Xu Zhonghang, Jin Yinzhi, Fang Xuedong
Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China.
Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China.Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Oct 25;21(10):1196-1200.
Epidemiological studies in recent years have found that the incidence of gastric signet ring cell carcinoma (SRCC) has increased significantly. In this paper, we first reviewed cell origin and biomarkers of SRCC, and the relationship between SRCC and various pathological types of gastric cancer. The early diagnosis rate of gastric SRCC is low, which may be due to the unclear mechanism of pathology and precancerous lesions. In clinical practice, SRCC has the characteristics of low differentiation and high degree of malignancy. Most of patients with gastric cancer Borrmann IV(diffuse infiltrative type) are gastric SRCC, and their prognosis is poor. The average age of gastric SRCC was 55 to 61 years old. Besides, in female, the incidence of SRCC was significantly higher than that of non-SRCC gastric cancer. It is found that the expressions of estrogen and progesterone receptors in SRCC tissues are high. The relationship between gastric SRCC and sex hormones may be the cause of gender differences in the pathogenesis of gastric SRCC. Due to the low risk of lymph node metastasis in early SRCC, endoscopic mucosal resection and endoscopic submucosal dissection can be performed for <3 cm, submucosal invasive, medium differentiated tumors, or <3 cm, highly differentiated, ulcerative and submucosal lesions. For non-metastatic advanced gastric SRCC, surgical resection and adequate lymph node dissection should be performed owing to the high risk of lymph node metastasis. Adjuvant chemotherapy is also considered to improve the long-term prognosis of patients. Taxane therapy may be more effective in gastric SRCC. Recent data show that gastric SRCC and diffuse gastric cancer are more sensitive to mitomycin C, doxorubicin and docetaxel than intestinal type gastric cancer, but are not sensitive to fluorouracil and cisplatin. These treatment perspectives still need to be confirmed in future studies.
近年来的流行病学研究发现，胃印戒细胞癌（SRCC）的发病率显著增加。在本文中，我们首先综述了SRCC的细胞起源、生物标志物以及SRCC与胃癌各种病理类型之间的关系。胃SRCC的早期诊断率较低，这可能是由于病理机制和癌前病变尚不清楚。在临床实践中，SRCC具有低分化和高恶性程度的特点。大多数Borrmann IV型（弥漫浸润型）胃癌患者为胃SRCC，其预后较差。胃SRCC患者的平均年龄为55至61岁。此外，在女性中，SRCC的发病率明显高于非SRCC型胃癌。研究发现，SRCC组织中雌激素和孕激素受体的表达较高。胃SRCC与性激素之间的关系可能是胃SRCC发病机制中性别差异的原因。由于早期SRCC的淋巴结转移风险较低，对于直径<3 cm、黏膜下浸润、中度分化的肿瘤，或直径<3 cm、高分化、溃疡性且侵犯黏膜下层的病变，可进行内镜黏膜切除术和内镜黏膜下剥离术。对于非转移性进展期胃SRCC，由于淋巴结转移风险高，应进行手术切除并充分清扫淋巴结。辅助化疗也被认为可改善患者的长期预后。紫杉烷类疗法在胃SRCC中可能更有效。最近的数据显示，胃SRCC和弥漫性胃癌比肠型胃癌对丝裂霉素C、阿霉素和多西他赛更敏感，但对氟尿嘧啶和顺铂不敏感。这些治疗观点仍需在未来的研究中得到证实。
