Difference Between Signet Ring Cell Gastric Cancers and Non-Signet Ring Cell Gastric Cancers: A Systematic Review and Meta-Analysis

Zhang, Chi; Liu, Ran; Zhang, Weihan; Chen, Xin-Zu; Li, Kai; Yang, Kun; Zhao, Lin-Yong; Chen, Zhuo; Zhou, Zong‐Guang; Hu, Jian‐Kun

doi:10.3389/fonc.2021.618477

Cited by 26 publications

(27 citation statements)

References 53 publications

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“…Many patients have advanced disease (stage III or IV) at the time of diagnosis with poor prognosis. Therefore, this type of GC has also received more and more attention [25][26][27][28] . However, there is still a lack of in-depth understanding of the biological characteristics of GSRC, such as pathogenesis, molecular biomarkers, and prognostic characteristics, especially the similarities and differences with GA. Further research is needed to formulate targeted treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Single cell RNA sequencing reveals the cytological characteristics and related immune microenvironment of gastric signet ring cell carcinoma

Jaturapitakkul¹,

Zhao²,

Jia

et al. 2022

Preprint

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BACKGROUND Gastric signet ring cell carcinoma (GSRC) is a special pathological type of gastric cancer (GC), which has the biological characteristics of high invasiveness, metastasis and poor prognosis, and has always been a major problem in clinical diagnosis and treatment. The current research on GSRC is stagnant at the tissue level of exome and mRNA sequencing, and lacks precision. We tried to use single-cell RNA sequencing (scRNA-seq)to reveal the biological characteristics of GSRC at the cellular level to guide clinical diagnosis and treatment, which has important theoretical and practical significance. METHODS We analyzed 32456 single cells from para-cancerous tissues of 5 patients and 117326 single cells from the cancer tissues of 13 patients by scRNA-seq. Results of the analysis were validated by immunohistochemistry, cell line cultures and bioinformatics. RESULTS The single-cell plot of GSRC was successfully constructed for the first time. There is also significant heterogeneity among Signet ring cell carcinoma (SRCC) sub-clusters. Microseminoprotein Beta (MSMB) as a marker can guide the identification of SRCC and moderate/poorly differentiated adenocarcinoma (M/PDA) cells. The up-regulated genes in SRCC were mainly enriched in abnormally active cancer-related signaling pathways and immune response signaling pathways. SRCC can be also significantly enriched in mitogen-activated protein kinases (MAPK) and estrogen signaling pathway, and they can interact and promote each other, and continue to amplify the effect. SRCC has lower cell adhesion and higher immune evasion ability, they also have an immunosuppressive microenvironment, these may be closely related to the relatively poor prognosis of GSRC. CONCLUSIONS Compared to M/PDA, GSRC has unique cytological characteristics and immune microenvironment, which will provide assistance for precision diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Single cell RNA sequencing reveals the cytological characteristics and related immune microenvironment of gastric signet ring cell carcinoma

Jaturapitakkul¹,

Zhao²,

Jia

et al. 2022

Preprint

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“…These reports suggest that despite the microscopic primary cancer lesion, as noted in Krukenberg tumor cases, gastric cancer with undifferentiated histology can progress to PTTM because of its tendency to include lymphovascular invasion. Recent studies have reported that early gastric SRCC, despite classification as undifferentiated histology, has a low risk of lymph node metastasis and a comparable prognosis with differentiated cancer [ 11 , 12 ]. In addition, small size (less than 20 mm) and intramucosal lesions have a lower risk of lymph node metastasis [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases

et al. 2021

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Background Pulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy have been reported. Moreover, several cases of early gastric cancer that are undetectable on endoscopy or macroscopic postmortem examination have been reported. Case presentation A previously healthy 50-year-old man presented with progressive dyspnea and cough for 1 month. Echocardiography suggested pulmonary hypertension. Computed tomography revealed diffuse lymphadenopathy, whereas blood work revealed an elevation in several serum tumor marker levels. Despite normal upper endoscopic findings, a presumptive diagnosis of PTTM due to gastric cancer was made based on pathological findings of cervical lymph node biopsy, which indicated signet ring cell carcinoma. Imatinib and tegafur/gimeracil/oteracil plus oxaliplatin therapy were started on day 7. The patient’s condition was initially stable. However, his symptoms suddenly progressed, and the patient died on day 8. Macroscopic postmortem examination revealed no abnormal gastric wall findings. Microscopically, PTTM was confirmed, and multiple serial sections of the stomach revealed early gastric cancer. Conclusions Despite normal endoscopic findings, micro-occult gastric cancer can lead to PTTM. Physicians should be aware of this disease presentation. Taking prompt action is needed when PTTM is suspected, even if the patient appears stable.

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“…However, according to Li, Kim, and Yokota, SRCC had a similar or worse survival prognosis compared to non-SRCC patients [13][14][15]. Recently, a systematic review and meta-analysis by Zhang et al including 36 studies showed that for patients with advanced stage, SRCC was a negative prognostic factor [16]. However, concerning non-endemic countries, only four studies are available (from France and Belgium) with small sample sizes and further limitations.…”

Section: Introductionmentioning

confidence: 99%

Comparison between signet-ring cell carcinoma and non-signet-ring cell carcinoma of the stomach: clinicopathological parameters, epidemiological data, outcome, and prognosis—a cohort study of 123 patients from a non-endemic country

et al. 2022

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Background Signet-ring cell carcinoma of the stomach (SRCC) is a particular gastric cancer entity. Its incidence is increasing. Its diagnosis is pathological; it corresponds to adenocarcinoma with a majority of signet-ring cells component (> 50%). These histological features give it its aggressiveness characteristics. This has repercussions on the prognostic level and implications for the alternatives of therapy, especially since some authors suggest a potential chemoresistance. This survey aimed to identify the epidemiological, pathological, therapeutic, and prognostic characteristics of SRCC as a separate disease entity. Methods This was a retrospective study of 123 patients admitted for gastric adenocarcinoma to Habib Thameur Hospital in Tunis over 11 years from January 2006 to December 2016. A comparative study was performed between 2 groups: the SRCC group with 62 patients and the non-SRCC (non-signet-ring cell carcinoma of the stomach) with 61 patients. Results The prevalence of SRCC in our series was 50%. SRCC affected significantly younger patients (55 vs 62 years; p = 0.004). The infiltrative character was more common in SRCC tumors (30.6 vs 14.8%; p = 0.060), whereas the budding character was more often noted in non-SRCC tumors (78.7 vs 58.1%; p = 0.039). There was no significant difference in tumor localization between both groups. Linitis plastica was noted in 14 patients with SRCC against a single patient with non-SRCC (p = 0.001). The tumor size was more important in the non-SRCC group (6.84 vs 6.39 cm; p = 0.551). Peritoneal carcinomatosis was noted in 4.3% of cases in the SRCC group versus 2.2% of cases in the NSRCC group (p = 0.570). Total gastrectomy was more often performed in the SRCC group (87 vs 56%; p = 0.001). Resection was more often curative in the non-SRCC group (84.4 vs 78.3%; p = 0.063). Postoperative chemotherapy was more commonly indicated in the SRCC group (67.4 vs 53.3%; p = 0.339). Tumor recurrence was more common in the non-SRCC group (35.7 vs 32%; p = 0.776). The most common type of recurrence was peritoneal carcinomatosis in the SRCC group (62.5%) and hepatic metastasis in the non-SRCC group (60%; p = 0.096). The overall 5-year survival in the SRCC group was lower than in the non-SRCC group, with no statistically significant difference (47.1 vs 51.5%; p = 0.715). The overall survival was more important for SRCC in early cancer (100 vs 80%; p = 0.408), whereas it was higher for non-SRCC in advanced cancer (48.1 vs 41.9%; p = 0.635). Conclusion Apart from its epidemiological and pathological features, SRCC seems to have a worse prognosis. Indeed, it is diagnosed at a more advanced stage and has a worse prognosis in advanced cancer than non-SRCC. It is therefore to be considered as a particular entity of gastric adenocarcinoma requiring a specific therapeutic protocol where the place of chemotherapy remains to be more investigated.

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Difference Between Signet Ring Cell Gastric Cancers and Non-Signet Ring Cell Gastric Cancers: A Systematic Review and Meta-Analysis

Cited by 26 publications

References 53 publications

Single cell RNA sequencing reveals the cytological characteristics and related immune microenvironment of gastric signet ring cell carcinoma

Single cell RNA sequencing reveals the cytological characteristics and related immune microenvironment of gastric signet ring cell carcinoma

Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases

Comparison between signet-ring cell carcinoma and non-signet-ring cell carcinoma of the stomach: clinicopathological parameters, epidemiological data, outcome, and prognosis—a cohort study of 123 patients from a non-endemic country

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