Objective: The aim of this study was to analyze the clinicopathologic characteristics and prognosis of signet ring cell carcinoma (SRC) according to disease status (early vs advanced gastric cancer) in gastric cancer patients.
Background: The prognostic implication of gastric SRC remains a subject of debate.
Methods: A retrospective analysis was performed using the clinical records of 7667 patients including 1646 SRC patients who underwent radical gastrectomy between 2001 and 2010. A further analysis was also performed after dividing patients into three groups according to histologic subtype: SRC, well-to-moderately differentiated (WMD), and poorly differentiated adenocarcinoma.
Results: SRC patients have younger age distribution and female predominance compared with other histologic subtypes. Notably, the distribution of T stage of SRC patients was distinct, located in extremes (T1: 66.2% and T4: 20%). Moreover, the prognosis of SRC in early gastric cancer and advanced gastric cancer was contrasting. In early gastric cancer, SRC demonstrated more favorable prognosis than WMD after adjusting for age, sex, and stage. In contrast, SRC in advanced gastric cancer displayed worse prognosis than WMD. As stage increased, survival outcomes of SRC continued to worsen compared with WMD.
Conclusions: Although conferring favorable prognosis in early stage, SRC has worse prognostic impact as disease progresses. The longstanding controversy of SRC on prognosis may result from disease status at presentation, which leads to differing prognosis compared with tubular adenocarinoma.
*Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA Univerisity, Seongnam, Korea
†Yonsei Graduate School, Yonsei University College of Medicine, Seoul, Korea
‡Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
§Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
||Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
¶Department of internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicinem Guri, Korea
**Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
††Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
Reprints: Hei-Cheul Jeung, MD, PhD, Division of Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro (146–92, Dogok-Dong), Gangnam-Gu, Seoul 06273, Korea. E-mail: firstname.lastname@example.org.
Disclosure: This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (1420060), the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI13C2096), and the Research Driven Hospital R&D project, funded by the CHA Bundang Medical Center (grant number: BDCHA R&D 2015-38).
Authors’ contributions: H.C.J., H.J.C., and W.J.H. contributed in the study concept, design, and supervision. H.C.J., H.J.C., W.J.H., S.H.N. contributed in the acquisition of data. H.C.J., H.J.C., W.J.H., S.P., H.K., C.K., C.H.P., J.H.K., J.B.A., H.C.C., S.Y.R., and S.H.N. contributed in the analysis and interpretation of data and drafting of the manuscript. H.C.J., H.J.C., W.J.H., S.P., C.K., C.H.P., J.H.K., J.B.A., H.C.C., S.Y.R., and S.H.N. contributed in the critical revision of the manuscript for important intellectual content. H.C.J., H.J.C., W.J.H., S.P., and C.K. contributed in the statistical analysis of the study. H.C.J. obtained funding, technical, and material support.
H.J.C and W.J.H. contributed equally to this work as co-first authors
The authors declare no conflicts of interest.
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