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. 2021 Dec 16;9(35):10969-10978.
doi: 10.12998/wjcc.v9.i35.10969.

Clinical significance of signet ring cells in surgical esophageal and esophagogastric junction adenocarcinoma: A systematic review and meta-analysis

Yi-Fan Wang  1 , Si-Yu Xu  2 , Yan Wang  3 , Guo-Wei Che  3 , Hai-Tao Ma  4
Affiliations

Clinical significance of signet ring cells in surgical esophageal and esophagogastric junction adenocarcinoma: A systematic review and meta-analysis

Yi-Fan Wang et al. World J Clin Cases. .

Abstract

Background: The clinical significance of signet ring cells (SRCs) in surgical esophageal and esophagogastric junction adenocarcinoma (EEGJA) remains unclear now.

Aim: To explore the association between the presence of SRCs and the clinicopathological and prognostic characteristics in surgical EEGJA patients by combining and analyzing relevant studies.

Methods: The PubMed, Web of Science, and EMBASE electronic databases were searched for the relevant literature up to March 28, 2021. The relative risk (RR) with 95% confidence interval (CI) was calculated to assess the relationship between SRCs and clinicopathological parameters of surgical EEGJA patients, and the hazard ratio (HR) with 95%CI was calculated to explore the impact of SRC on the prognosis. All statistical analyses were conducted with STATA 12.0 software.

Results: A total of ten articles were included, involving 30322 EEGJA patients. The pooled results indicated that the presence of SRCs was significantly associated with tumor location (RR: 0.76, 95%CI: 0.61-0.96, P = 0.022; I 2 = 49.4%, P = 0.160) and tumor-node-metastasis stage (RR: 1.30, 95%CI: 1.02-1.65, P = 0.031; I 2 = 73.1%, P = 0.002). Meanwhile, the presence of SRCs in surgical EEGJA patients predicted a poor overall survival (HR: 1.36, 95%CI: 1.12-1.65, P = 0.002; I 2 = 85.7%, P < 0.001) and disease-specific survival (HR: 1.86, 95%CI: 1.55-2.25, P < 0.001; I 2 = 63.1%, P = 0.043).

Conclusion: The presence of SRCs is related with advanced tumor stage and poor prognosis and could serve as a reliable and effective parameter for the prediction of postoperative survival and formulation of therapy strategy in EEGJA patients. However, more high-quality studies are still needed to verify the above findings.

Keywords: Clinicopathological characteristics; Esophageal and esophagogastric junction adenocarcinoma; Meta-analysis; Prognosis; Signet ring cells; Systematic review.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Flow diagram of this meta-analysis. 1PubMed (n = 175), EMBASE (n = 169), and Web of Science (n = 287).
Figure 2
Figure 2
Forest plot of association between presence of signet ring cells and overall survival[11-13,15-20]. HR: Hazard ratio; CI: Confidence interval.
Figure 3
Figure 3
Forest plot of association between presence of signet ring cells and disease-free survival[12,15,17]. HR: Hazard ratio; CI: Confidence interval.
Figure 4
Figure 4
Sensitivity analysis of association between presence of signet ring cells and overall survival[11-13,15-20]. CI: Confidence interval.
Figure 5
Figure 5
Begg’s funnel plot of association between presence of signet ring cells and overall survival.
See this image and copyright information in PMC

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