Tailored treatment for signet ring cell gastric cancer

Abstract

Gastric cancer with Laurèn diffuse types is increasing in the West. The raising trend is more evident when considering signet ring cells (SRC) histology. However, to control the biologic potential of this GC subtype, some hypotheses of tailored therapeutic strategies for SRC cancers have been made. A review of the literature was performed using the key words "signet ring cells" AND "gastric cancer". Results of literature review were descriptively reported. Endoscopic submucosal dissection (ESD), according to the Japanese extended criteria, could be a therapeutic option for early SRC tumours. However, according to the evidences from more recent studies, indications for ESD to these tumours types should be carefully considered. Concerning the optimal surgical treatment, considering the high lymphotropism and infiltrating behaviour of SRC histotype, the extension of gastric resection should be wider than for intestinal type cancer and laparoscopic surgery should be performed carefully. Moreover, D3 lymphadenectomy could provide a benefit in diffuse-type and SRC histology. The role of surgery in gastric cancer with peritoneal carcinomatosis is still debated and studies on this topic should stratify the good results according to GC histotype. Finally, despite the evidences of chemoresistance in SRC, ongoing randomized trials suggest that multimodal therapy could be the best treatment. Based on the assumption that SRC tumours have specific features, they deserve a specific multimodal treatment. However, a preliminary step to generate strong evidences in this field is the standardization of terminology used to define signet ring cells carcinoma.

Nomograms for Predicting the Lymph Node Metastasis in Early Gastric Cancer by Gender: A Retrospective Multicentric Study

“…Among the WHO type and Lauren type, signet-ring cell carcinoma and diffuse type owned the greatest risk of LNM, respectively ( Figure 4 ) due to their high lymph tropism and infiltrating behavior. Therefore, the extension of gastric resection might be more beneficial for EGC patients with diffuse type and signet-ring cell carcinoma ( 27 ). LVI, as another contraindication for ER, is easily ignored before surgery.…”

Development and Validation of a Prognostic Nomogram for Gastric Signet Ring Cell Carcinoma: A Multicenter Population-Based Study

“…Nevertheless, radical tumor resection (R0 resection) is still the optimal treatment ( 5 ). Due to the non-specific symptoms, such as pain or vomiting, curative resection is not suitable for most patients, resulting in a negative impact on GSRCC patients’ prognosis ( 6 ). Therefore, research on GC containing signet ring cell components becomes essential.…”

Signet ring cell cancer of stomach and gastro-esophageal junction: molecular alterations, stage-stratified treatment approaches, and future challenges

“…Japan Gastric Cancer Association (JGCA) treatment guidelines also recommends extended criteria for undifferentiated histology; however, ambiguity still persists regarding oncological safety of therapeutic endoscopic approach [60]. In the west, EGC has higher reported rate of lymph node metastasis than those reported in eastern studies [4,61]. Recent studies have also reported higher rate of lymph node spread in SRCC [62,63].…”

“…The Italian Research Group for Gastric Cancer (GIRCG) in a retrospective study reported lower recurrence rate in advanced gastric cancer with diffuse histology following D3 lymphadenectomy [69]. Due to the lymph tropism and higher tendency for metastasis to D3 lymph nodes in diffuse histology [4,70], the role of extended lymphadenectomy needs to be established in future studies.…”

“…The incidence of gastro-esophageal junction (GEJ) cancers, however, has been increasing in high income countries [1,2]. Recent studies have found an increase in incidence of GEJ/gastric cardia intestinal and Lauren diffuse histological subtypes with a decrease in the incidence of non-cardia intestinal subtypes [3,4]. There has been a constant rise in the incidence of signet ring cell cancers (SRCC) as well [4][5][6][7][8].…”