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      Clinicopathological Characteristics and Survival Outcomes of Primary Signet Ring Cell Carcinoma in the Stomach: Retrospective Analysis of Single Center Database

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          Abstract

          Purpose

          To investigate the clinicopathological features and prognosis of signet ring cell carcinoma of the stomach (SRC).

          Methods

          A total of 1464 gastric cancer patients who underwent curative gastrectomy from 2000 to 2008 at a single center were evaluated. Signet ring cell carcinoma (SRC) was defined as the presence of at least 50% signet ring cells in the pathologic specimen. The clinicopathological parameters and prognosis of SRC were analyzed by comparing with non-signet ring cell carcinoma (NSRC).

          Results

          Of 1464 patients, 138 patients (9.4%) were classified as SRC. There were significant differences in gender, age, tumor location, TNM stage, p21 expression, and p53 expression between SRC and NSRC. The 5-year survival rates of SRC and NSRC were 36.2% and 49.5%, respectively. The prognosis of SRC was poorer than that of NSRC ( P <0.001). Multivariate analysis showed that SRC histology was an independent factor for poor prognosis ( P <0.001).

          Conclusion

          Patients with SRC tend to present with a more advanced stage and poorer prognosis than patients with other types of gastric carcinoma.

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          Most cited references12

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          Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach.

          Signet ring cell carcinoma (SRC) of the stomach is a histological type based on microscopic characteristics. Although the distinctive clinicopathological features of SRC have been reported, results are inconsistent and survival outcomes are uncertain.
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            Advanced Gastric Carcinoma with Signet Ring Cell Histology

            Background: Gastric signet ring cell carcinoma (SRC) is a histological type based on microscopic characteristics and not on biological behavior. This study compared the clinicopathological features and prognosis of advanced SRC with non-signet ring cell adenocarcinoma (NSRC) of the stomach. Methods: We reviewed the records of 4,759 consecutive patients diagnosed with advanced gastric adenocarcinoma who were resected surgically from 1987 to 2003. Of these, 662 patients (13.9%) had SRC and were compared with 4,097 patients with NSRC. Results: Significant differences were noted in tumor size, Borrmann type, depth of invasion, lymph node metastasis, peritoneal dissemination and TNM stage. The cumulative 5-year survival rate for advanced SRC was 42.4%, compared with 50.1% in NSRC (p = 0.009). Multivariate analysis showed that tumor size ≧5 cm, Borrmann III and IV, T3–4 invasion and SRC histology were independent risk factors for lymph node metastasis. Depth of invasion, lymph node metastasis, hepatic and peritoneal metastasis and surgical curability were significant factors affecting survival. SRC histology alone was not an independent prognostic factor. Conclusions: Advanced gastric SRC tends toward deeper tumor invasion and more lymph node and peritoneal metastasis than NSRC. Advanced gastric SRC had a worse prognosis than NSRC. Therefore, curative surgical operation with extended lymph node dissection is recommended.
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              Prognostic significance of signet ring cell carcinoma of the stomach.

              A retrospective analysis of 3,702 gastric cancer patients operated on between 1981 and 1991 was carried out to compare the clinicopathological features of signet ring cell (SRC) gastric cancer with other cell types. Four hundred and fifty patients (12.2%) had signet ring cell gastric carcinoma. There was a tendency for patients with the signet ring cell gastric cancer to be younger and female, and of the middle-third part of stomach to be involved. The proportion of early gastric cancers in signet ring cell gastric cancers was 43%, which was significantly higher than in the other histological types [33% in well differentiated (WD) type, 23% in moderately differentiated (MD) type, and 13% in poorly differentiated (PD) type]. Early stage signet ring cell gastric carcinomas were less invasive in depth and had less lymph node metastasis. However, signet ring cell gastric cancers in advanced stage were more invasive and had more lymph node metastasis than other cell types. There was no significant difference in five year survival rates (5YSR) among patients with different histological cell types in early stage gastric cancers. But, in advanced gastric cancers, the prognosis for patients with the signet ring cell type was significantly worse than for the other types (SRC, 31.9% 5YSR; WD, 45.1% 5YSR; MD, 38.4% 5YSR; PD, 34.5% 5YSR) (P < 0.05), which can be explained by the finding that advanced gastric cancers with signet ring cell type have a larger tumour size, more lymph node metastasis, a deeper invasive depth and more Borrmann type 4 lesions than other histological types. This study suggests that signet ring cell gastric cancer may have a different biological behaviour.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 December 2015
                2015
                : 10
                : 12
                : e0144420
                Affiliations
                [1 ]Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai 200032, China
                [2 ]Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
                [3 ]Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
                Duke Cancer Institute, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: XWL YNW. Performed the experiments: XWL ZWL WQS LY. Analyzed the data: XWL HC YNW YQS. Contributed reagents/materials/analysis tools: YQS WQS LY. Wrote the paper: XWL YNW.

                Article
                PONE-D-15-19712
                10.1371/journal.pone.0144420
                4671648
                26642199
                04a75d74-fb83-4869-b35c-1eac81bca393
                © 2015 Liu et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 6 May 2015
                : 18 November 2015
                Page count
                Figures: 3, Tables: 6, Pages: 13
                Funding
                This research is supported by grants from the Shanghai Committee of Science and Technology Funds (Contract grant numbers: 14ZR1407800, 124119a4302), and the National Natural Science Foundation of China (81502027). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of manuscript.
                Categories
                Research Article
                Custom metadata
                Data are available from the Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, for researchers who meet the criteria for access to confidential data. Interested researchers may contact the corresponding author with queries related to data access.

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