gms | German Medical Science

Introduction: Gastric signet-ring cell carcinoma(SRCC) is one of the major histopathological subtypes of gastric cancer, which is defined as poorly differentiated adenocarcinoma. In fact, several studies comparing SRCC and NSRCC have yield inconsistent results. Little is known about the clinicopathological features of gastric SRCC patients. In this study, we aimed to evaluate of the clinicopathologic characteristics of SRCC compared with NSRCC, and to clarify the prognostic factors in gastric SRCC patients who underwent curative resection.

Material and methods: We report a retrospective study from January 2008 to September 2009 concerning 584 patients with gastric carcinoma at the Second Affiliated Hospital, Zhejiang University School of Medicine, China. The survival rates of the patients were calculated by using the Kaplan-Meier method and the relative prognostic importance of the parameters was investigated by using the Cox proportional hazards model.

Results: 101 patients(19.4%) of the 520 folow-up patients were pathologically diagnosed with SRCC. Multivariate analysis showed that presence of serosal invasion, lymph node metastasis, and operative type were significant prognostic factors for survival of gastric SGCC patients with curative resection. The median survival was shorter in the patients with adjuvant chemotherapy than that of the non-adjuvant chemotherapy patients(12.8 vs. 14.0 months, P = 0.046). Using univariate analysis, both the N stage of 7th edition UICC TNM classification(7th UICC N stage) and 6th UICC N stage were associated with the 3-year DFS of SGCC after curative surgery. However, Cox regression Multivariable analysis showed that the 7th UICC N stage was an independent prognostic factor instead of the 6th UICC N stage(P<0.01).

Conclusion: Gastric signet-ring cell carcinoma has a poor progenosis. Serosal invasion, lymph node metastasis, and type of operation were statistically significant parameters associated with survival of gastric SRCC. Adjuvant chemotherapy provided no survival benefit in patients with gastric SRCC after curative surgery. The 7th UICC classification for lymph node metastasis is thought to be a more reliable prognostic factor for gastric SRCC than the 6th classification.