The prognostic value of signet ring cell histology in resected gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 128-128 ◽  
Author(s):  
Lauren McLendon Postlewait ◽  
Malcolm Hart Squires ◽  
David A. Kooby ◽  
George A. Poultsides ◽  
Sharon M. Weber ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Cox Regression ◽  
Preoperative Evaluation ◽  
Signet Ring Cell ◽  
Tnm Stage ◽  
Specific Analysis ◽  
Pathologic Features ◽  
Signet Ring ◽  
Ring Cell

128 Background: Conflicting data exist on the prognostic implication of signet ring cell (SRC) histology in gastric adenocarcinoma (GAC). Our aim was to assess the association of SRC with recurrence and survival in patients undergoing resection of GAC. Methods: All pts who underwent curative intent resection for GAC from 2000 to 2012 at 7 academic institutions comprising the US Gastric Cancer Collaborative were included. 30-day mortalities were excluded. Survival analyses included Kaplan Meier log rank and multivariate Cox regression. Primary endpoints were recurrence-free survival (RFS) and overall survival (OS). Stage-specific analysis was performed. Results: Of 965 pts, 768 met inclusion criteria. SRC was present in 39.5% and was associated with female gender (52.9% vs 38.6%; p<0.001), younger age (61 vs 67 yrs; p<0.001), poor differentiation (94.8% vs 50.3%; p<0.001), perineural invasion (PNI: 41.4% vs 23%; p<0.001), distal location (82.2% vs 70.1%; p<0.001), receipt of adjuvant therapy (63% vs 51.2%; p=0.002), and more advanced stage (Stage 3: 55.2% vs 36.5%; p<0.001). SRC was associated with earlier recurrence (56.7mo vs median not reached (MNR); p=0.009) and decreased OS (33.7mo vs 46.6mo; p=0.011). When accounting for other adverse pathologic features, PNI (HR 1.57; p=0.016) and higher TNM stage (HR 2.63; p<0.001) were associated with decreased RFS, but SRC was not. PNI (HR 1.53; p=0.006), higher TNM Stage (HR 2.10; p<0.001), greater size (HR 1.05; p=0.014), and adjuvant therapy (HR 0.50; p<0.001) were associated with OS. SRC was not an independent predictor of OS. Stage-specific analysis showed no association between SRC and RFS or OS in Stage 1 or 3. In Stage 2, SRC was associated with earlier recurrence (38.1mo vs MNR; p=0.005) but not OS. The negative association of SRC with decreased RFS persisted in multivariate analysis (HR 3.11; p=0.015). Conclusions: Signet ring histology is associated with other adverse pathologic features including higher grade and higher TNM stage but is not independently associated with reduced RFS or OS. Identification of signet ring histology during preoperative evaluation should not, in isolation, dictate treatment strategy.

scholarly journals Should signet-ring cell histology alter the treatment approach for clinical stage I gastric cancer?

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 321-321
Author(s):  
Michael K. Turgeon ◽  
Adriana C. Gamboa ◽  
Manali Rupji ◽  
Rachel M. Lee ◽  
Jeffrey M. Switchenko ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Clinical Stage ◽  
Signet Ring Cell ◽  
Stage I ◽  
Perioperative Chemotherapy ◽  
Pathologic Stage ◽  
Signet Ring ◽  
Ring Cell

321 Background: Upfront surgery is standard of care for stage I gastric cancer. Despite this, many clinicians administer preoperative therapy for clinical stage I disease with signet ring cell histology, given its aggressive biology. We aimed to assess the validity of this practice. Methods: The National Cancer Database (2004-2015) was reviewed for pts with non-metastatic signet ring cell gastric cancer who underwent treatment with surgery alone, perioperative chemotherapy, neoadjuvant therapy, or adjuvant therapy. Analysis was stratified by preoperative clinical stage and pathologic stage. Primary outcome was overall survival (OS). Results: Of 3000 pts, median age was 61 (IQR: 51-70). 34% were clinical stage I (n = 1018) of which 53% received surgery alone (n = 542), 5% perioperative chemotherapy (n = 47), 12% neoadjuvant therapy (n = 125), and 30% adjuvant therapy (n = 304). Median follow-up was 26 mos. For clinical stage I disease, surgery alone was associated with improved median OS (108 mos) when compared to perioperative chemotherapy (80 mos), neoadjuvant therapy (41 mos), or adjuvant therapy (73 mos, all p < 0.001). For pathologic stage I, surgery alone had equivalent survival to perioperative and adjuvant therapy (5-yr OS: 81 vs 82 vs 79%, p = 0.22). Concordance between clinical and pathologic stage I was 56%, specifically, 41% of clinical stage I pts were upstaged to pathologic stage II (44%) and stage III (56%). Adjuvant therapy for these pts was associated with improved median OS compared to pretreatment (perioperative chemotherapy / neoadjuvant therapy) for those upstaged to pathologic stage II (122 vs 37mos, p < 0.001) or stage III (40 vs 18mos, p < 0.001) disease. Conclusions: Our stage-stratified study demonstrates improved survival with upfront surgery for clinical stage I signet ring cell gastric cancer. Despite 41% of clinical stage I pts being upstaged to stage II or III on final pathology, adjuvant therapy offers a favorable rescue strategy, with improved outcomes compared to those treated preoperatively. Surgery alone also affords similar survival for pathologic stage I disease compared to multimodal therapy. This study challenges the intrinsic bias to over-treat stage I signet ring cell gastric cancer.

Subgroup analysis of JCOG0501 phase III study to confirm superiority of additional neoadjuvant chemotherapy with S-1 plus cisplatin to D2 gastrectomy with S-1 adjuvant chemotherapy for resectable type IV or large type III gastric cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 110-110 ◽  
Author(s):  
Hitoshi Katai ◽  
Yoshiaki Iwasaki ◽  
Masanori Terashima ◽  
Junki Mizusawa ◽  
Hiroshi Katayama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Treatment Effect ◽  
Cox Regression ◽  
Signet Ring Cell ◽  
Phase Iii ◽  
Peritoneal Cytology ◽  
Large Type ◽  
Signet Ring ◽  
Ring Cell

110 Background: We previously reported that the superiority of neoadjuvant chemotherapy (NAC) with S-1 plus cisplatin was not demonstrated for schirrhous or similar macroscopic type (type 4 or large type 3) gastric cancer. However, overall survival (OS) in both arms was better than previous reports (3-year OS: 62.4% in gastrectomy plus adjuvant S-1 [arm A] and 60.9% in NAC followed by gastrectomy plus adjuvant S-1 [arm B]). Therefore, we explored whether histology and peritoneal cytology are associated with treatment effect. Methods: After staging laparoscopy, a total of 300 eligible patients with clinically resectable disease were randomized to arm A, or arm B. In this report, treatment effect was explored in key subgroups such as histology and peritoneal cytology using the data from JCOG0501. Cox regression model was used to investigate the interaction between arms and subgroups. Results: Hazard ratio (HR) classified by histology (excluding one missing) was 0.686 (95% CI: 0.414-1.138) for non-signet type (n = 123) and 1.158 (95% CI: 0.805-1.666) for signet type (n = 176) (p = 0.098 for interaction). HR by peritoneal cytology was 0.870 (95%CI: 0.616-1.228) for the negative (n = 240) and 1.051 (95% CI: 0.598-1.845) for the positive (n = 60) (p = 0.513 for interaction). 3 year-OS of signet ring cell histology was 63.2% (95% CI: 52.2-72.4) in arm A and 51.7% (95% CI: 40.9-61.5) in arm B, that of non-signet ring cell histology was 62.3% (95% CI: 48.9-73.1) in arm A and 74.2% (95% CI: 61.4-83.3) in arm B, and that of peritoneal cytology positive was 35.7% (95% CI: 18.9-53.0) in arm A and 25.0% in arm B (95% CI: 11.8-40.7), and that of peritoneal cytology negative was 68.6% (95% CI: 59.5-76.1) in arm A and 70.6% (95% CI: 61.5-77.9) in arm B. Conclusions: NAC might be beneficial for non-signet ring cell histology. Considering the survival results, primary surgery followed by S-1 could be recommended for this disease even though histology was signet ring cell type or peritoneal cytology was positive. Clinical trial information: UMIN000000279.

scholarly journals Transcriptome Analysis and the Prognostic Role of NUDC in Diffuse and Intestinal Gastric Cancer

2021 ◽  
Vol 20 ◽  
pp. 153303382110195
Author(s):  
Sang-Ho Jeong ◽  
Miyeong Park ◽  
Sun Yi Park ◽  
Jiho Park ◽  
Tae-Han Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Signet Ring Cell ◽  
Negative Group ◽  
Diffuse Type ◽  
Prognostic Role ◽  
Cancer Driver ◽  
Signet Ring ◽  
Ring Cell ◽  
Variant Analysis ◽  
Well Differentiated

Introduction: There have been few studies about gene differences between patients with diffuse-type gastric cancer and those with intestinal-type gastric cancer. The aim of this study was to compare the transcriptomes of signet ring cell gastric cancer (worst prognosis in diffuse-type) and well-differentiated gastric cancer (best prognosis in intestinal-type); NUDC was identified, and its prognostic role was studied. Materials and Methods: We performed next-generation sequencing with 5 well-differentiated gastric cancers and 3 of signet ring cell gastric cancer surgical samples. We performed gene enrichment and functional annotation analysis using the Database for Annotation, Visualization and Integrated Discovery bioinformatics resources. Immunohistochemistry was used to validate NUDC expression. Results: Overall, 900 genes showed significantly higher expression, 644 genes showed lower expression in signet ring cell gastric cancer than in well-differentiated gastric cancers, and there was a large difference in adhesion, vascular development, and cell-to-cell junction components between the 2 subtypes. We performed variant analysis and found 52 variants and 30 cancer driver genes, including NUDC. We analyzed NUDC expression in gastric cancer tissue and its relationship with prognosis. Cox proportional hazard analysis identified T stage, N stage, and NUDC expression as independent risk factors for survival ( P < 0.05). The overall survival of the NUDC-positive group was significantly higher (53.2 ± 0.92 months) than that of the NUDC-negative group (44.6 ± 3.7 months) ( P = 0.001) in Kaplan-Meier survival analysis. Conclusion: We found 30 cancer driver gene candidates and found that the NUDC-positive group showed significantly better survival than the NUDC-negative group via variant analysis.

scholarly journals A Prognostic Model for Patients With Gastric Signet Ring Cell Carcinoma

2021 ◽  
Vol 20 ◽  
pp. 153303382110279
Author(s):  
Qinping Guo ◽  
Yinquan Wang ◽  
Jie An ◽  
Siben Wang ◽  
Xiushan Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Training Set ◽  
Cox Regression Analysis ◽  
Signet Ring ◽  
Ring Cell ◽  
Independent Risk Factors

Background: The aim of our study was to develop a nomogram model to predict overall survival (OS) and cancer-specific survival (CSS) in patients with gastric signet ring cell carcinoma (GSRC). Methods: GSRC patients from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to the training and validation sets. Multivariate Cox regression analyses screened for OS and CSS independent risk factors and nomograms were constructed. Results: A total of 7,149 eligible GSRC patients were identified, including 4,766 in the training set and 2,383 in the validation set. Multivariate Cox regression analysis showed that gender, marital status, race, AJCC stage, TNM stage, surgery and chemotherapy were independent risk factors for both OS and CSS. Based on the results of the multivariate Cox regression analysis, prognostic nomograms were constructed for OS and CSS. In the training set, the C-index was 0.754 (95% CI = 0.746-0.762) for the OS nomogram and 0.762 (95% CI: 0.753-0.771) for the CSS nomogram. In the internal validation, the C-index for the OS nomogram was 0.758 (95% CI: 0.746-0.770), while the C-index for the CSS nomogram was 0.762 (95% CI: 0.749-0.775). Compared with TNM stage and SEER stage, the nomogram had better predictive ability. In addition, the calibration curves also showed good consistency between the predicted and actual 3-year and 5-year OS and CSS. Conclusion: The nomogram can effectively predict OS and CSS in patients with GSRC, which may help clinicians to personalize prognostic assessments and clinical decisions.

Comparison of 68Ga-FAPI-04 and 18F-FDG for the Detection of Primary Gastric Cancers and Metastasis 

2021 ◽  
Author(s):  
Donglang Jiang ◽  
Xing Chen ◽  
Zhiwen You ◽  
Hao Wang ◽  
Xiaoyun Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cell Carcinoma ◽  
Cancer Diagnosis ◽  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Gastric Cancers ◽  
Signet Ring ◽  
Ring Cell

Abstract Introduction Early and precise diagnosis and staging of gastric cancer are important for its treatment and management. However, the low sensitivity of 18F-fluorodeoxyglucose (18F-FDG) for gastric cancer diagnosis limits its application. Currently, the tracer 68Ga-FAPI, which targets fibroblast activation protein (FAP), is widely used to diagnose various cancers. However, the diagnostic value of 68Ga-FAPI in gastric cancer is still unclear. In this study, we aimed to investigate the potential advantage of 68Ga-FAPI-04 over 18F-FDG in the evaluation of gastric cancer.Methods: Thirty-eight patients with gastric cancer (31 with adenocarcinoma and 7 with signet ring cell carcinoma) were recruited for this study. All of the participants underwent 68Ga-FAPI-04 and 18F-FDG imaging by positron emission tomography (PET)/computed tomography (CT) or PET/magnetic resonance (MR). The results were interpreted by two experienced nuclear medicine physicians, and the maximum standardized uptake value (SUVmax) was calculated.Results: For the detection of primary gastric cancer, the sensitivities of 68Ga-FAPI-04 PET and 18F-FDG PET were 100% (38/38) and 81.6% (31/38), respectively. Four cases of adenocarcinoma and three cases of signet ring cell carcinoma were missed by 18F-FDG PET. The SUVmax of 68Ga-FAPI-04 in tumors greater than 4 cm (11.0 ± 4.5) was higher than tumors less than 4 cm (4.5 ± 3.2) (P = 0.0015). The SUVmax of 68Ga-FAPI-04 was higher in T2-4 tumors (9.7 ± 4.4) than in T1 tumors (3.1 ± 1.5) (P = 0.0002). For the detection of metastatic lesions, the sensitivities of 68Ga-FAPI-04 PET and 18F-FDG PET in 10 patients with regional lymph node metastasis and distant metastasis were 6/10 and 5/10, respectively.Conclusion: Compared to 18F-FDG PET, 68Ga-FAPI-04 PET had superior potential in detecting primary gastric cancers and metastatic lymph nodes, 68Ga-FAPI-04 PET also had a better performance on small gastric cancer detection. 68Ga-FAPI-04 PET could provide better performance for gastric cancer diagnosis and staging.

scholarly journals Evaluation of Traditional Prognostic Factors for Stage I-III Colorectal Cancer Patients Who Survived for Over Five Years After Surgery

2021 ◽  
Vol 11 ◽  
Author(s):  
Dakui Luo ◽  
Yufei Yang ◽  
Zezhi Shan ◽  
Qi Liu ◽  
Sanjun Cai ◽  
...  
Keyword(s):  
Vascular Invasion ◽  
Perineural Invasion ◽  
Cox Regression ◽  
Signet Ring Cell ◽  
Stage I ◽  
Regression Analyses ◽  
Pathological Stage ◽  
Entire Cohort ◽  
Signet Ring ◽  
Ring Cell

The aim of this study was to explore the prognostic factors in stage I-III colorectal cancer (CRC) patients who had survived for over five years. A total of 9754 stage I-III CRC patients who received curative surgery in the Department of Colorectal Surgery, Fudan University Shanghai Cancer Center were enrolled in this study. Of them, 3640 patients had survived for over five years after surgery. Univariate and multivariate Cox regression analyses were performed in the entire cohort and those who had survived for over five years. Compared with patients in the entire cohort, patients who had survived for over five years were more likely to be younger, have less disease of signet ring cell histology, perineural invasion and vascular invasion, more well differentiated tumors and stage I disease. In the entire cohort, increased age, signet ring cell, poor differentiation, more advanced pathological stage, perineural invasion and vascular invasion were inversely associated with disease-free survival (DFS) and overall survival (OS) using multivariable Cox regression analyses. Only age, pathological stage and perineural invasion remained significant in patients who had survived for over five years. Moreover, tumor location was an independent factor for OS in this subgroup. Predictors for prognosis of CRC change over time. Age, pathological stage and perineural invasion deserve more attention among patients who have survived for over five years.

scholarly journals Anatomic Subsites and Prognosis of Gastric Signet Ring Cell Carcinoma: A SEER Population-based 1:1 Propensity-matched Study

2021 ◽  
Author(s):  
Yangyang Xie ◽  
Xue Song ◽  
Haimin Jin ◽  
Zhongkai Ni ◽  
Xiaowen Li ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Mortality Risk ◽  
Cox Regression ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Survival Prediction ◽  
Cancer Specific Survival ◽  
Dismal Prognosis ◽  
Signet Ring ◽  
Ring Cell

Abstract Background: The dismal prognosis of gastric signet ring cell carcinoma (GSRC) is a global problem. The current study is conducted to comprehensively evaluate clinicopathological features and survival outcomes in GSRC patients stratified by anatomic subsites. Then predictive nomograms are constructed and validated to improve the effectiveness of personalized management.Method: The patients diagnosed with GSRC were recruited from the online SEER database. The influence of anatomic subsites on overall survival (OS) and cancer-specific survival (CSS) was evaluated using multivariate Cox regression and Kaplan-Meier analysis. Then we employed propensity score matching (PSM) technique to decrease selection bias and balance patients’ epidemiological factors. Predictive nomograms were constructed and validated.Results: Multivariate Cox regression demonstrated that the patients with overlapping gastric cancer (OGC) suffered the highest mortality risk for OS (HR, 1.29; 95%CI, 1.23-1.36; P<0.001) and CSS (HR, 1.33; 95%CI, 1.28-1.37; P<0.001). Age, TNM stage, tumor localization, tumor size, surgery and chemotherapy presented a highly significant relationship with OS and CSS. Following subgroup and PSM analysis, OGC patients were confirmed to have the worst OS and CSS. Then nomograms predicting 6 months, 12 months and 36 months OS and CSS were constructed. The calibration curves and reveiver operating characteristic curves demonstrated the great performance of the nomograms.Conclusion: We identified anatomic subsites as a predictor of survival in those with GSRC. Patients with OGC suffered the highest mortality risk. The proposed nomograms allowed a relatively accurate survival prediction for GSRC patients.

scholarly journals Wernicke Encephalopathy Due to Prolonged Total Parenteral Nutrition in A Child with Signet Ring Cell Gastric Carcinoma

2020 ◽  
pp. 30-33
Author(s):  
Buket KARA ◽  
Ayse KARTAL ◽  
Mehmet ÖZTÜRK ◽  
Yavuz KÖKSAL
Keyword(s):  
Gastric Cancer ◽  
Gastric Carcinoma ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Signet Ring Cell ◽  
Diffuse Gastric Cancer ◽  
Wernicke Encephalopathy ◽  
Signet Ring ◽  
Ring Cell

Signet ring cell gastric carcinoma is extremely rare during childhood. One of the most important problems in these patients is nutritional difficulty and impairment, and these patients are often supported by total parenteral nutrition. Herein, the authors report a case of Wernicke encephalopathy due to prolonged total parenteral nutrition in a 13-year-old girl with diffuse gastric cancer with signet ring cell.

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