Stage-Stratified Prognosis of Signet Ring Cell Histology in Patients Undergoing Curative Resection for Gastric Adenocarcinoma

Bamboat, Zubin M.; Tang, Laura H.; Viñuela, Eduardo; Kuk, Deborah; Gönen, Mithat; Shah, Manish A.; Brennan, Murray F.; Coit, Daniel G.; Strong, Vivian E.

doi:10.1245/s10434-013-3466-8

Cited by 116 publications

(113 citation statements)

References 23 publications

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“…In many previous reports, SRC histology appears to occur frequently in female and young patients [13, 17–19], whereas mucinous histology was not associated with gender and age of patients [10, 15, 20]. In our present study, the distribution of differentiation status was significantly associated with gender and age of patients.…”

Section: Discussionsupporting

confidence: 59%

Prognostic value of differentiation status in gastric cancer

et al. 2018

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BackgroundUp to date, investigation of the prognostic value of differentiation status mainly focused on signet ring cell and mucinous gastric cancer. Thus, the present study aims to investigate the clinicopathological features and prognosis of gastric cancer patients with well, moderately and poorly differentiation status.MethodsFrom September 2008 to March 2015, a total of 3090 gastric cancer patients treated with radical D2 gastrectomy were enrolled in the present study. Clinicopathological characteristics and prognosis of gastric cancer patients with well, moderately and poorly differentiation status were analyzed.ResultsThere were 2422 male (78.4%) and 668 female (21.6%). The median age was 58 (20–90) years. There were 370 (12.0%) well differentiated tumors, 836 (27.0%) moderately differentiated tumors and 1884 (61.0%) poorly differentiated tumors. Well and moderately differentiation status were associated with older age, male gender, smaller tumor, shallower invasion, less lymph node involvement and earlier tumor stage (all p < 0.001). Inversely, poorly differentiation status was associated with younger age, female gender, larger tumor, deeper invasion, more lymph node involvement and later tumor stage (all p < 0.001). With respect to prognosis, well differentiation status was associated with favorable overall survival and poorly differentiation status was associated with unfavorable overall survival (p < 0.001). However, after matching with age, tumor size, T and N stage, there was no significant difference among the overall survival of the three groups (p = 0.415).ConclusionsWell, moderately and poorly differentiation status was significantly associated with clinicopathological features of gastric cancer patients. However, it was not associated with the prognosis of gastric cancer patients.

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Section: Discussionsupporting

confidence: 59%

Prognostic value of differentiation status in gastric cancer

et al. 2018

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“…Although gastric adenocarcinoma seems to behave differently in Asian and Western countries [36,37], the four studies performed in the United States and Europe that have compared SRC with non-SRC gastric adenocarcinoma obtained similar results [4,5,23,38]. As also noted in those studies, we found that the SRC type was associated with a lower curative resection rate (79.8 vs 90.1 %; p \ 0.001) and poorer median overall survival (26.2 ± 1.62 vs 51.13 ± 6.09 months; p \ 0.001) than the non-SRC subtype, with significantly more frequent involvement of adjacent organs (16 vs 11.9 %), linitis (24.7 vs 2.1 %), peritoneal carcinomatosis (9.8 vs 4.3 %), advanced T stage (61.3 vs 41.8 % of pT3 and pT4 stage), Signet-ring cells in gastric cancer 1035 and lymph node involvement (73.2 vs 56 %).…”

Section: Discussionmentioning

confidence: 91%

Is signet-ring cell carcinoma a specific entity among gastric cancers?

et al. 2015

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Background The prognosis and chemoresistance of signet-ring cell (SRC) gastric adenocarcinoma have been reported and debated, and the utility of perioperative chemotherapy for such a tumor has been questioned. This study was performed to assess the impact of the SRC type on survival following resection of gastric adenocarcinoma, and to assess whether the prognostic factors (including perioperative chemotherapy) for non-SRC adenocarcinoma differed from those for SRC adenocarcinoma. Methods 1799 cases of adenocarcinoma that were consecutively treated from 1997 to 2010 in 19 French centers by subtotal or total gastrectomy were included in a retrospective study. A D2 lymphadenectomy was performed for antropyloric tumors, and a modified D2 for upper tumors. SRC adenocarcinoma was diagnosed based on the presence of isolated carcinoma cells containing mucin. Results A total gastrectomy was performed in 979 (54.4 %) patients. SRC adenocarcinoma was diagnosed in 899 (50 %) patients. Patients with an SRC tumor were more frequently female, younger, and malnourished, had lower ASA scores, and had larger tumors than non-SRC patients. Median survival in patients with non-SRC carcinoma was 51 months, as compared to 26 months in patients with SRC carcinoma (p \ 0.001). At multivariate analysis, SRC type remained an independent adverse prognostic factor (HR = 1.182). Factors that were prognostic in the SRC subgroup but not in the non-SRC subgroup were age [60 years, linitis, and involvement of adjacent organs. In contrast to non-SRC tumors, pre-and postoperative chemotherapy did not significantly impact on survival following resection of SRC adenocarcinoma. On behalf of the FREGAT (French Eso-GAstric Tumours) working group-FRENCH (Fédération de Recherche en Chirurgie).Electronic supplementary material The online version of this article (doi:10.1007/s10120-015-0564-2) contains supplementary material, which is available to authorized users. Conclusion In comparison to non-SRC adenocarcinoma, the SRC type has a worse prognosis, different prognostic factors, and is only poorly sensitive to perioperative chemotherapy. Non-SRC and SRC adenocarcinomas should be considered different entities in future therapeutic trials.

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“…Notably, 18 F-FDG PET/CT has low sensitivity in detecting early GC (EGC) and signet ring cell (SRC) GC, but many previous studies overlooked this, including heterogeneous populations in the studies and analyzing the clinical characteristics of the population as a whole. Because SRC GC is a unique histologic subtype of GC with a distinct tumor biology and bioenergetics, it should be analyzed separately [11][12][13][14].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer

et al. 2018

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Background The prognostic impact of preoperative 18 F-FDG PET/CT in advanced gastric cancer (AGC) remains a matter of debate. This study aims to evaluate the prognostic impact of SUV max in preoperative 18 F-FDG PET/CT of AGC according to histologic subtype, with a focus on the differences between tubular adenocarcinoma and signet ring cell (SRC) carcinoma. Methods As a discovery set, a total of 727 AGC patients from prospective database were analyzed according to histologic subtype with Cox proportional hazard model and p-spline curves. In addition, another 173 patients from an independent institution was assessed as an external validation set. Results In multivariate analysis, high SUV max in preoperative 18 F-FDG PET/CT of AGC was negatively correlated with disease-free survival (DFS) and overall survival (OS) in patients with diffuse type (DFS: HR 2.17, P < 0.001; OS: HR 2.47, P < 0.001) or SRC histology (DFS: HR 2.26, P = 0.005; OS: HR 2.61, P = 0.003). This negative prognostic impact was not observed in patients with intestinal type or well or moderately differentiated histology. These findings have been consistently confirmed in a validation set. The p-spline curves also showed a gradual increase in log HR as SUV max rises only for SRC histology and for diffuse-type AGC. Finally, a novel predictive model for recurrence of AGC with diffuse type or SRC histology was generated and validated based on the preoperative SUV max . Conclusions Preoperative high SUV max of AGC is a poor prognostic factor in those with diffuse type or SRC histology. This study is the first to demonstrate the differential prognostic impact of preoperative PET/CT SUV max in AGC according to histologic subtype and provide a clue to explain previous discrepancies in the prognostic impact of preoperative PET/CT in AGC. Prospective studies are required to validate the role of preoperative SUV max in AGC.

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Stage-Stratified Prognosis of Signet Ring Cell Histology in Patients Undergoing Curative Resection for Gastric Adenocarcinoma

Abstract: When compared with intestinal-type tumors, SRC tumors at early stages are not necessarily associated with poor outcomes.

Cited by 116 publications

References 23 publications

Prognostic value of differentiation status in gastric cancer

Prognostic value of differentiation status in gastric cancer

Is signet-ring cell carcinoma a specific entity among gastric cancers?

The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer

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