},{"id":507977697,"identity":"29431a00-3cd8-4b1f-8191-bf0961c77ed9","order_by":1,"name":"Xueyi Xue","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xueyi","middleName":"","lastName":"Xue","suffix":""},{"id":507977698,"identity":"1eab1579-2404-4b96-b746-79181fb249b4","order_by":2,"name":"Hao Zeng","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Zeng","suffix":""},{"id":507977699,"identity":"e68520d1-6da6-4209-814e-7e0486d5fa16","order_by":3,"name":"Zhipeng Que","email":"","orcid":"","institution":"Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhipeng","middleName":"","lastName":"Que","suffix":""},{"id":507977700,"identity":"c843972b-1fee-42f7-95d1-2ddd1b97b34d","order_by":4,"name":"Dongbo Xu","email":"","orcid":"","institution":"Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dongbo","middleName":"","lastName":"Xu","suffix":""},{"id":507977701,"identity":"a24c505b-5095-42ba-a355-8096529e1129","order_by":5,"name":"Xiaojie Wang","email":"","orcid":"","institution":"Fujian Medical University Union Hospital, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaojie","middleName":"","lastName":"Wang","suffix":""},{"id":507977702,"identity":"94af192e-363f-477f-874d-9b5efa42fb95","order_by":6,"name":"Shuangming Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYDCCAwyMBxIYauT42RsbH34gUgsDUMsxY8mew83GEkRrYWBgTjS4kd4mwEOMDr7jzQ8OPNzBlmBw82EbgwSDnZxuAwEtkmeOGRxIPCOTJ3k7se1BAUOysdkBAloMbuQwHEhsYyvmu53YbiABZG8jUgtzYsPNg20SPCRpmXCDkUgtEL+0gQI5ERjIBkT4BRhiDx/+bANF5fGHDz9U2MkR1ILuTtKUj4JRMApGwSjAAQAh7UwIJV0q6gAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shuangming","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2025-08-25 14:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7454580/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7454580/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90542775,"identity":"fee6e047-0d49-45e7-8919-1e6ab7a19af1","added_by":"auto","created_at":"2025-09-04 00:08:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50200,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of patient cohort definition.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7454580/v1/92bb2f500a995032636eec1e.png"},{"id":90542777,"identity":"811b34bf-b338-47a7-bed5-3e066b2b7f46","added_by":"auto","created_at":"2025-09-04 00:08:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":146151,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative Survival Outcomes in Early Gastric Cancer: Signet Ring Cell vs. Non-Signet Ring Cell Histotypes. A. CSS in unmatched patients; B. OS in unmatched patients; C. CSS in propensity - matched patients; D. OS in propensity - patients matched. CSS cancer - specific survival; OS overall survival.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7454580/v1/0d54a528830393e3966f437a.png"},{"id":90542774,"identity":"6284e46e-c443-4592-8ff4-fcb0d4db19cf","added_by":"auto","created_at":"2025-09-04 00:08:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":73116,"visible":true,"origin":"","legend":"\u003cp\u003eExternal Validation of Survival Differences Between Signet Ring Cell and Non-Signet Ring Cell Early Gastric Cancer After Curative Resection surgery. A. CSS of patients; B. OS of patients. CSS: cancer-specific survival; OS: overall survival.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7454580/v1/5579ed6fa563f9445ec86a9a.png"},{"id":98776124,"identity":"6fc5d943-5930-496a-ba04-7791b231603d","added_by":"auto","created_at":"2025-12-22 12:22:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1501818,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7454580/v1/348f0c92-e6ca-4cd1-b7f6-d27bc25c5d2f.pdf"},{"id":90542784,"identity":"3fe7f549-41b0-45d5-96ff-630b84d11a8b","added_by":"auto","created_at":"2025-09-04 00:08:05","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":18716,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7454580/v1/97474adbeacdaa712e45388a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognostic Comparison Between Early Gastric Signet Ring Cell Carcinoma and Non-Signet Ring Cell Carcinoma: A Large-Sample Matched Study with External Single-Center Validation","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eGastric cancer ranks as the fifth most prevalent malignant neoplasm worldwide, with a notably more favorable prognosis for early gastric cancer (EGC) compared to advanced-stage gastric cancer \u003csup\u003e[1]\u003c/sup\u003e. Signet Ring Cell Carcinoma (SRCC), a distinctive subtype, is pathologically characterized by the intracellular mucus accumulation that gives rise to a \"signet-ring\" appearance (as per WHO classification) \u003csup\u003e[2]\u003c/sup\u003e. Recent epidemiological investigations have revealed a noteworthy increase in the incidence of SRCC, despite an overall decline in gastric cancer rates. This rise is particularly prominent among young women, with rates ranging from 5\u0026ndash;10% in East Asia and 20\u0026ndash;40% in Europe and the United States \u003csup\u003e[3\u0026ndash;5]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe prognosis of SRCC exhibits a distinct stage-dependent pattern. While advanced SRCC is highly invasive, progresses rapidly, and has a poor survival rate, early-stage SRCC presents more favorable prognostic features \u003csup\u003e[6\u0026ndash;8]\u003c/sup\u003e. This phenomenon, known as the \"prognosis paradox,\" has garnered significant attention in the academic community. Emerging evidence suggests that the survival outcomes of early-stage SRCC may even surpass those of non-signet-ring cell carcinoma (Non-SRCC, NSRCC) \u003csup\u003e[7][9]\u003c/sup\u003e. However, the underlying biological behavior and prognostic factors of early-stage SRCC remain understudied. Importantly, the clinicopathological differences and survival outcomes between early-stage SRCC and NSRCC warrant further investigation through large-scale studies \u003csup\u003e[8]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study leveraged the extensive the Surveillance, Epidemiology, and End Results (SEER) database (2010\u0026ndash;2019) and employed 1:1 propensity score matching (PSM) to balance baseline confounding factors across a large cohort. It systematically compared long-term survival outcomes, including overall survival (OS) and cancer-specific survival (CSS), between early-stage SRCC and NSRCC. The findings were further validated using an independent cohort from the authors' institution. The aim was to elucidate the unique clinicopathological features of early-stage gastric cancer, thereby informing the development of personalized diagnostic and therapeutic strategies.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Included participants\u003c/h2\u003e\u003cp\u003eThis retrospective cohort study utilized data from the SEER cancer database of the US National Cancer Institute (2010\u0026ndash;2019), covering gastric cancer patients from 18 registries (only patients with a single primary tumor were included). Version 8.4.3 of the SEER*Stat software was used to screen and download patient data. Inclusion criteria were as follows: (1) The tumor site was defined as gastric cancer according to the third edition of the International Classification of Diseases for Oncology (ICD - O \u0026minus;\u0026thinsp;3). (2) The diagnosis date was between 2010 and 2019. (3) Patients were diagnosed with stage Ⅰ gastric cancer according to the 8th edition of the AJCC guidelines \u003csup\u003e[10]\u003c/sup\u003e. (4) There were follow - up data, and the cause of death was clear for deceased patients. Exclusion criteria were: (1) Non - primary tumor cases. (2) Patients with distant metastasis of the tumor found during preoperative examination or intraoperative exploration who did not undergo radical surgery. (3) Patients with two or more concurrent malignant tumors found during preoperative or postoperative follow - up. (4) Cases with unclear pathological diagnosis or invalid follow - up data. (5) Unclear information on postoperative radiotherapy/chemotherapy, tumor size, number of detected lymph nodes, or N classification according to the 8th edition of the AJCC \u003csup\u003e[10]\u003c/sup\u003e. The following information was collected for each patient: age, gender, Grade classification, pathological T and N stages, number of regional lymph nodes removed, postoperative chemotherapy/radiotherapy status, tumor size, number of harvested lymph nodes, and marital status.\u003c/p\u003e\u003cp\u003eThis study analyzed data from 6,758 patients in the SEER cancer database (2010\u0026ndash;2019) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additionally, clinicopathological data from 52 early-stage gastric cancer patients (9 with gastric signet-ring cell carcinoma and 43 with gastric non-signet-ring cell carcinoma) who underwent radical surgery at our center between December 2016 and February 2019 were collected for external validation. The last follow-up was on May 31, 2022. Tumor grading was classified as Grade I (well differentiated), Grade II (moderately differentiated), Grade III (poorly differentiated), and Grade IV (undifferentiated; anaplastic). Marital status was categorized as married or unmarried (including single, widowed, divorced, and separated). This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Approval was obtained from the hospital\u0026rsquo;s Ethics Committee, with the approval number: (2020) Ethics Review Scientific Research No. (071).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Statistical\u003c/h2\u003e\u003cp\u003eSurvival outcomes were assessed for each patient as follows: (1) Overall survival (OS), defined from diagnosis to death from any cause; (2) Cancer-specific survival (CSS), defined from diagnosis to cancer metastasis, recurrence, cancer-related death, or end of follow-up. CSS was the primary endpoint, with OS as the secondary. Categorical variables were compared via Fisher's exact test, and continuous variables via the t-test. Kaplan-Meier survival curves estimated OS and CSS, with the log-rank test evaluating group differences. To address baseline data imbalance, 1:1 PSM was conducted using logistic regression, considering variables such as age, gender, Grade classification, pathological T and N stages, number of regional lymph nodes removed, postoperative chemotherapy/radiotherapy status, tumor size, number of harvested lymph nodes, and marital status. Prognostic factors for OS and CSS in EGC patients were analyzed using univariate and multivariate Cox proportional hazards models. A \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance. Analyses were performed with R version 4.3.1.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Basic characteristics of the patients\u003c/h2\u003e\u003cp\u003eThis study retrospectively analyzed 6758 gastric cancer patients in the SEER database, including 645 cases of SRCC and 6112 cases of NSRCC. The baseline characteristics of the two groups of patients are shown in \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e. The results showed that compared with the NSRCC group, the proportions of patients in the SRCC group with age\u0026thinsp;\u0026lt;\u0026thinsp;65 years, female gender, pathological Grade III - IV, T1a stage, undergoing regional lymph node dissection, obtaining\u0026thinsp;\u0026ge;\u0026thinsp;12 lymph nodes (LNS), and receiving postoperative chemotherapy were all higher than those in the NSRCC group (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, the two groups of patients were similar in terms of postoperative radiotherapy, tumor size, and marital status (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The baseline characteristics after PSM are shown in \u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e. The results showed that the baseline characteristics of SRCC patients and NSRCC patients were balanced after PSM, with no significant differences (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Survival analysis and conditional survival analysis\u003c/h2\u003e\u003cp\u003eThe Kaplan-Meier survival analysis prior to PSM revealed that patients with SRCC exhibited better OS compared to those with NSRCC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0035). However, there was no statistically significant difference in CSS between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.26). After applying PSM, the Kaplan-Meier survival curves showed no significant differences in OS and CSS between SRCC and NSRCC patients \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, P\u0026thinsp;=\u0026thinsp;0.71 and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.50, respectively). Furthermore, in the external validation cohort from our hospital center, there were no statistical differences in CSS and OS between early-stage SRCC and NSRCC patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.64 and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.48, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The baseline characteristics of our institutional data are shown in \u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Univariate and multivariate COX regression analyses of the prognosis of patients with early gastric cancer\u003c/h2\u003e\u003cp\u003eCOX univariate analysis was performed with the prognosis of patients with EGC as the observation index. The results showed that age\u0026thinsp;\u0026ge;\u0026thinsp;65 years, male gender, Grade classification, AJCC_T stage, number of regional lymph nodes removed, postoperative radiotherapy, tumor size\u0026thinsp;\u0026gt;\u0026thinsp;10 mm, and unmarried status were risk factors for prognosis (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Number of harvested lymph nodes\u0026thinsp;\u0026ge;\u0026thinsp;12 LNS was a protective factor for prognosis ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eIn the COX multivariate analysis, the results showed that age\u0026thinsp;\u0026ge;\u0026thinsp;65 years (HR 2.360, 95%CI 2.038\u0026ndash;2.734, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), male gender (HR 1.567, 95%CI 1.365\u0026ndash;1.798, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Grade II (HR 1.569, 95%CI 1.205\u0026ndash;2.043, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), Grade III (HR 2.193, 95%CI 1.689\u0026ndash;2.847, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Grade IV (HR 3.047, 95%CI 1.772\u0026ndash;5.239, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), AJCC_NN1 (HR 1.382, 95%CI 1.107\u0026ndash;1.724, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), no regional lymph node dissection (HR 2.107, 95%CI 1.508\u0026ndash;2.945, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), postoperative radiotherapy (HR 2.062, 95%CI 1.691\u0026ndash;2.515, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), tumor size\u0026thinsp;\u0026gt;\u0026thinsp;10 mm (HR 4.261, 95%CI 3.451\u0026ndash;5.262, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and marital status (HR 1.385, 95%CI 1.219\u0026ndash;1.572, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independent risk factors for prognosis (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The number of retrieved lymph nodes\u0026thinsp;\u0026ge;\u0026thinsp;12 LNS (HR 0.747, 95%CI 0.618\u0026ndash;0.903, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) was an independent protective factor for prognosis (see \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e for details).\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eGastric cancer is a prevalent malignancy of the digestive system globally. While the incidence of gastric cancer is declining, the proportion of SRCC has shown a significant increasing trend in recent decades \u003csup\u003e[11]\u003c/sup\u003e. The prognostic significance of early-stage SRCC remains disputed. SRCC has traditionally been associated with poor OS in gastric cancer patients \u003csup\u003e[5][12]\u003c/sup\u003e. However, some studies have challenged this notion, finding that early-stage SRCC may not necessarily confer a worse prognosis compared to other gastric cancer subtypes \u003csup\u003e[4]\u003c/sup\u003e. A meta-analysis even suggested that the prognosis of early-stage SRCC patients may be better than that of non-SRCC (NSRCC) patients \u003csup\u003e[7]\u003c/sup\u003e. The results of the present study indicate no significant difference in long-term survival outcomes between early-stage SRCC and NSRCC.\u003c/p\u003e\u003cp\u003eMultivariate Cox regression analysis identified age\u0026thinsp;\u0026ge;\u0026thinsp;65 as an independent prognostic risk factor in early-stage gastric cancer (HR 2.360, 95% CI 2.038\u0026ndash;2.734, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), aligning with previous studies \u003csup\u003e[13\u0026ndash;15]\u003c/sup\u003e. Hua Xiao et al.'s retrospective analysis of 902 stage I gastric cancer patients confirmed age\u0026thinsp;\u0026ge;\u0026thinsp;65 as a risk factor for disease-free survival (HR 2.808, 95% CI 1.543\u0026ndash;5.109, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003csup\u003e[13]\u003c/sup\u003e. This survival disparity is especially marked in early-stage patients, whereas in advanced gastric cancer, tumor aggressiveness typically dictates prognosis. In early-stage SRCC, age-related physiological decline and reduced treatment tolerance significantly influence outcomes. While stage I SRCC generally has a favorable prognosis (5-year survival rate: 96.3%), elderly patients often opt for palliative care due to limited tolerance for radical surgery or severe comorbidities, resulting in lower survival rates \u003csup\u003e[15][16]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDo Dam Suh et al. found that there were no significant differences in recurrence-free survival (RFS) and OS between young male and female patients (\u0026le;\u0026thinsp;55 years old) with EGC. In elderly patients (\u0026gt;\u0026thinsp;55 years old), however, males had worse OS and females had worse RFS, and male gender was an independent poor prognostic factor for OS in EGC patients \u003csup\u003e[17]\u003c/sup\u003e. This study also confirmed that male gender was an independent risk factor for the prognosis of EGC patients (adjusted HR\u0026thinsp;=\u0026thinsp;1.567, 95% CI: 1.365\u0026ndash;1.798, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This phenomenon may be related to the higher proportion of males and the majority of elderly patients in the cohort, leading to an overall increase in baseline risks (such as incidence and potential tumor invasiveness). Large-scale clinical trials are needed for further verification in the future. Regarding grade classification, this study showed that it had a significant impact on the prognosis of EGC. This is consistent with the conclusion of Simeng Zhang et al. \u003csup\u003e[18]\u003c/sup\u003e for middle-aged patients with EGC that histologic grade is an independent risk factor for prognosis; moreover, high-grade is independently associated with the risk of distant metastasis of gastric cancer \u003csup\u003e[19]\u003c/sup\u003e. The possible mechanism is that high-grade tumors are more likely to undergo lymph node metastasis, resulting in poor prognosis \u003csup\u003e[20]\u003c/sup\u003e. However, some studies did not find a significant association between grade and survival rate \u003csup\u003e[21]\u003c/sup\u003e. This difference may be due to the heterogeneity of the study population (e.g., including advanced cases may dilute the grading effect).\u003c/p\u003e\u003cp\u003eThe present study corroborates a fundamental tenet of radical gastrectomy: an adequate lymph node yield (LNY\u0026thinsp;\u0026ge;\u0026thinsp;12) is an independent positive prognostic factor for OS and CSS in EGC patients \u003csup\u003e[22\u0026ndash;24]\u003c/sup\u003e. Conversely, lymph node metastasis and suboptimal regional lymph node dissection are independent negative prognostic factors. These findings underscore the principle that \"the quality of surgical resection determines the accuracy of staging and, more importantly, the long-term prognosis.\"\u003c/p\u003e\u003cp\u003eThis study corroborates that retrieval of \u0026ge;\u0026thinsp;12 lymph nodes is an independent protective factor for patients with early-stage gastric cancer, aligning with numerous prior investigations \u003csup\u003e[25][26]\u003c/sup\u003e. This finding further substantiates that comprehensive lymph node dissection can enhance the accuracy of pathological staging and confer therapeutic benefits by eliminating micrometastatic foci. Notably, this protective effect is consistently observed in both the SRCC and non-SRCC subgroups, underscoring that systematic lymph node dissection should serve as a fundamental indicator for surgical management of EGC, irrespective of histological type.\u003c/p\u003e\u003cp\u003eAlthough early SRCC usually has a relatively shallow invasion and a low lymph node metastasis rate \u003csup\u003e[27][28]\u003c/sup\u003e, this study reveals that the absence of standardized regional lymph node dissection will significantly worsen its prognosis. This suggests that even for early SRCC patients pre - operatively evaluated as cN0, the risk of occult lymph node metastasis should still be vigilant. Therefore, it is recommended to prioritize D1\u0026thinsp;+\u0026thinsp;or D2 lymph node dissection for early SRCC to avoid staging migration and undertreatment \u003csup\u003e[29]\u003c/sup\u003e. Standardized regional lymph node dissection is crucial for improving the survival outcomes of early SRCC. Even though its biological behavior is more invasive, effective control of regional lymph node metastatic foci remains a key link for survival benefits. Particular attention should be paid to the relatively high risks of occult and skip metastases in SRCC \u003csup\u003e[30][31]\u003c/sup\u003e, which pose stricter technical requirements for the thoroughness of dissection.\u003c/p\u003e\u003cp\u003eMultiple studies have confirmed that tumor size affects the prognosis of EGC patients by influencing lymph node metastasis. Xiaoyuan Fan et al. demonstrated that tumor size is an independent predictor of lymph node metastasis in EGC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) \u003csup\u003e[32]\u003c/sup\u003e. Similarly, Sridevi K Pokala et al. reported that tumor size (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) is a strong predictor of lymph node metastasis, particularly in T1a stage tumors \u003csup\u003e[33]\u003c/sup\u003e. For EGC with a tumor diameter less than 1 cm confined to the mucosal layer, the risks of lymph node metastasis and recurrence are relatively low, suggesting these patients may be suitable for more limited surgical intervention \u003csup\u003e[34]\u003c/sup\u003e. Furthermore, Jun Ho Lee et al. found that larger early gastric tumors are more likely to contain undifferentiated components, which significantly increase the risk of lymph node metastasis \u003csup\u003e[35]\u003c/sup\u003e. Consequently, larger tumors may necessitate more extensive lymph node dissection to ensure radical resection \u003csup\u003e[36][37]\u003c/sup\u003e, consistent with the findings of the present study.\u003c/p\u003e\u003cp\u003eThis study found that postoperative radiotherapy was an independent risk factor for the prognosis of patients with EGC, while the effect of postoperative chemotherapy did not reach statistical significance. Although postoperative radiotherapy is feasible in high-risk non-metastatic gastric cancer (such as T3-4, N1-3), EGC patients usually do not belong to this high-risk group \u003csup\u003e[38][39]\u003c/sup\u003e. Multiple randomized trials (such as INT0116) have confirmed that postoperative chemoradiotherapy can improve the survival benefit of patients with locally advanced gastric cancer (LAGC) \u003csup\u003e[40\u0026ndash;42]\u003c/sup\u003e. However, due to the relatively low recurrence risk of EGC patients, the marginal benefit brought by adjuvant radiotherapy may be limited. Studies have indicated that in EGC patients, there is no significant difference in prognosis between SRCC and non-SRCC, and the overall effect of adjuvant therapy on improving the survival of EGC patients is limited \u003csup\u003e[43]\u003c/sup\u003e. For EGC patients who have undergone D2 lymph node dissection, Asian guidelines tend to recommend adjuvant chemotherapy rather than radiotherapy \u003csup\u003e[44]\u003c/sup\u003e. It is worth noting that in Western trials (such as INT0116), radiotherapy is often used to compensate for surgical deficiencies (such as D0/D1 dissection). However, EGC patients typically receive adequate surgical treatment, so the additional value of radiotherapy is limited \u003csup\u003e[45]\u003c/sup\u003e. Moreover, postoperative radiotherapy (especially when combined with chemotherapy) may cause acute toxic reactions, such as gastrointestinal and hematological toxicity \u003csup\u003e[40]\u003c/sup\u003e. Given the generally good postoperative prognosis of EGC patients, additional radiotherapy may increase the unnecessary toxic burden. Regarding postoperative chemotherapy, a study by Wang et al. showed that the prognosis of patients with pT1 (early-stage) gastric cancer mainly depends on tumor size and pN stage, and postoperative chemotherapy does not significantly improve the survival rate of patients with pT1-2 stage \u003csup\u003e[46]\u003c/sup\u003e. This may be because for T1 stage patients whose tumors do not invade the submucosa, surgery alone is usually sufficient to achieve a radical cure, so the role of postoperative chemotherapy is limited \u003csup\u003e[47]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn addition, consistent with the results of most studies, marital status, as an indirect indicator of psychosocial support, was also confirmed as an independent prognostic risk factor in this study \u003csup\u003e[21][48]\u003c/sup\u003e. Rongping Zhou et al. found in their study that married patients showed better 5-year gastric CSS than unmarried patients (including those who had never married, divorced/separated, and widowed). Moreover, this difference remained significant in the stratified analysis of histological types and pathological differentiation degrees. Unmarried patients exhibited a higher risk of cancer death in gastric adenocarcinoma, signet-ring cell carcinoma, moderately differentiated, and poorly differentiated/undifferentiated carcinomas \u003csup\u003e[49]\u003c/sup\u003e. The significantly poorer prognosis of unmarried patients may be due to the indirect influence of marital status on prognosis through social support (such as emotional support and financial security from a spouse). Married patients may seek treatment earlier and adhere to medical advice more strictly, while widowed or divorced patients may experience treatment delays or interruptions due to loneliness or financial stress \u003csup\u003e[50][51]\u003c/sup\u003e. This suggests that during the treatment decision-making process, we should more comprehensively evaluate the psychosocial factors of patients to achieve more comprehensive humanistic care.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the retrospective design may introduce selection bias, and key details are lacking in the SEER database (e.g., the standardization of surgical techniques, tumor grading, specific adjuvant treatment regimens, and molecular marker status). This limits the comprehensive analysis of prognostic factors. Second, the failure to distinguish between pure and mixed SRCC subtypes may obscure their potentially heterogeneous biological behaviors. Third, the sample size of the external validation cohort was relatively small, particularly for the SRCC subgroup (n\u0026thinsp;=\u0026thinsp;9), reducing the statistical power of validation. Additionally, although PSM was used to mitigate baseline differences, the single-center external validation cohort from our institution comprised primarily East Asian patients, contrasting with the predominantly European and American populations in the SEER database. This significant racial disparity may limit the generalizability of our findings. Future prospective, multicenter studies incorporating molecular subtyping and detailed treatment data are warranted to further validate the prognostic features of early-stage SRCC.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThere was no statistically significant difference observed in the long-term survival rates between patients with early signet-ring cell carcinoma (SRCC) and those with non-signet-ring cell carcinoma (NSRCC). Factors such as age equal to or greater than 65 years, male gender, poor tumor differentiation, tumor size larger than 10 mm, presence of lymph node metastasis, non-standardized lymph node dissection, and being unmarried were identified as independent risk factors affecting the prognosis of EGC. Conversely, the dissection of 12 or more lymph nodes emerged as an independent protective factor influencing prognosis. The findings underscore the critical importance of standardized surgical procedures, particularly emphasizing the significance of lymph node dissection, in enhancing the prognosis of EGC.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e We would like to thank Prof. Xiaojie Wang and Prof. Shuangming Lin for his help in data interpretation and Manuscript writing, which made this study possible.\u003c/p\u003e\n\u003cp\u003eAuthor contributions Conception and design:\u0026nbsp;BL, HZ, XW. Collection and assembly of data: BL, ZQ. Data analysis and interpretation: HZ, BL, XX. Manuscript writing: BL, HZ, XX. Final approval of manuscript: SL DX.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This work was supported by Natural Science Foundation of Fujian Province (2021J011442), Longyan City Joint Funding (2021LYF17042), Longyan City Joint Funding (2022LYF17094), Longyan City Joint Funding (2022LYF17033).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u0026nbsp;\u003c/strong\u003eConflict of interest The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e The SEER database is an open public database, and the release of data from the SEER database does not require informed patient consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch involving human participants and/or animals\u003c/strong\u003e The research involving human participants in this study is based on the analysis of de-identified data from the Surveillance, Epidemiology, and End Results (SEER) database.\u0026nbsp;As the SEER database contains information that is publicly available and de-identified, the study does not involve direct interaction with human participants, and ethical approval was not required for this specific analysis. This article does not contain any studies with human participants or animals performed by any of the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSmyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020 Aug 29;396(10251):635-648. doi: 10.1016/S0140-6736(20)31288-5. PMID: 32861308.\u003c/li\u003e\n\u003cli\u003eFl\u0026eacute;jou JF. Classification OMS 2010 des tumeurs digestives: la quatri\u0026egrave;me \u0026eacute;dition [WHO Classification of digestive tumors: the fourth edition]. Ann Pathol. 2011 Nov;31(5 Suppl):S27-31. French. doi: 10.1016/j.annpat.2011.08.001. Epub 2011 Sep 3. PMID: 22054452.\u003c/li\u003e\n\u003cli\u003eFung BM, Patel M, Patel N, Brown AF, Ostrzega NL, Tabibian JH. Signet Ring Cell Gastric Carcinoma: Clinical Epidemiology and Outcomes in a Predominantly Latino County Hospital Population. Dig Dis Sci. 2021 Apr;66(4):1240-1248. doi: 10.1007/s10620-020-06341-z. Epub 2020 May 24. 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[Advances in the research of gastric signet ring cell carcinoma]. Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Oct 25;21(10):1196-1200. Chinese. PMID: 30370520.\u003c/li\u003e\n\u003cli\u003eFan X, Shi C, Lu D. High risk factors related to lymph node metastasis in early gastric cancer: A retrospective observational study. Medicine (Baltimore). 2023 Mar 31;102(13):e33431. doi: 10.1097/MD.0000000000033431. PMID: 37000054; PMCID: PMC10063287.\u003c/li\u003e\n\u003cli\u003ePokala SK, Zhang C, Chen Z, Gamboa AM, Cristofaro SL, Keilin SA, Cai Q, Willingham FF. Lymph node metastasis in early gastric adenocarcinoma in the United States of America. Endoscopy. 2018 May;50(5):479-486. doi: 10.1055/s-0043-122379. Epub 2017 Dec 11. PMID: 29228402.\u003c/li\u003e\n\u003cli\u003eLo SS, Wu CW, Chen JH, Li AF, Hsieh MC, Shen KH, Lin HJ, Lui WY. Surgical results of early gastric cancer and proposing a treatment strategy. Ann Surg Oncol. 2007 Feb;14(2):340-7. doi: 10.1245/s10434-006-9077-x. Epub 2006 Nov 9. 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Treatment of high-risk gastric cancer postoperatively using intensity-modulated radiotherapy: a single-institution experience. Hepatogastroenterology. 2012 Jan-Feb;59(113):159-63. doi: 10.5754/hge11280. PMID: 22260830.\u003c/li\u003e\n\u003cli\u003eBadakhshi H, Gruen A, Graf R, Boehmer D, Budach V. Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study. Gastric Cancer. 2014;17(3):537-41. doi: 10.1007/s10120-013-0310-6. Epub 2013 Oct 11. PMID: 24122094.\u003c/li\u003e\n\u003cli\u003eNg K, Meyerhardt JA, Fuchs CS. Adjuvant and neoadjuvant approaches in gastric cancer. Cancer J. 2007 May-Jun;13(3):168-74. doi: 10.1097/PPO.0b013e318074e351. PMID: 17620766.\u003c/li\u003e\n\u003cli\u003eHo VKY, Jansen EPM, Wijnhoven BPL, Neelis KJ, van Sandick JW, Verhoeven RHA, Lemmens VEP, van Laarhoven HWM. Adjuvant Chemoradiotherapy for Non-Pretreated Gastric Cancer. 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PMID: 25320509; PMCID: PMC4194555.\u003c/li\u003e\n\u003cli\u003eFalcone A. Future strategies and adjuvant treatment of gastric cancer. Ann Oncol. 2003;14 Suppl 2:ii45-7. doi: 10.1093/annonc/mdg729. PMID: 12810458.\u003c/li\u003e\n\u003cli\u003eWang J, Yu JC, Kang WM, Ma ZQ. Prognostic significance of intraoperative chemotherapy and extensive lymphadenectomy in patients with node-negative gastric cancer. J Surg Oncol. 2012 Mar 15;105(4):400-4. doi: 10.1002/jso.22089. Epub 2011 Aug 30. PMID: 22311818.\u003c/li\u003e\n\u003cli\u003eSiegel JB, Mukherjee R, DeChamplain B, Sutton JM, Mahvi DM, Lancaster WP. Neoadjuvant Chemotherapy is Associated With Decreased Survival in Early-Stage Gastric Cancer. Am Surg. 2024 Jan;90(1):28-37. doi: 10.1177/00031348231191182. Epub 2023 Jul 30. PMID: 37518065.\u003c/li\u003e\n\u003cli\u003eLi J, Cui T, Huang Z, Mu Y, Yao Y, Xu W, Chen K, Liu H, Wang W, Chen X. Analysis of risk factors for lymph node metastasis and prognosis study in patients with early gastric cancer: A SEER data-based study. Front Oncol. 2023 Mar 17;13:1062142. doi: 10.3389/fonc.2023.1062142. PMID: 37007147; PMCID: PMC10064290.\u003c/li\u003e\n\u003cli\u003eZhou R, Yan S, Li J. Influence of marital status on the survival of patients with gastric cancer. J Gastroenterol Hepatol. 2016 Apr;31(4):768-75. doi: 10.1111/jgh.13217. PMID: 26513206.\u003c/li\u003e\n\u003cli\u003eZhao H, Zhou Y, Che CC, Chong MC, Zheng Y, Hou Y, Chen C, Zhu Y. Marital Self-Disclosure Intervention for the Fear of Cancer Recurrence in Chinese Patients With Gastric Cancer: Protocol for a Quasiexperimental Study. JMIR Res Protoc. 2024 Apr 29;13:e55102. doi: 10.2196/55102. PMID: 38684089; PMCID: PMC11091802.\u003c/li\u003e\n\u003cli\u003eBowden MB, Walsh NJ, Jones AJ, Talukder AM, Lawson AG, Kruse EJ. Demographic and clinical factors associated with suicide in gastric cancer in the United States. J Gastrointest Oncol. 2017 Oct;8(5):897-901. doi: 10.21037/jgo.2017.08.02. PMID: 29184695; PMCID: PMC5674247.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable. 1\u0026nbsp;\u003c/strong\u003eBaseline characteristics.\u003c/p\u003e\n\u003ctable width=\"686\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u003cstrong\u003eNSRCC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003eSRCC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e\u0026lt;65 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e2429 (39.74%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;341 (52.87%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e\u0026gt;=65 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e3683 (60.26%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;304 (47.13%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e2675 (43.77%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;346 (53.64%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e3437 (56.23%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;299 (46.36%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eGrade\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eGrade I\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;793 (12.97%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 0 (0.00%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eGrade II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e1030 (16.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp; 18 (2.79%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eGrade III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;757 (12.39%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;334 (51.78%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eGrade IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp; 36 (0.59%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp; 13 (2.02%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eUnknown/Blank\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e3496 (57.20%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;280 (43.41%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eAJCC_T\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eT1a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e1438 (23.53%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;275 (42.64%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eT1b\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e1584 (25.92%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;175 (27.13%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eT1NOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e1635 (26.75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp; 48 (7.44%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e1455 (23.81%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;147 (22.79%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eAJCC_N\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e0.974\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eN0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e5712 (93.46%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;603 (93.49%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eN1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;400 (6.54%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp; 42 (6.51%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eRegional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e1 to 3 regional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;210 (3.44%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp; 29 (4.50%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e4 or more regional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e2771 (45.34%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;467 (72.40%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e3131 (51.23%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;149 (23.10%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eRadiation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e0.568\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eNone/Unknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e5383 (88.07%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;573 (88.84%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;729 (11.93%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp; 72 (11.16%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eChemotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eNo/Unknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e4910 (80.33%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;464 (71.94%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e1202 (19.67%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;181 (28.06%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eTumor_Size\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e\u0026lt;=10mm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e2333 (38.17%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;202 (31.32%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e\u0026gt;10mm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e3779 (61.83%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;443 (68.68%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eNumber of harvested lymph nodes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e\u0026lt;12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e4104 (67.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;294 (45.58%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003e\u0026gt;=12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e2008 (32.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;351 (54.42%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eMarital_status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e0.993\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e3505 (57.35%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;370 (57.36%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"321\"\u003e\n\u003cp\u003eUnmarried/Unkonw\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e2607 (42.65%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;275 (42.64%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"93\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable. 2 \u003c/strong\u003eBaseline characteristics after propensity score matching.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"686\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eNSRCC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eSRCC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.249\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u0026lt;65 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e291 (48.34%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e311 (51.66%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u0026gt;=65 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e311 (51.66%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e291 (48.34%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.454\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e298 (49.50%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e311 (51.66%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e304 (50.50%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e291 (48.34%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eGrade\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eGrade II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;18 (2.99%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;18 (2.99%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eGrade III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e303 (50.33%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e303 (50.33%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eGrade IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp; 8 (1.33%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp; 8 (1.33%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eUnknown/Blank\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e273 (45.35%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e273 (45.35%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eAJCC_T\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.892\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eT1a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e229 (38.04%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e238 (39.53%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eT1b\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e181 (30.07%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e172 (28.57%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eT1NOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;52 (8.64%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;48 (7.97%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e140 (23.26%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e144 (23.92%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eAJCC_N\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.724\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eN0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e565 (93.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e562 (93.36%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eN1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;37 (6.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;40 (6.64%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eRegional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.350\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e1 to 3 regional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;31 (5.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;21 (3.49%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e4 or more regional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e429 (71.26%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e432 (71.76%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e142 (23.59%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e149 (24.75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eRadiation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.431\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eNone/Unknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e523 (86.88%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e532 (88.37%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;79 (13.12%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;70 (11.63%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eChemotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eNo/Unknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e433 (71.93%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e433 (71.93%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e169 (28.07%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e169 (28.07%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eTumor_Size\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.092\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u0026lt;=10mm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e151 (25.08%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e177 (29.40%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u0026gt;10mm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e451 (74.92%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e425 (70.60%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eNumber of harvested lymph nodes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.603\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u0026lt;12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e275 (45.68%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e284 (47.18%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u0026gt;=12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e327 (54.32%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e318 (52.82%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eMarital_status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.908\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e337 (55.98%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e335 (55.65%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eUnmarried/Unkonw\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003e265 (44.02%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e267 (44.35%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable. 3 \u003c/strong\u003eUnivariate and multivariable analysis of factors associated with cancer-specific survival.\u003c/p\u003e\n\u003ctable width=\"728\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" width=\"251\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" width=\"262\"\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"106\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"117\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026lt;65 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026gt;=65 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e2.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e3.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.360\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e2.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2.734\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.567\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.798\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eGrade\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eGrade I\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eGrade II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.569\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2.043\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eGrade III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e2.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e3.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.193\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.689\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2.847\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eGrade IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e3.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e2.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e6.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e3.047\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.772\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e5.239\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eUnknown/Blank\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e2.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.515\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.182\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eHistological type\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eNSRCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eSRCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e0.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.256\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eAJCC_T\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eT1a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eT1b\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.146\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e0.964\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.364\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.123\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eT1NOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e0.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.531\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.226\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.912\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e0.857\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.227\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.785\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eAJCC_N\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eN0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eN1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e2.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.382\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.107\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.724\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003cstrong\u003eegional lymph nodes removed\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e1 to 3 regional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e4 or more regional lymph nodes removed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e0.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e0.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.614\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e0.960\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e0.675\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.819\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.046\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.107\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.508\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2.945\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eRadiation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eNone/Unknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e3.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e3.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e4.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.062\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.691\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e2.515\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eChemotherapy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eNo/Unknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e2.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e2.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e0.838\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.236\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.856\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eTumor_Size\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026lt;=10mm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026gt;10mm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e4.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e3.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e4.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e4.261\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e3.451\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e5.262\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of harvested lymph nodes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026lt;12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u0026gt;=12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e0.747\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e0.618\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.903\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital_status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eUnmarried/Unkonw\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"26\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.385\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e1.219\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e1.572\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Early gastric cancer, Signet ring cell carcinoma (SRCC), Prognosis, SEER database, Propensity score matching, Lymph node dissection","lastPublishedDoi":"10.21203/rs.3.rs-7454580/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7454580/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eWhile gastric signet ring cell carcinoma (SRCC) is traditionally considered aggressive, emerging evidence suggests a \"prognostic paradox\" wherein early-stage SRCC may exhibit favorable outcomes. The comparative prognosis between early gastric SRCC and non-SRCC (NSRCC) remains controversial and requires large-scale validation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This retrospective cohort study analyzed 6,758 stage I gastric cancer patients from the SEER database (2010–2019; SRCC: n = 645, NSRCC: n = 6,112). 1:1 propensity score matching (PSM) balanced baseline characteristics (age, gender, Grade classification, pathological T and N stages, number of regional lymph nodes removed, postoperative chemotherapy/radiotherapy status, tumor size, number of harvested lymph nodes, and marital status). Overall survival (OS) and cancer-specific survival (CSS) were compared using Kaplan-Meier/log-rank tests. Multivariable Cox regression identified independent prognostic factors. An external cohort (n = 52) was included for validation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eBefore PSM, SRCC showed better OS than NSRCC (\u003cem\u003eP\u003c/em\u003e = 0.0035) but comparable CSS (\u003cem\u003eP\u003c/em\u003e= 0.26). After PSM, no significant differences existed in OS (log-rank \u003cem\u003eP\u003c/em\u003e= 0.71) or CSS (P = 0.50). External validation confirmed no survival difference (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). Multivariable analysis identified independent risk factors: age ≥ 65 years (HR 2.360, 95%CI 2.038 - 2.734, \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001), male gender (HR 1.567, 95%CI 1.365 - 1.798, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), Grade II (HR 1.569, 95%CI 1.205 - 2.043, \u003cem\u003eP\u003c/em\u003e = 0.001), Grade III (HR 2.193, 95%CI 1.689 - 2.847, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), Grade IV (HR 3.047, 95%CI 1.772 - 5.239, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), AJCC_NN1 (HR 1.382, 95%CI 1.107 - 1.724, \u003cem\u003eP\u003c/em\u003e= 0.004), no regional lymph node dissection (HR 2.107, 95%CI 1.508 - 2.945, \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001), postoperative radiotherapy (HR 2.062, 95%CI 1.691 - 2.515, \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001), tumor size \u0026gt; 10 mm (HR 4.261, 95%CI 3.451 - 5.262, \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001), and marital status (HR 1.385, 95%CI 1.219 - 1.572, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) . The number of retrieved lymph nodes ≥ 12 LNS was protective (HR 0.747, 95%CI 0.618 - 0.903, \u003cem\u003eP\u003c/em\u003e = 0.003).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eEarly-stage SRCC and NSRCC have comparable long-term survival after confounding adjustment. Key prognostic factors include age ≥65, male sex, poor differentiation, large tumor size, lymph node metastasis, inadequate lymphadenectomy, and unmarried status. Adequate lymph node dissection (≥12 nodes) significantly improves survival, underscoring the critical role of standardized surgical quality in early gastric cancer management.\u003c/p\u003e","manuscriptTitle":"Prognostic Comparison Between Early Gastric Signet Ring Cell Carcinoma and Non-Signet Ring Cell Carcinoma: A Large-Sample Matched Study with External Single-Center Validation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-04 00:07:59","doi":"10.21203/rs.3.rs-7454580/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4013a671-9a8c-4d5a-9643-7ce97e6c043e","owner":[],"postedDate":"September 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-21T15:09:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-04 00:07:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7454580","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7454580","identity":"rs-7454580","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}