Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2025; 31(30): 109465
Published online Aug 14, 2025. doi: 10.3748/wjg.v31.i30.109465
Prognostic value of signet-ring cell carcinoma proportion in undifferentiated gastric cancer: Implications for endoscopic treatment decisions
Chanyoung Kim, Hye Seung Lee, Hee Young Na, Hyun Jung Kwon, Ji Ae Lee, Yun-Suhk Suh, So Hyun Kang, Hyung-Ho Kim, Sang-Hoon Ahn, Hyeon Jeong Oh
Chanyoung Kim, Hee Young Na, Hyun Jung Kwon, Hyeon Jeong Oh, Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, South Korea
Hye Seung Lee, Department of Pathology, Seoul National University Hospital, Seoul 03080, South Korea
Hye Seung Lee, Hee Young Na, Hyeon Jeong Oh, Department of Pathology, Seoul National University College of Medicine, Seoul 03080, South Korea
Ji Ae Lee, Pathology Center, Seegene Medical Foundation, Seoul 04805, South Korea
Yun-Suhk Suh, So Hyun Kang, Hyung-Ho Kim, Sang-Hoon Ahn, Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, South Korea
Yun-Suhk Suh, So Hyun Kang, Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
Hyung-Ho Kim, Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong 14353, Gyeonggi-do, South Korea
Sang-Hoon Ahn, Department of Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, South Korea
Author contributions: Kim C and Oh HJ conceptualized the study, performed microscopic review and analysis, and drafted the manuscript; Oh HJ supervised the project and critically revised the manuscript as the corresponding author; Lee HS, Na HY, Kwon HJ, and Lee JA contributed to the pathological diagnosis of gastric cancer tissue samples; Suh YS, Kang SH, Kim HH, and Ahn SH recruited patients with gastric cancer and provided surgical tissue specimens; All authors reviewed and approved the final manuscript.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Seoul National University Bundang Hospital (No. B-2403-888-303).
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The dataset and statistical code used in this study are available from the corresponding author at biohjoh212@gmail.com. Informed consent for data sharing was not obtained, but the presented data are anonymized and the risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyeon Jeong Oh, MD, PhD, Department of Pathology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si 13620, Gyeonggi-do, South Korea. biohjoh212@gmail.com
Received: May 14, 2025
Revised: June 17, 2025
Accepted: July 21, 2025
Published online: August 14, 2025
Processing time: 86 Days and 0.5 Hours
Abstract
BACKGROUND

Poorly cohesive gastric carcinomas are classified based on the proportion of signet-ring cell carcinoma (SRCC) components. In surgically resected gastric cancer, SRCC is diagnosed when the signet-ring cell (SRC) component constitutes ≥ 50% of the entire tumor, whereas poorly cohesive carcinoma (PCC) not otherwise specified is diagnosed when the proportion of the SRC component is < 50% of the entire tumor. The SRCC proportion in PCC varies along the spectrum, and its prognostic significance in gastric cancer remains unclear.

AIM

To investigate how the proportion of SRCC affects tumor pathology, clinical outcomes, and prognosis and treatment decision-making.

METHODS

This retrospective study included 1066 patients with PCC who underwent gastric cancer surgery at Seoul National University Bundang Hospital from 2016 to 2023. Patients were classified into four groups based on the SRCC proportion: < 10%, ≥ 10% and < 50%, ≥ 50% and < 90%, and ≥ 90%. Clinicopathological and molecular data were compared between the groups. The correlation between SRCC proportion and pathological factors associated with indications for endoscopic resection in patients with early-stage gastric cancer (EGC) was analyzed.

RESULTS

A higher SRCC proportion was associated with smaller tumor size, lower tumor stage pathological tumor-node-metastasis, and reduced rates of lymphatic, vascular, and neural invasion (P < 0.001). Notably, the ≥ 90% SRCC group exhibited the highest recurrence-free survival (P = 0.0072) and overall survival (P = 0.0002). In EGC, lower SRCC rates were correlated with increased ulceration, larger tumor size, and deeper submucosal invasion (P < 0.001).

CONCLUSION

Higher SRCC proportions in the PCC correlate with lower tumor aggressiveness and improved prognosis. Its role in EGC should be validated as a factor influencing therapeutic strategies, including endoscopic submucosal dissection.

Keywords: Gastric cancer; Signet-ring cell carcinoma; Poorly cohesive carcinoma; Prognosis; Endoscopic submucosal dissection

Core Tip: A higher proportion of signet-ring cell carcinoma (SRCC) in poorly cohesive gastric carcinoma indicates less aggressive tumor behavior, reflected by smaller size, lower stage, and reduced lymphovascular invasion. Patients with ≥ 90% SRCC show excellent recurrence-free and overall survival. In early gastric cancer, lower SRCC proportions are linked to ulceration, larger size, and deeper invasion. These findings highlight the prognostic value of SRCC proportion and its potential to guide therapeutic strategies, including endoscopic resection.