Tian Hua-Kai, Zhang Zuo, Ning Zhi-Kun, Liu Jiang, Liu Zi-Tao, Huang Hao-Yu, Zong Zhen, Li Hui
Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Department of Obstetrics and Gynecology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
World J Clin Cases. 2022 Oct 16;10(29):10451-10466. doi: 10.12998/wjcc.v10.i29.10451.
The clinicopathological features and prognosis of gastric signet ring cell carcinoma (GSRC) remain controversial, particularly with regard to sensitivity to postoperative adjuvant therapy.
To compare the pathological features of GSRC with those of gastric adenocarcinoma of different degrees of differentiation and the differences in survival prognosis between the different disease processes.
By screening gastric cancer patients from 2010 to 2015 in the database of Surveillance, Epidemiology and End Results, and collecting the clinicopathological and prognostic data of gastric cancer patients who underwent surgery from January 2014 to December 2016 in the Second Affiliated Hospital of Nanchang University, we analyzed the general pathological characteristics of GSRC by the chi-square test. Univariate and multivariate analyses were conducted to compare the factors affecting the survival and prognosis of early and advanced gastric adenocarcinoma. The Kaplan-Meier curves were plotted to reveal the survival difference between early and advanced GSRC and different differentiated types of gastric adenocarcinoma. The prognosis model of advanced GSRC was established with R software, and the area under curve (AUC) and C-index were used to assess the accuracy of the model.
Analysis of pathological features revealed that signet ring-cell carcinoma (SRC) was more frequently seen in younger (< 60 years), female, and White patients compared to non-SRC patients. SRC was less commonly associated with early gastric cancer (EGC) (23.60% 39.10%), lower N0 (38.61% 61.03%), and larger tumour sizes > 5 cm (31.15% 27.10%) compared to the differentiated type, while the opposite was true compared to the undifferentiated type. Survival prognostic analysis found no significant difference in the prognosis of SRC patients among EGC patients. In contrast, among advanced gastric cancer (AGC) patients, the prognosis of SRC patients was correlated with age, race, tumour size, AJCC stage, T-stage, and postoperative adjuvant therapy. The predictive model showed that the 3-year AUC was 0.787, 5-year AUC was 0.806, and C-index was 0.766. Compared to non-SRC patients, patients with SRC had a better prognosis in EGC [hazard ratio (HR): 0.626, 95% confidence interval (CI): 0.427-0.919, < 0.05] and a worse prognosis in AGC (HR: 1.139, 95%CI: 1.030-1.258, < 0.05). When non-SRC was divided into differentiated and undifferentiated types for comparison, it was found that in EGC, SRC had a better prognosis than differentiated and undifferentiated types, while there was no significant difference between differentiated and undifferentiated types. In AGC, there was no significant difference in prognosis between SRC and undifferentiated types, both of which were worse than differentiated types. A prognostic analysis of postoperative adjuvant therapy for SRC in patients with AGC revealed that adjuvant postoperative radiotherapy or chemotherapy significantly improved patient survival (34.6% and 36.2% 18.6%, < 0.05).
The prognosis of SRC is better than that of undifferentiated type, especially in EGC, and its prognosis is even better than that of differentiated type. SRC patients can benefit from early detection, surgical resection, and aggressive adjuvant therapy.
胃印戒细胞癌（GSRC）的临床病理特征及预后仍存在争议，尤其是在对术后辅助治疗的敏感性方面。
比较GSRC与不同分化程度胃腺癌的病理特征以及不同病程间生存预后的差异。
通过监测、流行病学和最终结果数据库筛选2010年至2015年的胃癌患者，并收集南昌大学第二附属医院2014年1月至2016年12月接受手术的胃癌患者的临床病理及预后数据，采用卡方检验分析GSRC的一般病理特征。进行单因素和多因素分析以比较影响早期和晚期胃腺癌生存及预后的因素。绘制Kaplan-Meier曲线以揭示早期和晚期GSRC以及不同分化类型胃腺癌之间的生存差异。使用R软件建立晚期GSRC的预后模型，并采用曲线下面积（AUC）和C指数评估模型的准确性。
病理特征分析显示，与非印戒细胞癌（SRC）患者相比，印戒细胞癌（SRC）在年龄较小（<60岁）、女性和白人患者中更为常见。与分化型相比，SRC与早期胃癌（EGC）的关联较少（23.60%对39.10%），N0较低（38.61%对61.03%），肿瘤大小>5 cm的比例较高（31.15%对27.10%），而与未分化型相比则相反。生存预后分析发现，EGC患者中SRC患者的预后无显著差异。相比之下，在进展期胃癌（AGC）患者中，SRC患者的预后与年龄、种族、肿瘤大小、AJCC分期、T分期及术后辅助治疗相关。预测模型显示，3年AUC为0.787，5年AUC为0.806，C指数为0.766。与非SRC患者相比，SRC患者在EGC中的预后较好[风险比（HR）：0.626，95%置信区间（CI）：0.427 - 0.919，P<0.05]，而在AGC中的预后较差（HR：1.139, 95%CI：1.030 - 1.258，P<0.05）。当将非SRC分为分化型和未分化型进行比较时，发现在EGC中，SRC的预后优于分化型和未分化型，而分化型和未分化型之间无显著差异。在AGC中，SRC与未分化型的预后无显著差异，两者均比分化型差。对AGC患者中SRC术后辅助治疗的预后分析显示，术后辅助放疗或化疗显著提高了患者生存率（34.6%和36.2%对18.6%，P<0.05）。
SRC的预后优于未分化型，尤其是在EGC中，其预后甚至优于分化型。SRC患者可从早期检测、手术切除及积极的辅助治疗中获益。
