Journal of Gastrointestinal Surgery

, Volume 14, Issue 4, pp 601–606 | Cite as

Clinicopathologic Features of Gastric Carcinoma with Signet Ring Cell Histology

  • Ming Zhang
  • Guanyu Zhu
  • Hongfeng Zhang
  • Hongyu Gao
  • Yingwei XueEmail author
Original Article



Reports of clinicopathological features and prognosis in patients with signet ring cell carcinoma of the stomach (SRC) are conflicting. The aim was to describe the clinicopathological features and prognosis of patients with SRC in comparison with non-signet ring cell carcinoma of the stomach (NSRC).


In this retrospective study, we reviewed the records of 1,439 consecutive patients diagnosed with gastric carcinoma who were resected surgically from 1993 to 2003. Among them, 218 patients (15.1%) with SRC were compared with 1,221 patients with NSRC.


There were significant differences in tumor size, tumor location, macroscopic type, depth on invasion, lymph node metastasis, lymphatic invasion, tumor stage, chemotherapy, and curability between the patients with SRC histology and NSRC. The overall 5-year survival of patients with SRC was 44.9% as compared with 36.0% for patients with NSRC (P = 0.013). Multivariate analysis showed that lymph node metastasis and curative resection were significant factors affecting survival. A significant survival benefit for curative resection was observed, with a 5-year survival rate of 58.5% compared with non-curatively resected cases (8.4%).


When stage matched, SRC patients had a similar survival to NSRC patients. Curative resection is recommended to improve the prognosis of patients with SRC.


Curative resection Gastric cancer Prognosis Signet ring cell carcinoma Survival 


  1. 1.
    Watanabe H, Jass JR, Sobin LH. Histological typing of esophageal and gastric tumors: WHO international histological classification of tumors, 2nd edn. Berlin: Springer, 1990.Google Scholar
  2. 2.
    Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 1965;64:31–49.PubMedGoogle Scholar
  3. 3.
    Ribeiro MM, Sarmento JA, Simoes SMA, Bastos J. Prognostic significance of Lauren and Ming classifications and other pathologic parameters in gastric carcinoma. Cancer 1981;47:780–784.CrossRefPubMedGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English edn. Gastric Cancer 1998;1:10–24.CrossRefPubMedGoogle Scholar
  5. 5.
    Ming SC. Gastric carcinoma. A pathobiological classification. Cancer 1977;39:2475–2485.CrossRefPubMedGoogle Scholar
  6. 6.
    Sobin LH, Wittekind C, International Union Against Cancer (UICC). TNM classification of malignant tumours, 5th edn. New York: Wiley-Liss, 1997.Google Scholar
  7. 7.
    Theuer CP, Nastanski F, Brewster WR, Butler JA, Anton-Culver H. Signet ring cell histology is associated with unique clinical features but does not affect gastric cancer survival. Am Surg 1999;65:915–921.PubMedGoogle Scholar
  8. 8.
    Maehara Y, Sakaguchi Y, Moriguchi S, Orita H, Korenaga D, Kohnoe S, Sugimachi K. Signet ring cell carcinoma of the stomach. Cancer 1992;69:1645–1650.CrossRefPubMedGoogle Scholar
  9. 9.
    Antonioli DA, Goldman H. Changes in the location and type of gastric adenocarcinoma. Cancer 1982;50:775–781.CrossRefPubMedGoogle Scholar
  10. 10.
    Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Akiyama H. Therapeutic strategy for signet ring cell carcinoma of the stomach. Br J Surg 2004;91:1319–1324.CrossRefPubMedGoogle Scholar
  11. 11.
    Li C, Kim S, Lai JF , Hyung WJ, Choi WH, Choi SH, Noh SH. Advanced gastric carcinoma with signet ring cell histology. Oncology 2007;72:64-68.CrossRefPubMedGoogle Scholar
  12. 12.
    Otsuji E, Yamaguchi T, Sawai K, Takahashi T. Characterization of signet ring cell carcinoma of the stomach. J Surg Oncol 1998;67:216–220.CrossRefPubMedGoogle Scholar
  13. 13.
    Hyung WJ, Noh SH, Lee JH, Huh JJ, Lah KH, Choi SH, Min JS. Early gastric carcinoma with signet ring cell histology. Cancer 2002;94:78–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim DY, Park YK, Joo JK , Ryu SY, Kim YJ, Kim SK, Lee JH. Clinicopathological characteristics of signet ring cell carcinoma of the stomach. ANZ J Surg 2004;74:1060-1064.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim JP, Kim SC, Yang HK. Prognostic significance of signet ring cell carcinoma of the stomach. Surg Oncol 1994;3:221–227.CrossRefPubMedGoogle Scholar
  16. 16.
    Greene FL, Page DL, Fleming ID. AJCC cancer staging manual, 6th edn. New York: Springer, 2002.Google Scholar
  17. 17.
    Sugihara H, Hattori T, Fukuda M, Fujita S. Cell proliferation and differentiation in intramucosal and advanced signet ring cell carcinoma of the human stomach. Virchows Arch 1987;411:117–127.CrossRefGoogle Scholar
  18. 18.
    Wang X, Wan F, Pan J, Yu GZ, Chen Y, Wang JJ. Tumor size: a non-neglectable independent prognostic factor for gastric cancer. J Surg Oncol 2008;97:236-240.CrossRefPubMedGoogle Scholar
  19. 19.
    Saito H, Osaki T, Murakami D, Sakamoto T, Kanaji S, Oro S, Tatebe S, Tsujitani S, Ikeguchi M. Macroscopic tumor size as a simple prognostic indicator in patients with gastric cancer. Am J Surg 2006;192:296-300.CrossRefPubMedGoogle Scholar
  20. 20.
    Shiraishi N, Sato K, Yasuda K, Inomata M, Kitano S. Multivariate prognostic study on large gastric cancer. J Surg Oncol 2007;96:14–18.CrossRefPubMedGoogle Scholar
  21. 21.
    Morgagni P, Garcea D, Marrelli D, De Manzoni G, Natalini G, Kurihara H, Marchet A, Saragoni L, Scarpi E, Pedrazzani C, Di Leo A, De Santis F, Panizzo V, Nitti D, Roviello F. Resection line involvement after gastric cancer surgery: clinical outcome in nonsurgically retreated patients. World J Surg 2008;32:2661–2667.CrossRefPubMedGoogle Scholar
  22. 22.
    Adachi Y, Yasuda K, Inomata M, Sato K, Shiraishi N, Kitano S. Pathology and prognosis of gastric carcinoma: Well versus poorly differentiated type. Cancer 2000;89:1418–1424.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Ming Zhang
    • 1
  • Guanyu Zhu
    • 1
  • Hongfeng Zhang
    • 1
  • Hongyu Gao
    • 1
  • Yingwei Xue
    • 1
    Email author
  1. 1.Department of Gastroenterologic SurgeryAffiliated Tumor Hospital of Harbin Medical UniversityHarbinChina

Personalised recommendations