Imamura Taisuke, Komatsu Shuhei, Ichikawa Daisuke, Kawaguchi Tsutomu, Kosuga Toshiyuki, Okamoto Kazuma, Konishi Hirotaka, Shiozaki Atsushi, Fujiwara Hitoshi, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Surg Oncol. 2016 Oct;114(5):607-612. doi: 10.1002/jso.24377. Epub 2016 Aug 26.
The aim of this study was to evaluate the clinical characteristics of early signet ring cell carcinoma of the stomach (SRC) and to investigate the optimal treatment strategy for early SRC.
A total of 746 patients with pT1 gastric cancer (GC), who had undergone surgical resection between 1997 and 2012 were analyzed. Of these, 190 patients with SRC were enrolled in this study.
(i) The patients with SRC showed a significantly longer overall survival (P = 0.012) and disease free survival (P = 0.004) than patients with the other histological types. Multivariate analysis identified SRC as an independent factor predicting favorable prognosis in pT1 GC (HR = 0.38; 95% CI: 0.11-0.96; P = 0.041). Specifically, in undifferentiated pT1 GC, SRC was significantly less associated with lymph node metastasis (LNM) (OR = 0.39; 95% CI: 0.15-0.96; P = 0.042). (ii) From the viewpoint of a histological mixed-type, pure-SRC with pT1a was not associated with LNM regardless of tumor size (0.0%, 0/110), whereas mixed-SRC was an independent risk factor for LNM (OR = 7.19; 95% CI: 1.51-43.9; P = 0.012).
Patients with early SRC have a favorable prognosis with a low incidence of LNM. However, care should be taken with mixed-SRC, which consists of SRC and other histological types. J. Surg. Oncol. 2016;114:607-612. © 2016 Wiley Periodicals, Inc.
本研究旨在评估早期胃印戒细胞癌（SRC）的临床特征，并探讨早期SRC的最佳治疗策略。
分析了1997年至2012年间接受手术切除的746例pT1期胃癌（GC）患者。其中，190例SRC患者纳入本研究。
（i）SRC患者的总生存期（P = 0.012）和无病生存期（P = 0.004）显著长于其他组织学类型的患者。多因素分析确定SRC是pT1期GC预后良好的独立预测因素（HR = 0.38；95%CI：0.11 - 0.96；P = 0.041）。具体而言，在未分化的pT1期GC中，SRC与淋巴结转移（LNM）的相关性显著较低（OR = 0.39；95%CI：0.15 - 0.96；P = 0.042）。（ii）从组织学混合型的角度来看，无论肿瘤大小如何，pT1a期的纯SRC均与LNM无关（0.0%，0/110），而混合型SRC是LNM的独立危险因素（OR = 7.19；95%CI：1.51 - 43.9；P = 0.012）。
早期SRC患者预后良好，LNM发生率低。然而，对于由SRC和其他组织学类型组成的混合型SRC应予以关注。《外科肿瘤学杂志》2016年；114：607 - 6
