Signet Ring Cell Histology is an Independent Predictor of Poor Prognosis in Gastric Adenocarcinoma Regardless of Tumoral Clinical Presentation

Piessen, Guillaume; Messager, Mathieu; Leteurtre, Emmanuelle; Jean-Pierre, Triboulet; Mariette, C.

doi:10.1097/sla.0b013e3181b21c7b

Cited by 283 publications

(254 citation statements)

References 35 publications

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“…The prognostic significance of older age and histological type in our study is comparable to the results of other studies [13,20,21]. The prognosis was significantly better for lymphoma than for adenocarcinoma, and prognosis was worse for undifferentiated carcinoma than for adenocarcinoma.…”

Section: Discussionsupporting

confidence: 81%

Trends in the management of gastric cancer over a 32-year period: a French population-based study

et al. 2014

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Background Gastric cancer is still generating interest because of its poor prognosis. The aim of this study was to investigate time trends in diagnostic assessment, patterns of care, and survival of gastric cancers. Methods We considered 5,010 gastric cancers diagnosed between 1976 and 2007 in a well-defined French population. Logistic regressions were used to identify factors associated with R0 resection and operative mortality. A multivariate relative survival analysis was performed. Results Diagnostic modalities have changed. Since 1988, endoscopy is performed when gastric cancer is suspected (95.5 %). However, there has been no strong variation in stage over time: the proportion of stage I cancers increased from 5.5 % to 13.4 % between the periods 1976-1979 and 2004-2007 (p \ 0.001) whereas that of advanced cases remained stable, 64.8 % and 65.0 %, respectively. R0 resections rose from 36.7 % (1976-1979) to 46.7 % between 1980 and 1999, and decreased to 32.7 % thereafter. Age, tumor location, and period were associated with R0 resection. Neoadjuvant and adjuvant chemotherapy were rarely used before 2000, then reached 15.0 % and 19.1 %, respectively, during the later period. Operative mortality after R0 resection decreased from 18.3 % during the 1976-1979 period to 4.3 % during the 2004-2007 period (p \ 0.001). Prognosis slightly improved during the three first periods, from 13.0 % to 22.6 %, then leveled off, not exceeding 26.0 % thereafter. Stage, age, histology, and time period significantly influenced survival. Conclusion Changes in diagnostic modalities were associated with minor changes in stage and prognosis for gastric cancer. Earlier diagnosis and new therapeutic strategies are the best way to improve the prognosis.

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Section: Discussionsupporting

confidence: 81%

Trends in the management of gastric cancer over a 32-year period: a French population-based study

et al. 2014

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“…Some studies reported better 5-year survival rates in SRC than in other cell types [1,2]. However, others reported no significant differences [3] or a poorer prognosis [4][5][6]. In addition, studies that compared SRC with the other cell types in early gastric cancer (EGC) found that SRC had lower lymph node metastasis with better prognosis than other cell types and suggested endoscopic resection for the treatment of signet ring cell-type EGC patients [7].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach

et al. 2013

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Background 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. Methods We retrospectively studied 769 patients with gastric carcinoma who underwent gastrectomy in our institute from 1999 to 2009. Among them, 326 patients (42.4 %) had early gastric cancer (EGC) and 443 patients (57.6 %) had advanced gastric cancer (AGC). Sex, age, tumor location, macroscopic type, tumor size, microscopic invasion, and survival rate were compared between patients with SRC, differentiated-, and undifferentiated-type gastric carcinomas. Results Fifty-one patients (15.6 %) had SRC in EGC; there were significant differences in sex, age, location, macroscopic type, and size between SRC and the differentiated histological type. However, there was no difference between SRC and undifferentiated-type gastric carcinoma, except for the macroscopic type. Fifty-seven patients (12.9 %) had SRC in AGC. Sex, age, location, size, macroscopic type, perineural invasion, N stage, and hepatic metastasis were significantly different between SRC and the differentiated histological type. Undifferentiated-type gastric carcinoma differed in sex, macroscopic type, and hepatic metastasis. The overall survival rate differed between SRC and other cell types (P \ 0.001). Among all the study patients, age [hazard ratio (HR) 1.013, P = 0.041] and tumor, node, and metastasis (TNM) stage (HR 2.350, P \ 0.001) were important factors for predicting survival. Omitting patients with palliative resection or metastases, TNM stage was still an important factor for survival (HR 2.077, P \ 0.001). Conclusions Patients with SRC showed similar clinicopathological features with undifferentiated histology. The survival of patients with SRC reflected a better prognosis in patients with undifferentiated gastric carcinoma. However, when narrowing the patients to those with EGC only, survival in EGC patients exhibited no difference between histological types. Among AGC patients, SRC patients had a worse prognosis than other cell types.

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“…However, many reports regarding the clinical importance of a positive margin did not describe the method of evaluation of the true surgical margin or the most appropriate device to dissect the tissue. Although a positive margin has often been associated with poor prognosis in gastric cancer [5][6][7][8], it has lost prognostic relevance in some specific cohorts [9][10][11]. Besides the biological characteristics of these specific cohorts, inaccurate handling of the surgical margin for histologic evaluation may have led to these conflicting results.…”

Section: Discussionmentioning

confidence: 84%

In vivo evaluation of a modified linear stapling device designed to facilitate accurate pathologic examination of the surgical margin

et al. 2015

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Background Microscopic involvement of the resection margin could influence the long-term outcome of patients undergoing curative surgery for gastric cancer. Linear staplers, commonly used for gastrectomies, are often equipped with three lines of staples on either side of the resection line. Although multiple lines of staples reinforce closure of the gastric or intestinal stump, they could hinder accurate histopathologic evaluation of the surgical margin of the resected specimen. Methods We modified a linear stapling device by removing one line (stapler E2) or two lines (stapler E1) of staples on the specimen side, and attempted to dissect a silicon film and then the stomach from a porcine model using the stapling device and examined the distances between the cutting edge and the nearest staple line. Results The distance between the cutting edge and the staple line for stapler E1 was significantly greater than the distance between the cutting edge and the nearest staple line for stapler E2 or the control device. Consequently, specimens of exemplary quality were available for pathologic examination of the surgical margin. Moreover, the lack of multiple layers of staples did not result in contamination of the abdominal cavity with gastric juice during laparoscopic procedures in the porcine model. Conclusions Stapler E1 is safe and could be useful for the pathologic evaluation of the true surgical margin.

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Signet Ring Cell Histology is an Independent Predictor of Poor Prognosis in Gastric Adenocarcinoma Regardless of Tumoral Clinical Presentation

Cited by 283 publications

References 35 publications

Trends in the management of gastric cancer over a 32-year period: a French population-based study

Trends in the management of gastric cancer over a 32-year period: a French population-based study

Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach

In vivo evaluation of a modified linear stapling device designed to facilitate accurate pathologic examination of the surgical margin

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