Clinicopathological Characteristics and Prognostic Value of Signet Ring Cells in Gastric Carcinoma: A Meta-Analysis

Abstract

Background and Objectives: Previous studies of the prognostic value of the signet ring cell (SRC) type have yielded inconsistent results. Therefore, the aim of the present meta-analysis is to explore the clinicopathological characteristics and prognostic value of SRCs. Methods: Relevant articles that compared SRC and non-SRC type in PubMed and Web of Science were comprehensively searched. Then, a meta-analysis was performed. Results: A total of 19 studies including 35947 cases were analyzed. Compared with non-SRC patients, SRC patients tended to be younger (WMD: -3.88, P=0.001) and predominantly female (OR: 1.60, P<0.001). Additionally, SRC patients exhibited less upper third tumor location (OR: 0.62, P<0.001) and less frequent hematogenous metastasis (OR: 0.41, P<0.001). There was no difference in overall survival (OS) between SRC and non-SRC patients in the total population (HR: 1.02, P=0.830). Early gastric cancer with SRCs was associated with better OS (HR: 0.57, P=0.002), while advanced gastric cancer with non-SRCs was associated with a worse prognosis (HR: 1.17, P<0.001). Conclusions: This meta-analysis revealed that SRC tends to affect young females and tends to be located in the middle and lower third of the stomach. Early SRCs are associated with better prognoses, while advanced SRCs are associated with worse prognoses.

Keywords: gastric cancer; prognosis; signet ring cell; survival..

Figure 1

Flow diagram of the included studies.

Figure 2

Forrest plot assessing different clinicopathological characteristics following SRC and non-SRC gastric cancer in the total population. A, age; B, female; C, tumor location; D, tumor size; E, early gastric cancer ratio; F, lymph node involvement; G, lymphovascular invasion; H, peritoneal dissemination; and I, hematogenous metastasis

Figure 3

Forrest plot assessing different clinicopathological characteristics following SRC and non-SRC in early gastric cancer. A, tumor size; B, depressed gross type; C, mucosal invasion; and D, lymph node involvement

Figure 4

Forrest plot assessing different clinicopathological characteristics following SRC and non-SRC in advanced gastric cancer. A, tumor size; B, Borrmann IV type; C, T4 invasion; D, lymph node involvement; and E, peritoneal dissemination

Figure 5

Forrest plot assessing overall survival following SRC and non-SRC in the total population (A), in early gastric cancer (B), and in advanced gastric cancer (C)

Figure 6

Funnel plot to assess publication bias of overall survival in the meta-analysis.