Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10451-10466
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10451
Clinicopathological characteristics and prognosis of gastric signet ring cell carcinoma
Hua-Kai Tian, Zuo Zhang, Zhi-Kun Ning, Jiang Liu, Zi-Tao Liu, Hao-Yu Huang, Zhen Zong, Hui Li
Hua-Kai Tian, Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Zuo Zhang, Department of Obstetrics and Gynecology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Zhi-Kun Ning, Department of Day Ward, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Jiang Liu, Zi-Tao Liu, Hao-Yu Huang, Zhen Zong, Department of Gastrointestinal Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Hui Li, Department of Rheumatology and Immunology, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Tian HK, Zhang Z, and Ning ZK contributed equally to this work; Tian HK and Li H conceived and designed this study; Zhang Z and Ning ZK collected and assembled the data; Zhang Z and Liu J analysed and interpreted the data; Tian HK and Liu J drafted the manuscript; Zong Z, Liu ZT, and Huang HY prepared the figures and tables; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81860433; Natural Science Youth Foundation of Jiangxi Province, No. 20192BAB215036; Jiangxi Province Natural Science Key R&D Project-General Project, No. 20202BBG73024; Training Plan for Academic and Technical Young Leaders of Major Disciplines in Jiangxi Province, No. 20204BCJ23021; and Jiangxi Provincial Education Department, Science and Technology Research Project-Youth Project, No. GJJ210252.
Institutional review board statement: The Ethics Committee of the Second Affiliated Hospital of Nanchang University approved the study [No. Review[2018]No.(100)].
Informed consent statement: Since this is a retrospective clinical study, no informed consent form was signed.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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: Hui Li, MD, Doctor, Department of Rheumatology and Immunology, First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang 330006, Jiangxi Province, China. lihui0791nc@126.com
Received: May 22, 2022
Peer-review started: May 22, 2022
First decision: July 14, 2022
Revised: July 21, 2022
Accepted: September 1, 2022
Article in press: September 1, 2022
Published online: October 16, 2022
Abstract
BACKGROUND

The clinicopathological features and prognosis of gastric signet ring cell carcinoma (GSRC) remain controversial, particularly with regard to sensitivity to postoperative adjuvant therapy.

AIM

To compare the pathological features of GSRC with those of gastric adenocarcinoma of different degrees of differentiation and the differences in survival prognosis between the different disease processes.

METHODS

By screening gastric cancer patients from 2010 to 2015 in the database of Surveillance, Epidemiology and End Results, and collecting the clinicopathological and prognostic data of gastric cancer patients who underwent surgery from January 2014 to December 2016 in the Second Affiliated Hospital of Nanchang University, we analyzed the general pathological characteristics of GSRC by the chi-square test. Univariate and multivariate analyses were conducted to compare the factors affecting the survival and prognosis of early and advanced gastric adenocarcinoma. The Kaplan-Meier curves were plotted to reveal the survival difference between early and advanced GSRC and different differentiated types of gastric adenocarcinoma. The prognosis model of advanced GSRC was established with R software, and the area under curve (AUC) and C-index were used to assess the accuracy of the model.

RESULTS

Analysis of pathological features revealed that signet ring-cell carcinoma (SRC) was more frequently seen in younger (< 60 years), female, and White patients compared to non-SRC patients. SRC was less commonly associated with early gastric cancer (EGC) (23.60% vs 39.10%), lower N0 (38.61% vs 61.03%), and larger tumour sizes > 5 cm (31.15% vs 27.10%) compared to the differentiated type, while the opposite was true compared to the undifferentiated type. Survival prognostic analysis found no significant difference in the prognosis of SRC patients among EGC patients. In contrast, among advanced gastric cancer (AGC) patients, the prognosis of SRC patients was correlated with age, race, tumour size, AJCC stage, T-stage, and postoperative adjuvant therapy. The predictive model showed that the 3-year AUC was 0.787, 5-year AUC was 0.806, and C-index was 0.766. Compared to non-SRC patients, patients with SRC had a better prognosis in EGC [hazard ratio (HR): 0.626, 95% confidence interval (CI): 0.427-0.919, P < 0.05] and a worse prognosis in AGC (HR: 1.139, 95%CI: 1.030-1.258, P < 0.05). When non-SRC was divided into differentiated and undifferentiated types for comparison, it was found that in EGC, SRC had a better prognosis than differentiated and undifferentiated types, while there was no significant difference between differentiated and undifferentiated types. In AGC, there was no significant difference in prognosis between SRC and undifferentiated types, both of which were worse than differentiated types. A prognostic analysis of postoperative adjuvant therapy for SRC in patients with AGC revealed that adjuvant postoperative radiotherapy or chemotherapy significantly improved patient survival (34.6% and 36.2% vs 18.6%, P < 0.05).

CONCLUSION

The prognosis of SRC is better than that of undifferentiated type, especially in EGC, and its prognosis is even better than that of differentiated type. SRC patients can benefit from early detection, surgical resection, and aggressive adjuvant therapy.

Keywords: Gastric adenocarcinoma, Gastric signet ring cell carcinoma, Pathological features, Survival prognosis, Prognostic model, Adjuvant therapy

Core Tip: This observational study analysed the clinicopathological features and prognosis of gastric signet ring cell carcinoma (GSRC). We compared GSRC with differentiated gastric adenocarcinoma and found that GSRC had unique clinicopathological features, was more common in younger female patients, and was more aggressive, showing higher lymph node metastasis and tumour size. However, the prognosis of early GSRC was relatively good, even better than that of differentiated adenocarcinoma. GSRC should be diagnosed early, and radical surgical resection with adjuvant radiotherapy and chemotherapy can significantly improve the survival rate of patients, though it still needs more clinical data to verify.