• Bibliometric analysis
• CiteSpace
• Gastric cancer
• Signet ring cell carcinoma
• VOSviewer

• Comorbidity
• Gastrointestinal tract cancer
• Overall survival
• Predictive model

• Humans
• Male
• Female
• Comorbidity
• Prospective Studies
• Aged
• Gastrointestinal Neoplasms/mortality
• Gastrointestinal Neoplasms/epidemiology
• Middle Aged
• Nomograms
• Survival Rate
• Bayes Theorem
• Prognosis
• ROC Curve
• Proportional Hazards Models
• Aged, 80 and over

• XD2104 Doctoral Startup Fund by Shanxi Medical University
• 2022YFC2009600 National Key Research and Development Program of China
• 202303021211202 Shanxi Provincial Basic Research Program

• Gastric signet ring cell
• Nomogram
• Prognosis
• Restricted cubic spline (RCS)
• SEER
• Survival
• Tumor size

• Humans
• Nomograms
• Carcinoma, Signet Ring Cell/mortality
• Carcinoma, Signet Ring Cell/pathology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Male
• Female
• Prognosis
• Middle Aged
• SEER Program
• Survival Rate
• Aged
• ROC Curve
• Tumor Burden
• Adult
• Cohort Studies

• 21JR1RA117 Natural Science Foundation of Gansu Province
• ldyyyn2021-8 Foundation of The First Hospital of Lanzhou University, China
• ldyyyn2021-59 Foundation of The First Hospital of Lanzhou University, China
• Foundation of The First Hospital of Lanzhou University, China

• SEER
• cancer‐directed surgery
• gastric cancer liver metastases
• overlap weighting
• survival

• Chemotherapy
• Elderly patients
• Gastric cancer
• Nomogram
• SEER database

• Aged
• Humans
• Nomograms
• Stomach Neoplasms/drug therapy
• Calibration
• Cell Division
• Databases, Factual
• SEER Program

• Diffuse type
• Gastric cancer
• Perioperative treatment
• Signet ring cell carcinoma
• Survival

• Humans
• Stomach Neoplasms/pathology
• Retrospective Studies
• Neoplasm Staging
• Adenocarcinoma/surgery
• Carcinoma, Signet Ring Cell/pathology
• Esophagogastric Junction/pathology

• Cancer-specific survival
• Gastric signet ring cell carcinoma
• Nomogram
• Overall survival
• Prognosis

• Humans
• Carcinoma, Signet Ring Cell/mortality
• Carcinoma, Signet Ring Cell/pathology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Nomograms
• Male
• Female
• Middle Aged
• Prognosis
• Aged
• SEER Program
• Adult
• Neoplasm Staging
• ROC Curve
• Proportional Hazards Models

• Humans
• Retrospective Studies
• Peritoneal Neoplasms/therapy
• Gastrectomy
• Adenocarcinoma/surgery
• Stomach Neoplasms/surgery
• Esophagogastric Junction/surgery
• Esophageal Neoplasms/surgery
• Neoplasm Staging

• external validation
• gastric signet ring cell carcinoma
• lymph node metastasis
• nomogram
• predictive model

• Humans
• Retrospective Studies
• Lymphatic Metastasis
• Carcinoma, Signet Ring Cell/pathology
• Nomograms
• Stomach Neoplasms/pathology

• Gastric cancer
• Nomogram
• Overall survival
• Prognosis
• Signet-ring cell carcinoma (SRCC)

• Humans
• Stomach Neoplasms/surgery
• Retrospective Studies
• Gastrectomy
• Prognosis
• Carcinoma, Signet Ring Cell/surgery

• Borrmann type IV gastric cancer
• overall survival
• peritoneal metastasis
• signet ring cell carcinoma

• Humans
• Prognosis
• Stomach Neoplasms/pathology
• Neoplasm Staging
• Peritoneal Neoplasms
• Retrospective Studies
• Survival Rate
• Carcinoma, Signet Ring Cell/surgery
• Carcinoma, Signet Ring Cell/pathology
• Gastrectomy

• Signet-ring cell
• lung adenocarcinoma
• lung cancer
• lymphangitic carcinomatosis

• Diagnostic laparoscopy
• Gastric cancer
• Nomogram
• Peritoneal seeding

• Borrmann type
• gastric cancer
• lymph node metastasis
• peritoneal metastasis
• signet ring cell carcinoma

While the incidence of gastric cancer (GC) in general has decreased worldwide in recent decades, the incidence of diffuse cancer historically comprising poorly cohesive cells-GC (PCC-GC) and including signet ring cell cancer is rising. Literature concerning PCC-GC is scarce and unclear, mostly due to a large variety of historically used definitions and classifications. Compared to other histological subtypes of GC, PCC-GC is nevertheless characterized by a distinct set of epidemiological, histological and clinical features which require a specific diagnostic and therapeutic approach. The aim of this review was to provide an update on the definition, classification and therapeutic strategies of PCC-GC. We focus on the updated histological definition of PCC-GC, along with its implications on future treatment strategies and study design. Also, specific considerations in the diagnostic management are discussed. Finally, the impact of some recent developments in the therapeutic management of GC in general such as the recently validated taxane-based regimens (5-Fluorouracil, leucovorin, oxaliplatin and docetaxel), the use of hyperthermic intraperitoneal chemotherapy as well as pressurized intraperitoneal aerosol chemotherapy and targeted therapy have been reviewed in depth for their relative importance for PCC-GC in particular.

• Poorly cohesive cells gastric carcinoma
• Review
• Definition
• Classification
• Therapeutic management

Signet-ring cell carcinoma of the stomach (SRCC) is a particular gastric cancer entity. Its incidence is increasing. Its diagnosis is pathological; it corresponds to adenocarcinoma with a majority of signet-ring cells component (> 50%).

These histological features give it its aggressiveness characteristics. This has repercussions on the prognostic level and implications for the alternatives of therapy, especially since some authors suggest a potential chemoresistance.

This survey aimed to identify the epidemiological, pathological, therapeutic, and prognostic characteristics of SRCC as a separate disease entity.

This was a retrospective study of 123 patients admitted for gastric adenocarcinoma to Habib Thameur Hospital in Tunis over 11 years from January 2006 to December 2016. A comparative study was performed between 2 groups: the SRCC group with 62 patients and the non-SRCC (non-signet-ring cell carcinoma of the stomach) with 61 patients.

The prevalence of SRCC in our series was 50%. SRCC affected significantly younger patients (55 vs 62 years; p = 0.004). The infiltrative character was more common in SRCC tumors (30.6 vs 14.8%; p = 0.060), whereas the budding character was more often noted in non-SRCC tumors (78.7 vs 58.1%; p = 0.039). There was no significant difference in tumor localization between both groups. Linitis plastica was noted in 14 patients with SRCC against a single patient with non-SRCC (p = 0.001). The tumor size was more important in the non-SRCC group (6.84 vs 6.39 cm; p = 0.551). Peritoneal carcinomatosis was noted in 4.3% of cases in the SRCC group versus 2.2% of cases in the NSRCC group (p = 0.570). Total gastrectomy was more often performed in the SRCC group (87 vs 56%; p = 0.001). Resection was more often curative in the non-SRCC group (84.4 vs 78.3%; p = 0.063). Postoperative chemotherapy was more commonly indicated in the SRCC group (67.4 vs 53.3%; p = 0.339). Tumor recurrence was more common in the non-SRCC group (35.7 vs 32%; p = 0.776). The most common type of recurrence was peritoneal carcinomatosis in the SRCC group (62.5%) and hepatic metastasis in the non-SRCC group (60%; p = 0.096). The overall 5-year survival in the SRCC group was lower than in the non-SRCC group, with no statistically significant difference (47.1 vs 51.5%; p = 0.715). The overall survival was more important for SRCC in early cancer (100 vs 80%; p = 0.408), whereas it was higher for non-SRCC in advanced cancer (48.1 vs 41.9%; p = 0.635).

Apart from its epidemiological and pathological features, SRCC seems to have a worse prognosis. Indeed, it is diagnosed at a more advanced stage and has a worse prognosis in advanced cancer than non-SRCC. It is therefore to be considered as a particular entity of gastric adenocarcinoma requiring a specific therapeutic protocol where the place of chemotherapy remains to be more investigated.

• Gastric cancer, Adenocarcinoma, Signet-ring cell carcinoma, Non-signet-ring cell carcinoma, Prognosis

Gastric cancer (GC) is one of the major causes of cancer-related mortality worldwide. The vast majority of GC cases are adenocarcinomas including intestinal and diffuse GC. The incidence of diffuse GCs, often associated with poor overall survival, has constantly increased in USA and Europe The molecular basis of diffuse GC aggressivity remains unclear. Using mRNA from diffuse and intestinal GC tumor samples of a Western cohort, this study reports the expression level of the immunomodulatory aryl-hydrocarbon receptor (AhR), and genes involved in immune suppression (PD1, PD-L1, PD-L2) and the early steps of tryptophan metabolism (IDO1, IDO2, TDO2). Strongly increased expression of IDO1 (p < 0.001) and PD1 (p < 0.003) was observed in the intestinal sub-type. The highest expression of IDO1 and PDL1 correlated with early clinical stage and absence of lymphatic invasion (×25 p = 0.004, ×3 p = 0.04, respectively). Our results suggest that kynurenine, produced by tryptophan catabolism, and AhR activation play a central role in creating an immunosuppressive environment. Correspondingly, as compared to intestinal GCs, expression levels of IDO1-TDO2 and PD-L1 were less prominent in diffuse GCs which also had less infiltration of immune cells, suggesting an inactive immune response in the advanced diffuse GC. Confirmation of these patterns of gene expression will require a larger cohort of early and advanced stages of diffuse GC samples.

Due to the fact that the definition of gastric signet ring cell cancer (GSRC) was still controversial in the past decades, the prognosis affected by the proportion of signet ring cells within gastric cancer is uncertain. This study compared the clinicopathological features and prognosis of GSRC with the various proportions of signet ring cells.

We collected GSRC cases without metastasis who underwent curative (R0) resection between 2011 and 2018. Individuals who were in the low-proportion signet ring cell group (LSRC, <50%) were matched to those who were in the high-proportion signet ring cell group (HSRC, >50%) through propensity score matching (1:1). We used Cox proportional hazard regression to calculate the adjusted hazard ratios (HR) and 95% confidence intervals (CI) and explored interactions with gender and stage.

We had 1:1 matched individuals including 231 cases from the LSRC group and 231 cases from the HSRC group. Patients with HSRC had a significantly higher overall survival rate in the multivariable model (aHR = 0.56, 95%CI = 0.38, 0.84) compared with those with LSRC. The association of HSRC appeared to be more substantial among individuals at early stage and N0 stage (p-interaction < 0.01).

This study confirms that GSRC with different proportions of signet ring cells could affect the survival of the patient. Further clinical studies should be developed in the future to provide an appropriate treatment strategy for GSRC.

• cancer survival
• gastric cancer
• prognosis
• signet ring cell
• treatment

Since 1965, the Laurén classification has been used most commonly for gastric adenocarcinoma, with two main types: intestinal type and diffuse type. Signet ring cell carcinoma (Sig) and non-solid poorly differentiated adenocarcinoma (Por2) are the histological forms of diffuse type that are often found in advanced tumors, and they seem to be associated with a poor prognosis. S-1-based adjuvant chemotherapy for patients with stage II/III gastric cancer has generally been accepted in Japan, but histological type does not alter treatment strategy. The aim of the present study was to investigate the prognostic impact of the histopathological mixture of Sig and Por2 in patients with stage II/III gastric cancer treated with S-1 adjuvant chemotherapy. The clinicopathological data of 968 patients with gastric carcinoma who underwent gastrectomy between 2007 and 2016 at Osaka City University Hospital were retrospectively analyzed. In the present study, tumors containing Sig or Por2 were classified as diffuse type, and those not containing them were classified as intestinal type. There were 307 cases of diffuse type and 661 cases of intestinal type. Diffuse type included 189 cases with Sig. A pathological diagnosis of Sig was an independent risk factor for peritoneal recurrence in patients with stage II/III gastric cancer. Patients with diffuse type had a worse overall survival rate than those with intestinal type at stage III gastric cancer. Among the patients who received S-1 adjuvant chemotherapy, the prognosis of patients with stage III gastric cancer with Sig but not Por2 was significantly worse compared with that of patients with intestinal type. Therefore, the present study revealed that the coexistence of Sig in the primary tumor was associated with a poor prognosis in patients with stage III gastric cancer. The current findings suggested that, since mixed Sig gastric cancer had a high risk of peritoneal recurrence even if adjuvant chemotherapy was performed, the pathological diagnosis should be considered when determining the therapeutic strategy for adjuvant chemotherapy in patients with stage III gastric cancer.

• diffuse type
• gastric cancer
• prognosis
• signet ring cell carcinoma

To better define the clinicopathologic characteristics of signet ring cell (SRC) gastric cancer and build a prognostic model for it.

SRC patient information from 2010 to 2015 were identified using Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier method and log-rank test were used to estimate Overall survival (OS) and to determine associations with histologic subtypes. In COX proportional hazards regression model–based univariate and multivariate analyses, significant variables for construction of a nomogram were screened out. The nomogram was validated by means of the concordance index (CI), calibration plots, and receiver operating characteristics (ROCs) curves.

A total of 11,363 gastric cancer patients were enrolled. On dividing the patients into SRC, well-to-moderately differentiated (WMD) adenocarcinoma, and poorly differentiated (PD) adenocarcinoma, differences among these subgroups emerged. SRC patients were more likely to occur in female and young patients than other histologic subtypes. Larger tumors, stage T4, and node stage N3 were more likely to be found in the SRC group. The survival for SRC patients was better than non-SRC patients in stage I. Univariate and multivariate analyses identified age, tumor site, larger tumor size, advanced T classification, advanced N classification, advanced TNM stage, and surgery of primary site as independent prognostic indicators. Then an OS nomogram was formulated.

SRC had distinct clinicopathological characteristics. The nomogram provided an accurate tool to evaluate the prognosis of SRC.

• carcinoma
• nomograms
• prognosis
• signet ring cell
• stomach neoplasms

Signet ring cell carcinoma (SRCC) is a poorly cohesive subtype of gastric cancer. It is more aggressive than other types of gastric cancer. There is no special method for its treatment, but gastrectomy and lymphadenectomy is the standard approach. The aim of this study is to investigate postoperative outcomes of D1 lymphadenectomy and D1(+)lymphadenectomy in gastric SRCC.

A total of 358 cases whohad a gastrectomy performed forthe diagnosis of gastric cancer between 2013 and 2019 in Ankara University Medical Faculty, Surgical Oncology Department were retrospectively investigated. In all, 128 of the cases had SRCC in the final pathology. We separated the cases into two types,D1 lymphadenectomy and D1(+) lymphadenectomy. The 5-year survival, early mortality, hospital mortality and postoperative complication rates were evaluated.

There were 59 patients in the D1 group and 64 patients in the D1(+) group.Metastatic lymph node amount and therefore N stage was found to be significantly higher in the D1(+) group (p=0.00 and p=0.03, respectively). Postoperative chyle fistula was found to be significantly higher in the D1(+) group (p=0.003). There was no statistically significant difference between the groups with regard tomean survival (p=0.065);the 5-year mean survival was 21% in the D1 group and 7% in the D1(+) group. Present findings suggest that extended lymphadenectomy does not provide a benefit in cases of SRCC.

• D1(+) lymphadenectomy
• Signet ring cell
• hospital mortality
• long-term survival
• peritoneal seeding

• biological behavior
• gastric neoplasm
• meta-analysis
• prognosis
• signet-ring cell carcinoma

• Academic
• Comprehensive cancer center
• Gastrectomy
• Gastric cancer
• Signet-ring cell gastric carcinoma

• Gastrectomy
• Gastric adenocarcinoma
• Gastric cancer
• Partial
• Signet-ring cell carcinoma
• Total

Background: There is controversy about the characteristics and prognostic implications of signet ring cell gastric cancers and non-signet ring cell gastric cancers.

Objective: This study aims to evaluate clinicopathological characteristics and prognoses of signet ring cell carcinoma (SRCC) and non-signet ring cell carcinoma (NSRCC) of stomach.

Methods: Studies compared between SRCC and NSRCC of the stomach after gastrectomy and published before September 1st, 2020, in the PubMed, Cochrane, and Embase databases, were identified systematically.

Results: A total of 2,865 studies were screened, and 36 studies were included, with 19,174 patients in the SRCC group and 55,942 patients in the NSRCC group. SRCC patients were younger in age (P < 0.001), less likely to be male patients (P < 0.001), more afflicted with upper third lesions (P < 0.001), and presenting with more Borrmann type IV tumors (P = 0.005) than NSRCC patients. Lymph nodes metastasis was similar between SRCC and NSRCC patients with advanced tumor stage (OR: 0.86, 95% CI: 0.671.10, P = 0.23), but lower in the SRCC than NSRCC patients with early tumor stage (OR: 0.73; 95% CI: 0.560.98, P = 0.02). SRCC patients had comparable survival outcomes with NSRCC patients for early gastric cancers (HR: 1.05, 95% CI: 0.651.68, P < 0.001) but had significantly poor prognosis for patients with advanced tumor stage (HR: 1.50, 95% CI: 1.281.76, P < 0.001).

Conclusions: Signet ring cell carcinomas of the stomach are an increasingly common histopathological subtype of gastric cancers. These kinds of patients tend to be younger in age and more often female. Although, signet ring cell gastric cancer is a negative prognostic factor for patients with advanced stage. The difference is that for early stage of signet ring cell gastric cancers, it has low lymph nodes metastasis rate and comparable prognosis with non-signet ring cell cancers.

• gastric cancer
• prognosis
• sex
• signet ring cell
• stage

• Gastric adenocarcinoma
• nomogram
• signet ring cell carcinoma
• survival

Signet ring cell containing gastric cancer (SRCGC) is a rare subtype of gastric cancer, and its adjuvant therapy is based on general gastric cancer. However, the effectiveness of radiotherapy for those SRCGC patients remains unknown.

The purpose of the study was to analyze whether the addition of radiotherapy to adjuvant chemotherapy (CT) can benefit survival in resected SRCGC patients.

Patients with SRCGC, who underwent D2 gastrectomy followed by adjuvant chemotherapy or chemoradiotherapy (CRT), were retrospectively collected. According to the proportion of signet ring cells, patients were histologically classified as pure SRCGC (pSRCGC) containing 100% of signet ring cells, mixed SRCGC (mSRCGC) containing >50% of signet ring cells, and contaminated SRCGC (cSRCGC) containing <50% of signet ring cells. Among the 272 patients, 156 were treated by CT alone and 116 by CRT. The primary endpoint was 3-year overall survival rate (3-year OS rate).

With a median follow-up of 80.5 months, the 3-year OS rate was significantly higher in the CT group (70.5% vs. 58.6%, HR = 0.633, P = 0.017) compared with CRT group. Three independent characteristics were predictive of a poor overall survival: CRT treatment (P = 0.019), tumor size ≥5 cm (P < 0.001), and the presence of vessel invasion (P = 0.009). Subgroup analyses showed CRT significantly impaired prognosis in SRCGC patients in the cSRCGC subset, as well as lesions located in lower-middle sites, subtotal gastrectomy, male, <60 year, and no vessel invasion. Peritoneal was the most common recurrence site in SRCGC patients. The adverse events leukopenia and neutropenia were more common in the CRT group (P = 0.007).

Adjuvant chemoradiotherapy was associated with poor survival compared with adjuvant chemotherapy in SRCGC patients with D2 gastrectomy.

• adjuvant therapy
• chemoradiotherapy
• chemotherapy
• gastric cancer
• signet ring cell carcinoma

Background: Limited evidence and contradictory results have been reported regarding the impact of signet ring cell carcinoma (SRC) and mucinous gastric cancer (MGC) classifications on the prognosis of gastric cancer (GC).

Results: Information on 6017 patients and 266 patients was extracted from the SEER database and our hospital records, respectively. We found that patients with MGC had a better survival rate than those with SRC (P=0.012), but in the early stage, MGC was a risk factor for a poor prognosis. After PSM, for both patients from the SEER database and our hospital, the prognosis of patients with SRC was poorer than that of patients with MGC (P<0.05), but patients with MGC in early-stage GC showed poorer survival. Additionally, SRC was demonstrated to be a risk factor in the multivariate competing risk regression model for cancer-specific survival.

Conclusion: Patients with SRC may have a worse prognosis than those with MGC, but for early-stage GC, patients with SRC have a better prognosis than those with MGC.

Method: Patients from the SEER database and from our hospital diagnosed with SRC or MGC were included in a Cox regression analysis, multivariate competing risk model and propensity score matching (PSM) analysis.

• SEER
• competing risk regression model
• mucinous gastric cancer
• propensity score matching
• signet ring cell carcinoma

• esophageal cancer
• gastric cancer
• histology
• prognosis
• staging
• surgery

• Hispanic
• epidemiology
• gastric cancer
• peritoneal carcinomatosis

• combined modality therapy
• gastric cancer
• pathology
• signet ring cell

• Chinese Academy of Medical Science/Peking Union Medical College

• PD-L1
• advanced GC
• genetic alterations
• meta-analysis
• prognostic factor review
• recurrence pattern
• signet-ring cell

• Gastric cancer
• histology type
• prognostic factor
• signet ring cell carcinoma
• survival

• Gastric cancer
• Histology
• Molecular classification

The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.

To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.

This retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach (cT3/4 and cN any) diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis (cTNM) staging system. We performed 1:1 propensity score matching (PSM) to reduce bias in patient selection. The histologic and prognostic effects of neoadjuvant chemotherapy were assessed. The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.

Of the 144 patients eligible for this study, 36 received neoadjuvant chemotherapy, and 108 received initial surgery after diagnosis. After adjustment by PSM, 36 pairs of patients were generated, and baseline characteristics, including age, sex, American Society of Anesthesiologists score, tumor location, and cTNM stage, were similar between the two groups. The R0 resection rates were 88.9% and 86.1% in the surgery-first and neoadjuvant chemotherapy groups after PSM, respectively (P = 1.000). The median follow-up period was 46.4 mo. The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0% and 65.0% (P = 0.235), respectively, before PSM and 50% and 64.7% (P = 0.192), respectively, after PSM. Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.

Neoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma. For resectable gastric signet-ring cell carcinoma, upfront surgery should be the primary therapy.

• Stomach neoplasms
• Neoadjuvant therapy
• Retrospective studies
• Carcinoma
• Signet ring cell
• Outcome assessment

• Carcinoma, Signet Ring Cell/mortality
• Carcinoma, Signet Ring Cell/therapy
• Chemotherapy, Adjuvant/mortality
• Female
• Gastrectomy/mortality
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy/mortality
• Prognosis
• Propensity Score
• Retrospective Studies
• Stomach Neoplasms/mortality
• Stomach Neoplasms/therapy
• Survival Rate
• Treatment Outcome

Gastric cancer is one of the most common cancers worldwide. In Turkey, stomach cancer is ranked 5th among men and 8th among women in all cancers and is located in the forefront in cancer-related deaths. Signet ring cell adenocarcinoma, which is the histopathological subtype of gastric cancer, has a poor prognosis. The incidence of signet ring cell adenocarcinoma is rising. In the present study, we aimed to describe the clinicopathologic features of signet ring cell adenocarcinoma.

A total of 79 patients with 30 being female (38%) and 49 male (62%) who were diagnosed with gastric signet ring cell adenocarcinoma in the Medical Oncology Department of Ankara Numune Training and Research Hospital between January 2004 and October 2015 were retrospectively evaluated.

The baseline demographic characteristics of the patients, such as tumor localization, tumor stage, preoperative serum tumor markers, and treatment type (surgery and chemotherapy regimen), and the effects of these variables on survival and mortality were evaluated. Total surgery, stage III disease, moderate to poor grade, preoperative serum CA 19-9 and CEA levels were found as independent predictors of progression risk (p < 0.05). Each 1 ng/mL increase in preoperative serum CEA level was found to increase the risk of progression by 1.20 folds. Again, each 1 U/mL in preoperative serum CA 19-9 level was found to increase the risk of progression and mortality by 1.06 folds.

The clinicopathologic features of signet ring cell stomach cancer were described. Tumor localization and disease, CA 19-9 and CEA levels, and treatment type (surgery and chemotherapy regimen) were effective on survival and mortality. However, further studies with larger patient groups are needed on this issue.

Altay SB, Akkurt G, Yılmaz N, et al. Clinicopathological Evaluation of Gastric Signet Ring Cell Carcinoma: Our Experience. Euroasian J Hepato-Gastroenterol 2020;10(2):76–84.

• Clinicopathologic features
• Early gastric cancer
• Signet ring cell adenocarcinoma

• Gastric cancer
• Histological phenotype
• Mucin
• Signet-ring cells
• Survival

• Aged
• Asian People/statistics & numerical data
• Carcinoma, Signet Ring Cell/ethnology
• Carcinoma, Signet Ring Cell/metabolism
• Carcinoma, Signet Ring Cell/pathology
• Carcinoma, Signet Ring Cell/therapy
• Cohort Studies
• Combined Modality Therapy
• Esophageal Neoplasms/ethnology
• Esophageal Neoplasms/metabolism
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/therapy
• Female
• Humans
• Male
• Middle Aged
• Mucin-1/metabolism
• Prognosis
• Stomach Neoplasms/ethnology
• Stomach Neoplasms/metabolism
• Stomach Neoplasms/pathology
• Stomach Neoplasms/therapy
• Survival Rate
• White People/statistics & numerical data

Our aims were to establish novel nomogram models, which directly targeted patients with signet ring cell carcinoma (SRC), for individualized prediction of overall survival (OS) rate and cancer-specific survival (CSS).

We selected 1,365 SRC patients diagnosed from 2010 to 2015 from Surveillance, Epidemiology and End Results (SEER) database, and then randomly partitioned them into a training cohort and a validation cohort. Independent predicted indicators, which were identified by using univariate testing and multivariate analyses, were used to construct our prognostic nomogram models. Three methods, Harrell concordance index (C-index), receiver operating characteristics (ROC) curve and calibration curve, were used to assess the ability of discrimination and predictive accuracy. Integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision curve analysis (DCA) were used to assess clinical utility of our nomogram models.

Six independent predicted indicators, age, race, log odds of positive lymph nodes (LODDS), T stage, M stage and tumor size, were associated with OS rate. Nevertheless, only five independent predicted indicators were associated with CSS except race. The developed nomograms based on those independent predicted factors showed reliable discrimination. C-index of our nomogram for OS and CSS was 0.760 and 0.763, which were higher than American Joint Committee on Cancer (AJCC) 8th edition tumor-node-metastasis (TNM) staging system (0.734 and 0.741, respectively). C-index of validation cohort for OS was 0.757 and for CSS was 0.773. The calibration curves also performed good consistency. IDI, NRI and DCA showed the nomograms for both OS and CSS had a comparable clinical utility than the TNM staging system.

The novel nomogram models based on LODDS provided satisfying predictive ability of SRC both in OS and CSS than AJCC 8th edition TNM staging system alone.

• Log odds of positive lymph nodes
• nomograms
• prognosis
• signet ring cell

• chemotherapy
• clinicopathological features
• gastric cancer
• prognostic factors
• signet ring cell carcinoma

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Signet Ring Cell/mortality
• Carcinoma, Signet Ring Cell/pathology
• Female
• Humans
• Immunohistochemistry
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Staging
• Prognosis
• Proportional Hazards Models
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Young Adult

• grants from Fujian Innovation project

• Gastric cancer
• Nomogram
• Propensity score
• Radiotherapy
• Signet ring cell carcinoma

• Shanghai Committee of Science and Technology