Sorrenti Salvatore, Malerba Silvia, Lori Eleonora, Pironi Daniele, Polom Karol, Skokowski Jaroslaw, Girnyi Sergii, Cwalinski Tomasz, Prete Francesco Paolo, Vashist Yogesh K, Testini Mario, Marano Luigi
Department of Surgery, "Sapienza" University of Rome, 00161 Roma, Italy.
Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70110 Bari, Italy.
Cancers (Basel). 2025 Jul 19;17(14):2400. doi: 10.3390/cancers17142400.
: Gastric signet-ring cell carcinoma (GSRCC) is an aggressive gastric cancer subtype with limited evidence supporting the role of neoadjuvant chemotherapy (NAC). This study evaluated the impact of NAC on overall survival (OS) in a large, population-based cohort. : We analyzed data from the SEER database (2011-2018), identifying patients aged 20-80 years with primary gastric tumors (C16.0-C16.9) and signet-ring cell histology who underwent curative-intent gastrectomy. Patients with metastatic disease, non-curative surgery, clinical Stage I, incomplete staging, or unknown survival were excluded. OS was assessed using Kaplan-Meier analysis and multivariable Cox regression. Subgroup analyses evaluated the interaction of NAC with tumor location and clinical stage. : A total of 978 patients met inclusion criteria; 436 (44.6%) received NAC. The 3- and 5-year OS rates were 43.9% and 38.3%, respectively. NAC was not associated with improved OS compared to surgery alone (5-year OS: 39.7% vs. 37.2%; log-rank = 0.34) and was not an independent prognostic factor in multivariable analysis ( = 0.651). Independent predictors of worse OS included larger tumor size, advanced stage, positive nodal status, and Black race (all < 0.05). Subgroup analysis indicated a survival benefit from NAC in patients with mid or distal gastric tumors ( < 0.001 for interaction). : In this SEER-based analysis, NAC did not improve OS in the overall GSRCC population. However, selected subgroups may derive benefit, supporting a personalized approach to neoadjuvant therapy in GSRCC.
胃印戒细胞癌（GSRCC）是一种侵袭性胃癌亚型，支持新辅助化疗（NAC）作用的证据有限。本研究评估了NAC对一个大型的、基于人群的队列中总生存期（OS）的影响。
我们分析了监测、流行病学和最终结果（SEER）数据库（2011 - 2018年）的数据，确定年龄在20 - 80岁之间、患有原发性胃肿瘤（C16.0 - C16.9）且组织学为印戒细胞的患者，这些患者接受了根治性胃切除术。排除有转移性疾病、非根治性手术、临床I期、分期不完整或生存情况未知的患者。使用Kaplan - Meier分析和多变量Cox回归评估总生存期。亚组分析评估了NAC与肿瘤位置和临床分期的相互作用。
共有978例患者符合纳入标准；436例（44.6%）接受了NAC。3年和5年总生存率分别为43.9%和38.3%。与单纯手术相比，NAC并未改善总生存期（5年总生存率：39.7%对37.2%；对数秩检验 = 0.34），并且在多变量分析中不是独立的预后因素（ = 0.651）。总生存期较差的独立预测因素包括肿瘤体积较大、晚期、淋巴结阳性状态和黑人种族（所有P < 0.05）。亚组分析表明，NAC对胃中部或远端肿瘤患者有生存获益（相互作用P < 0.001）。
在这项基于SEER的分析中，NAC并未改善GSRCC总体人群的总生存期。然而，特定亚组可能从中获益，支持对GSRCC采用个性化的新辅助治疗方法。
