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Comparative Study
. 2017 May;265(5):946-953.
doi: 10.1097/SLA.0000000000001793.

Differential Prognostic Implications of Gastric Signet Ring Cell Carcinoma: Stage Adjusted Analysis From a Single High-volume Center in Asia

Hong Jae Chon  1 , Woo Jin Hyung, Chan Kim, Sohee Park, Jie-Hyun Kim, Chan Hyuk Park, Joong Bae Ahn, Hyunki Kim, Hyun Cheol Chung, Sun Young Rha, Sung Hoon Noh, Hei-Cheul Jeung
Affiliations
Comparative Study

Differential Prognostic Implications of Gastric Signet Ring Cell Carcinoma: Stage Adjusted Analysis From a Single High-volume Center in Asia

Hong Jae Chon et al. Ann Surg. 2017 May.

Abstract

Objective: The aim of this study was to analyze the clinicopathologic characteristics and prognosis of signet ring cell carcinoma (SRC) according to disease status (early vs advanced gastric cancer) in gastric cancer patients.

Background: The prognostic implication of gastric SRC remains a subject of debate.

Methods: A retrospective analysis was performed using the clinical records of 7667 patients including 1646 SRC patients who underwent radical gastrectomy between 2001 and 2010. A further analysis was also performed after dividing patients into three groups according to histologic subtype: SRC, well-to-moderately differentiated (WMD), and poorly differentiated adenocarcinoma.

Results: SRC patients have younger age distribution and female predominance compared with other histologic subtypes. Notably, the distribution of T stage of SRC patients was distinct, located in extremes (T1: 66.2% and T4: 20%). Moreover, the prognosis of SRC in early gastric cancer and advanced gastric cancer was contrasting. In early gastric cancer, SRC demonstrated more favorable prognosis than WMD after adjusting for age, sex, and stage. In contrast, SRC in advanced gastric cancer displayed worse prognosis than WMD. As stage increased, survival outcomes of SRC continued to worsen compared with WMD.

Conclusions: Although conferring favorable prognosis in early stage, SRC has worse prognostic impact as disease progresses. The longstanding controversy of SRC on prognosis may result from disease status at presentation, which leads to differing prognosis compared with tubular adenocarinoma.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram. AJCC, American Joint Committee on Cancer, 7th edition.
FIGURE 2
FIGURE 2
(A–C) Kaplan-Meier (KM) survival curves of tubular adenocarcinoma (AC) and signet ring cell carcinoma (SRC) are shown for (A) overall survival (OS) of all stages, (B) OS of early gastric cancer (EGC), and (C) OS of advanced gastric cancer (AGC). (D) KM curves comparing the OS of patients with well differentiated (WD), moderately differentiated (MD), and poorly differentiated (PD) tubular AC and SRC at all stages. (E–I) KM curves comparing the OS of patients with well-to-moderately differentiated (WMD) and poorly differentiated (PD) tubular AC and SRC at: (E) EGC, (F) AGC, (G) American Joint Committee on Cancer, 7thh edition (AJCC) stage I, (H) AJCC stage II, and (I) AJCC stage III.
See this image and copyright information in PMC

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