Roviello Franco, Marano Luigi, Ambrosio Maria Raffaella, Resca Luca, D'Ignazio Alessia, Petrelli Federica, Petrioli Roberto, Costantini Maurizio, Polom Karol, Macchiarelli Raffaele, Biviano Ivano, Marrelli Daniele
Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
Eur J Surg Oncol. 2022 Mar;48(3):561-569. doi: 10.1016/j.ejso.2021.09.003. Epub 2021 Sep 7.
Signet ring cells (SRC) are widely acknowledged as a prognostically unfavorable histotype amongst poorly cohesive gastric cancer. In this study we evaluated the impact of SRC percentage on the clinical, pathological and prognostic features of these tumors according to the classification by the European Chapter of the IGCA.
We retrospectively reviewed records of patients with poorly cohesive gastric cancer that underwent surgery between 1995 and 2016, whose tissue specimens were available in a biological bank. All slides were put under revision, patients were reclassified into three groups according to the proportion of signet ring cells: "pure" SRC (containing ≥90% of SRCs), Poorly Cohesive-Not Otherwise Specified (PC-NOS) (containing ≤10% of SRCs), and PC-NOS/SRC (containing <90% but >10% of SRCs). The clinicopathological factors between different types were analyzed and prognostic differences were compared.
Among 143 enrolled patients, 51% were male and 49% were female. The mean (±SD) age at diagnosis was 61 ± 13.9 years. Eighty-seven patients (60.8%) were reclassified as PC-NOS, 56 (39.2%) as PC-NOS/SRC and none as "pure" SRC. Five-years overall survival was significantly higher in PC-NOS/SRC group (63.3%) compared with PC-NOS group (12.7%). The increase in mortality risk was more than four-fold in patients with PC-NOS pattern compared to those with PC-NOS/SRC (HR 4.32 [95% CI 2.5-7.4]. After adjustment for potential confounding factors, SRC pattern was still an independent predictor of survival.
The percentage of SRCs is inversely related to tumor aggressiveness, confirming the role of SRC pattern as an independent predictor of survival.
印戒细胞（SRC）在低黏附性胃癌中被广泛认为是一种预后不良的组织学类型。在本研究中，我们根据国际胃癌协会欧洲分会的分类方法，评估了SRC百分比对这些肿瘤的临床、病理和预后特征的影响。
我们回顾性分析了1995年至2016年间接受手术治疗的低黏附性胃癌患者的记录，这些患者的组织标本保存在生物样本库中。对所有切片进行复查，根据印戒细胞的比例将患者重新分为三组：“纯”SRC（含≥90%的SRC）、低黏附性-未另行指定（PC-NOS）（含≤10%的SRC）和PC-NOS/SRC（含<90%但>10%的SRC）。分析不同类型之间的临床病理因素，并比较预后差异。
在143例入组患者中，51%为男性，49%为女性。诊断时的平均（±标准差）年龄为61±13.9岁。87例患者（60.8%）被重新分类为PC-NOS，56例（39.2%）为PC-NOS/SRC，无患者被分类为“纯”SRC。PC-NOS/SRC组的5年总生存率（63.3%）显著高于PC-NOS组（12.7%）。与PC-NOS/SRC患者相比，PC-NOS模式患者的死亡风险增加了四倍多（HR 4.32 [95% CI 2.5 - 7.4]）。在调整潜在混杂因素后，SRC模式仍然是生存的独立预测因素。
SRC的百分比与肿瘤侵袭性呈负相关，证实了SRC模式作为生存独立预测因素的作用。
