Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2022; 14(8): 1406-1428
Published online Aug 15, 2022. doi: 10.4251/wjgo.v14.i8.1406
Poorly cohesive cells gastric carcinoma including signet-ring cell cancer: Updated review of definition, classification and therapeutic management
Vincent Drubay, Frederiek Nuytens, Florence Renaud, Antoine Adenis, Clarisse Eveno, Guillaume Piessen
Vincent Drubay, Frederiek Nuytens, Clarisse Eveno, Guillaume Piessen, Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille 59000, France
Vincent Drubay, Department of Digestive Surgery, Cambrai Hospital Center and Sainte Marie, Group of Hospitals of The Catholic Institute of Lille, Cambrai 59400, France
Frederiek Nuytens, Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk 8500, Belgium
Florence Renaud, Department of Pathology, University Lille Hospital, Lille 59000, France
Florence Renaud, Clarisse Eveno, Guillaume Piessen, CNRS, Inserm, UMR9020-U1277-CANTHER-Cancer, University Lille, CHU Lille, Lille 59000, France
Florence Renaud, Antoine Adenis, Clarisse Eveno, Guillaume Piessen, FREGAT Network, Claude Huriez University Hospital, Lille 59000, France
Antoine Adenis, Department of Medical Oncology, Montpellier Cancer Institute, Monpellier 34000, France
Antoine Adenis, IRCM, Inserm, University of Monpellier, Monpellier 34000, France
Author contributions: Drubay V and Nuytens F contributed to the analysis and interpretation of data, drafting the manuscript and final approval; Renaud F, Adenis A, Eveno C and Piessen G contributed to the analysis and interpretation of data, revision of the manuscript and final approval; Piessen G contributed to the design of the study, decision of publishing the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Frederiek Nuytens, MD, Surgeon, Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Rue Michel Polonowski, Lille 59000, France. frederiek.nuytens@gmail.com
Received: January 26, 2022
Peer-review started: January 26, 2022
First decision: April 17, 2022
Revised: May 8, 2022
Accepted: July 16, 2022
Article in press: July 16, 2022
Published online: August 15, 2022
Processing time: 195 Days and 16.6 Hours
Abstract

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.

Keywords: Poorly cohesive cells gastric carcinoma; Review; Definition; Classification; Therapeutic management

Core Tip: Although the worldwide incidence of gastric cancer (GC) has decreased in recent decades, the incidence of diffuse cancer historically comprising poorly cohesive cells-GC (PCC-GC) and including signet ring cell cancer is rising. While the existing literature concerning PCC-GC is scarce, this narrative review aims to provide an update on the classification and management of PCC-GC in light of several recent developments: (1) The updated definition according to World Health Organization classification and Verona consensus; (2) An update in curative approaches following the recent validation of 5-Fluorouracil, leucovorin, oxaliplatin and docetaxel regimen and development of hyperthermic intraperitoneal chemotherapy; and (3) Role of chemotherapy and targeted therapies in the treatment of PCC-GC.