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The Prognostic Value of Signet-Ring Cell Histology in Resected Gastric Adenocarcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Conflicting data exist on the prognostic implication of signet-ring cell (SRC) histology in gastric adenocarcinoma (GAC).

Methods

All patients who underwent curative-intent resection of GAC from the seven institutions of the U.S. Gastric Cancer Collaborative between 2000 and 2012 were included. Primary end points were recurrence-free survival (RFS) and overall survival (OS). Stage-specific analyses were performed.

Results

A total of 768 patients met the inclusion criteria. SRC was present in 40.6 % of patients and was associated with female sex (52.9 vs. 38.6 %; p < 0.001), younger age (61 vs. 67 years; p < 0.001), poor differentiation (94.8 vs. 50.3 %; p < 0.001), perineural invasion (PNI) (41.4 vs. 23 %; p < 0.001), microscopically positive resection margins (R1, 24.7 vs. 8.6 %; 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 (56.7 months vs. median not reached; p = 0.009) and decreased OS (33.7 vs. 46.6 months; p = 0.011). When accounting for other adverse pathologic features, PNI (hazard ratio [HR] 1.57; p = 0.016) and higher stage (HR 2.64; p < 0.001) were associated with decreased RFS, but SRC was not. Although PNI (HR 1.52; p = 0.007), higher stage (HR 2.11; p < 0.001), greater size (HR 1.05; p = 0.016), and adjuvant therapy (HR 0.50; p < 0.001) were associated with OS, SRC was not. Similarly, when accounting for adverse pathologic factors on multivariate analysis, stage-specific analyses showed no association between SRC and RFS or OS.

Conclusions

SRC histology is associated with adverse pathologic features including poor differentiation, higher stage, and microscopically positive resection margins 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.

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Acknowledgments

Supported in part by the Katz Foundation.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Lauren M. Postlewait MD, Malcolm H. Squires III MD, MS, David A. Kooby MD, Kenneth Cardona MD, Charles A. Staley MD & Shishir K. Maithel MD

  2. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD & David J. Worhunsky MD

  3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD, Alexandra W. Acher BS, Clifford S. Cho MD & Emily R. Winslow MD

  4. Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Mark Bloomston MD, Carl R. Schmidt MD & Neil Saunders MD

  5. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD & Linda X. Jin MD

  6. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD & Aslam Ejaz MD

  7. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD & Douglas Swords MD

Authors
  1. Lauren M. Postlewait MD
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  2. Malcolm H. Squires III MD, MS
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  3. David A. Kooby MD
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  4. George A. Poultsides MD
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  5. Sharon M. Weber MD
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  6. Mark Bloomston MD
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  7. Ryan C. Fields MD
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  8. Timothy M. Pawlik MD, MPH, PhD
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  9. Konstantinos I. Votanopoulos MD
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  10. Carl R. Schmidt MD
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  11. Aslam Ejaz MD
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  12. Alexandra W. Acher BS
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  13. David J. Worhunsky MD
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  14. Neil Saunders MD
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  15. Douglas Swords MD
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  16. Linda X. Jin MD
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  17. Clifford S. Cho MD
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  18. Emily R. Winslow MD
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  19. Kenneth Cardona MD
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  20. Charles A. Staley MD
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  21. Shishir K. Maithel MD
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Corresponding author

Correspondence to Shishir K. Maithel MD.

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Postlewait, L.M., Squires, M.H., Kooby, D.A. et al. The Prognostic Value of Signet-Ring Cell Histology in Resected Gastric Adenocarcinoma. Ann Surg Oncol 22 (Suppl 3), 832–839 (2015). https://doi.org/10.1245/s10434-015-4724-8

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  • DOI: https://doi.org/10.1245/s10434-015-4724-8

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