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Neural Invasion is a Significant Contributor to Peritoneal Recurrence in Signet Ring Cell Gastric Carcinoma

Annals of Surgical Oncology volume 25, pages 1167–1175 (2018)Cite this article

Abstract

Background

Gastric signet ring cell carcinoma (SRC) has shown a favorable outcome in early stages but has a worse prognosis than non-SRC in advanced stages. However, the cause for this stage-dependent prognostic impact has not been determined. This study aimed to compare clinicopathologic features and recurrence patterns between gastric SRC and non-SRC in a cohort of Eastern patients.

Methods

This study reviewed the prospectively collected data of 764 patients undergoing curative resection for gastric cancer from 2005 to 2008. The demographics, clinicopathologic characteristics, disease-specific survival (DSS) rate, and recurrence-free survival (RFS) rate of the patients were analyzed.

Results

The SRC patients (n = 176) had a worse prognosis than the non-SRC patients (n = 588), especially in stages T3 and T4. Peritoneal recurrence and the incidence of neural invasion (NI) were significantly increased in the SRC patients, albeit only in stages T3 and T4. In the T3 and T4 patients with NI, peritoneal recurrence occurred more frequently in SRC than in non-SRC (28.7% vs. 13.7%; p = 0.001), but not in the T3 and T4 patients without NI. Only in the patients with NI, SRC led to a significantly shorter DSS (67.6 vs. 90.7 months; p = 0.008) and RFS (67.1 vs. 80.3 months; p = 0.036) than non-SRC.

Conclusions

This report is the first to present the relationship between NI and peritoneal recurrence as the cause of stage-dependent prognoses for SRC. A better understanding of NI may lend insight into cancer spread and recurrence, especially in gastric SRC.

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Acknowledgments

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2017R1C1B2003970), by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI17C0364), and by the New Faculty Research Fund of Ajou University School of Medicine.

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Affiliations

  1. Department of Pathology, Ajou University School of Medicine, Suwon, Korea

    Dakeun Lee MD, PhD & Young-Bae Kim MD, PhD

  2. Department of Surgery, Ajou University School of Medicine, Suwon, Korea

    Sang-Yong Son MD, Sang-Uk Han MD, PhD & Hoon Hur MD, PhD

  3. Brain Korea 21 Plus Research Center for Biomedical Sciences, Ajou University, Suwon, Korea

    Hoon Hur MD, PhD

Authors
  1. Dakeun Lee MD, PhD
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  2. Sang-Yong Son MD
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  3. Young-Bae Kim MD, PhD
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  4. Sang-Uk Han MD, PhD
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  5. Hoon Hur MD, PhD
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Correspondence to Hoon Hur MD, PhD.

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Lee, D., Son, SY., Kim, YB. et al. Neural Invasion is a Significant Contributor to Peritoneal Recurrence in Signet Ring Cell Gastric Carcinoma. Ann Surg Oncol 25, 1167–1175 (2018). https://doi.org/10.1245/s10434-018-6371-3

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  • DOI: https://doi.org/10.1245/s10434-018-6371-3

Keywords

  • Peritoneal Recurrence
  • Neural Invasion (NI)
  • Gastric SRC
  • Signet Ring Cell Carcinoma (SRC)
  • Cancer Spread