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      Differences in clinicopathological characteristics and computed tomography findings between signet ring cell carcinoma and nonsignet ring cell carcinoma in early and advanced gastric cancer

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          Abstract

          Signet ring cell carcinoma ( SRC) of the stomach is a histological type based on microscopic characteristics. SRC's clinicopathological characteristics and prognosis are still controversial. Our study is to describe the clinicopathological features and multidetector computed tomography ( MDCT) findings of patients with SRC of the stomach in comparison with nonsignet ring cell adenocarcinoma ( NSRC). We retrospectively analyzed data from 241 patients who had undergone curative gastrectomy, including 62 SRC and 179 NSRC. Clinicopathological outcomes and MDCT findings were evaluated, and we investigated whether these variables were correlated with histopathological type. In early gastric carcinoma, patients with SRC were younger (50.2 vs. 60.2 years; =  0.000) and more likely to be observed in the middle and lower third stomach ( =  0.010). Early SRC had a tendency to be confined to the mucosa (82.1%). There were significant differences in degree of enhancement between early SRC and NSRC on MDCT imaging ( P < 0.001). In advanced gastric carcinoma, SRC was more likely to be stage T3‐4 (100%). SRC patients had thicker tumors ( P = 0.001) and a higher frequency of diffusely infiltrative gross appearance ( P < 0.001). SRC was more likely to have high‐degree contrast enhancement than were NSRC ( P = 0.001). The maximal diameter of SRC tumor on MDCT imaging correlated with lymph node metastasis (sensitivity 93.9%, specificity 74.1%) and serosal invasion (sensitivity 89.5%, specificity 78.0%) of SRC. In conclusion, SRC differs significantly from NSRC in clinicopathological features at presentation. MDCT could help differentiate advanced gastric SRC from NSRC based on the thickened stomach wall, high‐degree contrast enhancement, and a higher frequency of diffusely infiltrative gross appearance, particularly in combination.

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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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            Stage-stratified prognosis of signet ring cell histology in patients undergoing curative resection for gastric adenocarcinoma.

            The prognosis of signet ring cell (SRC) gastric adenocarcinoma is regarded as poor, although studies addressing outcomes in relation to non-SRC tumors are conflicting. Our objective was to compare the survival of SRC tumors with stage-matched intestinal-type tumors in a cohort of Western patients.
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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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                Author and article information

                Contributors
                cairong619@aliyun.com
                rengang@xinhuamed.com.cn
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                13 March 2018
                April 2018
                : 7
                : 4 ( doiID: 10.1002/cam4.2018.7.issue-4 )
                : 1160-1169
                Affiliations
                [ 1 ] Department of Radiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai 200092 China
                [ 2 ] Department of Radiotherapy Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai 200025 China
                [ 3 ] Department of Pathology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai 200092 China
                [ 4 ] Department of Surgery Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai 200092 China
                Author notes
                [*] [* ] Correspondence

                Rong Cai, Department of Radiotherapy, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, P.R. China. Tel: (011)8621‐64370045; Fax: (011)8621‐64156886; E‐mail: cairong619@ 123456aliyun.com

                and

                Gang Ren, Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kong‐Jiang Road, Shanghai, 200092, P.R. China. Tel: (011)8621‐25077032; Fax: (011)8621‐65153984; E‐mail: rengang@ 123456xinhuamed.com.cn

                [†]

                These authors have contributed equally to this work.

                Author information
                http://orcid.org/0000-0003-2455-9741
                Article
                CAM41417
                10.1002/cam4.1417
                5911613
                29533002
                6c97ff7b-0087-4eea-8403-229850ca6ef4
                © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 October 2017
                : 26 January 2018
                : 29 January 2018
                Page count
                Figures: 3, Tables: 4, Pages: 10, Words: 6945
                Funding
                Funded by: Shanghai Municipal Education Commission Fund
                Award ID: No.12Y2034
                Funded by: Shanghai Jiao‐tong University Medical School for Scientific Research
                Award ID: No. 09XJ21013
                Funded by: Shanghai Health Bureau Fund for Scientific Research
                Award ID: Nos. 2010029
                Award ID: 2010057
                Funded by: Shanghai Science and Technology Commission Fund for Scientific Research
                Award ID: No. 124119a0300
                Categories
                Original Research
                Clinical Cancer Research
                Original Research
                Custom metadata
                2.0
                cam41417
                April 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.4 mode:remove_FC converted:23.04.2018

                Oncology & Radiotherapy
                comparative study,gastric cancer,multidetector computed tomography,signet ring cell carcinoma

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