Gastric signet-ring cell carcinoma (GSRCC) is a more aggressive subtype of gastric cancer compared to gastric adenocarcinoma (GA), with an increasing incidence. However, the prognostic differences between these subtypes, particularly in resectable cases, remain unclear.

To evaluate prognostic factors and develop a predictive model for GA and GSRCC patients undergoing curative resection.

This retrospective cohort study included patients with GA and GSRCC who underwent curative surgery at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, from 2011 to 2018. Propensity score matching (PSM) (1:1) balanced the baseline characteristics. Prognostic factors were identified using univariate and multivariate Cox and least absolute shrinkage and selection operator (LASSO) regression analyses. Model performance was evaluated through calibration curves, decision curve analysis (DCA), and time-dependent receiver operating characteristic curves. Subgroup analysis and Kaplan-Meier survival curves were generated.

In a cohort of 3027 patients, the GSRCC group was characterized by a significantly higher prevalence of individuals under 60 years of age, females, cases with poor differentiation, and early-stage (stage I) disease (all P < 0.001). After PSM, the baseline was balanced and 761 patients were retained in each group. Variables identified through univariate Cox regression were included in the LASSO regression analysis. Multivariate Cox regression analysis identified age, tumor differentiation, tumor size, vascular invasion, and post-treatment nodal margin staging as independent prognostic factors. Subgroup analysis indicated a notably poorer prognosis for GSRCC in patients aged 60 and above (hazard ratio = 1.36, P = 0.025). The nomogram (C-index = 0.755) exhibited greater predictive accuracy than tumor node metastasis (TNM) staging for 1-, 3-, and 5-year overall survival (all P < 0.001), and provided a higher clinical net benefit according to DCA.

This study systematically compared resectable GA and GSRCC, revealing no overall survival difference. However, GSRCC demonstrated a significantly elevated mortality risk in subgroups stratified by age and tumor size. Multivariate analysis identified age, differentiation, tumor size, vascular invasion, and TNM stage as independent prognostic factors. The nomogram integrates clinicopathological features for precise risk stratification, surpassing traditional TNM staging.

• Gastric cancer
• Adenocarcinoma
• Signet-ring cell carcinoma
• Nomogram
• Prognostic model
• Retrospective cohort study

• Epstein–Barr virus
• early-onset gastric cancer
• gastric cancer
• human papillomavirus

• Humans
• Stomach Neoplasms/virology
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/pathology
• Female
• Male
• Herpesvirus 4, Human/genetics
• Herpesvirus 4, Human/isolation & purification
• Poland/epidemiology
• Pilot Projects
• Epstein-Barr Virus Infections/virology
• Epstein-Barr Virus Infections/complications
• Epstein-Barr Virus Infections/epidemiology
• Middle Aged
• Adult
• Papillomavirus Infections/virology
• Papillomavirus Infections/complications
• Papillomavirus Infections/epidemiology
• Papillomaviridae/genetics
• Papillomaviridae/isolation & purification
• Aged
• Human Papillomavirus Viruses

• SEER database
• gastric cancer
• nomogram
• signet ring cell carcinoma
• survival

• biomarker
• neoplasm
• prognosis
• tumour budding

• Humans
• Prognosis
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/mortality
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Neoplasms/mortality
• Biliary Tract Neoplasms/pathology
• Biliary Tract Neoplasms/mortality
• Adenocarcinoma/pathology
• Adenocarcinoma/mortality
• Gastrointestinal Tract/pathology

• Humans
• Carcinoma, Signet Ring Cell/drug therapy
• Carcinoma, Signet Ring Cell/pathology
• Carcinoma, Signet Ring Cell/mortality
• Female
• Male
• Middle Aged
• Machine Learning
• Prognosis
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Aged
• Kaplan-Meier Estimate
• SEER Program
• Adult
• Proportional Hazards Models

• Epidemiology
• Gastrectomy
• Gastric signet ring cell carcinoma (SRCC)
• Metastasis
• Surveillance
• Survival
• and end results (SEER) database

• Humans
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/surgery
• Carcinoma, Signet Ring Cell/drug therapy
• Carcinoma, Signet Ring Cell/surgery
• Carcinoma, Signet Ring Cell/pathology
• Gastrectomy
• Prognosis
• Liver Neoplasms/surgery

• Gastric cancer
• Gastric carcinoma
• Gastric signet ring cell carcinoma

• Adjuvant chemotherapy
• CAPOX
• Gastric cancer
• Poorly cohesive cells
• S-1

• Humans
• Stomach Neoplasms/drug therapy
• Oxaliplatin
• Chemotherapy, Adjuvant
• Fluorouracil/therapeutic use
• Combined Modality Therapy
• Adenocarcinoma

• gastrointestinal cancer
• tumour biomarkers
• cancer therapy

• Biomarkers, Tumor/genetics
• Biomarkers, Tumor/metabolism
• ErbB Receptors/metabolism
• Humans
• Phosphatidylinositol 3-Kinases/genetics
• Phosphatidylinositol 3-Kinases/metabolism
• Signal Transduction
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/genetics
• Stomach Neoplasms/therapy
• Tumor Suppressor Protein p53

• Guangdong Basic and Applied Basic Research Foundation #2021A1515010117
• The National Key Research and Development Program of China #2018YFA0902801 The 100 Top Talents Program of Sun Yat-Sen University (ZSQYBRJH0001)
• National Natural Science Foundation of China (National Science Foundation of China)
• Guangdong Provincial Key Laboratory of Digestive Cancer Research #2021B1212040006

Gastric cancer (GC) is a worldwide health condition of major concern, with gastric carcinoma with signet ring cell features being increasingly reported. A 61-year-old woman was admitted to the Emergency department with back pain, gastrointestinal complaints, and weight loss. A lumbar and hip computed tomography (CT) was performed and revealed multiple suspicious secondary bone lesions. Laboratory test results reported anemia, thrombocytopenia, and elevated alkaline phosphatase. On thoracic-abdominal-pelvic CT, multiple bone lesions suggestive of metastases were visible on the vertebral spine, ribs, pelvic bones, and proximal femurs, but no identifiable primary or visceral lesions were described. Upper endoscopy identified a gastric adenocarcinoma, and both gastric and bone lesions, especially bone lesions, contained a relevant amount of signet ring cells. The patient was referred to the Medical Oncology department, however, her condition evolved unfavorably. GC with restricted bone metastasis is rare at presentation and has a poor prognosis. Despite its infrequency, clinicians should consider GC involvement when evaluating secondary suspicious bone lesions.

• beta-bimonial distribution
• gastric signet ring cell carcinoma
• nodal staging score
• prognostic analysis

• case-control study
• gastric cancer
• microangiopathic hemolytic anemia
• signet ring
• systematic review

• Anemia, Hemolytic/complications
• Carcinoma, Signet Ring Cell/complications
• Carcinoma, Signet Ring Cell/pathology
• Case-Control Studies
• Humans
• Prognosis
• Stomach Neoplasms/pathology

• UL1 TR001863 NCATS NIH HHS

Signet‐ring cell carcinoma is an extremely rare histological variant of upper urinary tract carcinoma, associated with poor prognosis.

We report a case of a 75‐year‐old female diagnosed with left primary upper urinary tract signet‐ring cell carcinoma, initially treated with surgery. Post‐surgical development of multifocal metastases was followed by a devastating clinical course. An autopsy confirmed the tumor's primary origin in the upper urinary tract.

We experienced a case of upper urinary tract signet‐ring cell carcinoma, with a rare opportunity to thoroughly confirm its primary site with an autopsy.

• Signet ring cell carcinoma (SRCC)
• breast cancer
• case report
• gastrointestinal metastatic

Treatments for early-onset gastric cancer (EOGC) patients are rarely included in clinical trials, resulting in an unclear impact on survival. This study aimed to investigate the treatment patterns of EOGC patients and their impact on survival. Based on the Surveillance, Epidemiology, and End Results database, we conducted a retrospective analysis of 1639 EOGC patients (< 50 years) diagnosed between 2010 and 2018. Patients with larger tumours, distant metastasis, and AJCC TNM stage in IV were prone to receive nonsurgical treatment. Patients treated with surgery alone had a better prognosis than those receiving SROC or SCRT or nonsurgical treatment. However, analyses stratified by histological type, tumour size and TNM stage showed that patients did not benefit more from SROC and SCRT than from surgery alone. Similar results were observed in the stratified Cox regression risk analysis. Patients who received nonsurgical treatment had the highest risk of overall death [hazard ratio (HR) = 2.443, 95% confidence interval (CI) 1.865–3.200, P < 0.001]. This study indicated that additional radiotherapy, chemotherapy or chemoradiotherapy did not provide a coordinated survival benefit to EOGC patients.

To analyze the time trends in cardia cancer detection rates using endoscopic surveillance from 1999 to 2019 in a high-volume Chinese hospital.

In this retrospective, single-center study, data were collected from the Endoscopy Center of the Department of Gastroenterology, Tianjin Medical University General Hospital, from 1999 to 2019. Cases of cardia cancer (n = 1567) were extracted from a database of patients who underwent endoscopy. Clinical and epidemiological characteristics of patients with cardia cancer were analyzed, including sex, age, and proportion of early gastric cancer and degree of tumor differentiation. The joinpoint regression method was used to identify change points in incidence trends. Annual percent change (APC) values, with 95% confidence intervals (CI), were calculated for time periods before and after change points.

Of the 343942 patients who underwent endoscopy during 1999–2009, 1567 (4.6%) were identified with cardia cancer. The overall cardia adenocarcinoma detection rate decreased significantly from 1999 to 2004 (APC = −37.3, 95% CI: -20.9, -6.4), followed by a relatively slower decline rate from 2004 to 2019 (APC = −7.7, 95% CI: -4.4, -7.6). The crude rate of detection of early cardia cancer could not be determined by joinpoint analysis. Rates of detection reduced significantly in patients aged 60–69 and 70-79 years (APC = −8.3, 95% CI: -9.8, -6.8 and APC = −7.3, 95% CI: -8.8, -5.8, respectively). The detection rate in males decreased rapidly from 1999 to 2004 (APC = −35.9, 95% CI: -18.2, 5.6, P < 0.05), while the decline rate was relatively slow from 2005 to 2019 (APC = −6.9, 95% CI: -3.4, -6.1, P < 0.05). Among females, the detection rates also decreased from 1999 to 2004 (APC = −21.2, 95% CI: -28.1, -13.7), but remained stable from 2007 to 2019 (APC = −3.8, 95% CI: -7.9, -0.5). Detection of poorly differentiated cardia cancer also declined from 2009 to 2019 (APC = −12.8, 95% CI: -15.3, -10.0).

The detection rate of cardia cancer among gastric cancers has been stable from 2008 to 2019. The trend of detection rate of early cardia cancer showed no significant statistical meaning; hence, it remains necessary to carefully observe the cardia area during endoscopy examination.

Signet ring cell carcinoma (SRCC) is an uncommon and poorly differentiated tumor. It arises mostly in the gastrointestinal tract. The incidence of gastric SRCC has increased in the past few years. Volvulus is the twisting of the bowel around its mesentery. It is classified as either primary or secondary. It is relatively common in the cecum and sigmoid colon. Volvulus of other parts of the gastrointestinal tract is relatively rare. Herein, we present a case of small bowel volvulus (SBV) secondary to advanced gastric SRCC with peritoneal carcinomatosis. The patient had presented with nausea and vomiting. Initial computed tomography (CT) scan of abdomen unveiled jejunal volvulus. SBV resolved spontaneously on a repeat CT scan. Enteroscopy with histopathology confirmed the diagnosis of gastric SRCC, which turned to be metastatic to peritoneum on laparoscopy. We believe our case is unique due to the rarity of advanced gastric SRCC presenting as secondary jejunal SBV without appreciated gastric mass on imaging.

• chemotherapy
• deep learning
• diagnosis
• signet-ring cell carcinoma
• survival

Gastric cancer (GC) is one of the most common malignant tumors worldwide. Tensin 4 (TNS4) is an adhesive protein belonging to the tensin family. This protein is located in focal adhesion sites. The TNS4 gene is considered an oncogene in numerous cancers. This protein plays an important role in adhesion, migration and proliferation of cells.

To evaluate expression of TNS4 protein in GC tissues and analysis of the clinical and histopathological parameters as well as the overall survival rate of patients.

The expression of TNS4 was assessed in 89 patients using immunohistochemistry.

Positive expression of TNS4 was observed in 49 of 89 patients (55.06%). Higher TNS4 expression was more common in GC tumors with a diameter ≥ 5 cm (P = 0.040). We demonstrated that an increase in TNS4 expression was more frequent in tumors of the histological type without mucinous components than in tumors from mucosal cancers (P = 0.023). Furthermore, TNS4 expression was higher in moderately differentiated tumors than in poorly differentiated and non-differentiated tumors (P = 0.002). Increased TNS4 expression was also noted in the intestinal type of GC according to Lauren’s classification (P = 0.020). No statistically significant correlation was found between the expression of TNS4 and the overall survival rate of patients.

TNS4 expression was significantly higher in tumors with a diameter ≥ 5 cm of the moderately differentiated intestinal type (according to Lauren’s classification) of GC without a mucinous component. Therefore, increased TNS4 expression is related to the histological type of GC with a better prognosis.

• Gastric cancer
• Tensin 4
• Adhesion proteins
• Immunohistochemistry

• Derived monocyte to lymphocyte ratio
• Gastric signet ring cell carcinoma
• Inflammatory biomarker
• Lymph node metastasis
• Neutrophil to lymphocyte ratio

Since 1965, the Laurén classification has been used most commonly for gastric adenocarcinoma, with two main types: intestinal type and diffuse type. Signet ring cell carcinoma (Sig) and non-solid poorly differentiated adenocarcinoma (Por2) are the histological forms of diffuse type that are often found in advanced tumors, and they seem to be associated with a poor prognosis. S-1-based adjuvant chemotherapy for patients with stage II/III gastric cancer has generally been accepted in Japan, but histological type does not alter treatment strategy. The aim of the present study was to investigate the prognostic impact of the histopathological mixture of Sig and Por2 in patients with stage II/III gastric cancer treated with S-1 adjuvant chemotherapy. The clinicopathological data of 968 patients with gastric carcinoma who underwent gastrectomy between 2007 and 2016 at Osaka City University Hospital were retrospectively analyzed. In the present study, tumors containing Sig or Por2 were classified as diffuse type, and those not containing them were classified as intestinal type. There were 307 cases of diffuse type and 661 cases of intestinal type. Diffuse type included 189 cases with Sig. A pathological diagnosis of Sig was an independent risk factor for peritoneal recurrence in patients with stage II/III gastric cancer. Patients with diffuse type had a worse overall survival rate than those with intestinal type at stage III gastric cancer. Among the patients who received S-1 adjuvant chemotherapy, the prognosis of patients with stage III gastric cancer with Sig but not Por2 was significantly worse compared with that of patients with intestinal type. Therefore, the present study revealed that the coexistence of Sig in the primary tumor was associated with a poor prognosis in patients with stage III gastric cancer. The current findings suggested that, since mixed Sig gastric cancer had a high risk of peritoneal recurrence even if adjuvant chemotherapy was performed, the pathological diagnosis should be considered when determining the therapeutic strategy for adjuvant chemotherapy in patients with stage III gastric cancer.

• diffuse type
• gastric cancer
• prognosis
• signet ring cell carcinoma

There has been an increase in the incidence of signet ring cell cancer (SRCC) of the stomach and gastro-esophageal junction (GEJ). The multistage carcinogenesis involving genetic and epigenetic aberrations may have a major role in the increasing incidence of SRCC. Although there are numerous studies on the prognostic value of SRCC, they are markedly inconsistent in their results, making it impossible to draw any meaningful conclusions. We aimed to examine the available evidences on molecular alterations and stage-stratified treatment approaches in SRCC of the stomach and GEJ.

A systematic search was carried out in PubMed. Studies available in English related to SRCC of stomach and gastro-esophageal junction were identified and evaluated.

This study reviewed the current evidence and provided an insight into the molecular alterations, stage-stratified treatment approaches, and future challenges in the management of SRCC of the stomach and GEJ. Specific therapeutic strategies and personalized multimodal treatment have been recommended based on the tumor characteristics of SRCC.

Multistage carcinogenesis involving genetic and epigenetic aberrations in SRCC is interlinked with stage-dependent prognosis. Specific therapeutic strategy and personalized multimodal treatment should be followed based on the tumor characteristics of SRCC. Endoscopic resection, radical surgery, and perioperative chemotherapy should be offered in carefully selected patients based on stage and prognostic stratification. Future studies in genetic and molecular analysis, histopathological classification, and options of multimodality treatment will improve the prognosis and oncological outcomes in SRCC of gastric and GEJ.

• E-cadherin
• Gastro-esophageal junction cancer
• Molecular alterations
• Signet ring cell cancer
• Stage-stratified treatment
• Stomach cancer

To better define the clinicopathologic characteristics of signet ring cell (SRC) gastric cancer and build a prognostic model for it.

SRC patient information from 2010 to 2015 were identified using Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier method and log-rank test were used to estimate Overall survival (OS) and to determine associations with histologic subtypes. In COX proportional hazards regression model–based univariate and multivariate analyses, significant variables for construction of a nomogram were screened out. The nomogram was validated by means of the concordance index (CI), calibration plots, and receiver operating characteristics (ROCs) curves.

A total of 11,363 gastric cancer patients were enrolled. On dividing the patients into SRC, well-to-moderately differentiated (WMD) adenocarcinoma, and poorly differentiated (PD) adenocarcinoma, differences among these subgroups emerged. SRC patients were more likely to occur in female and young patients than other histologic subtypes. Larger tumors, stage T4, and node stage N3 were more likely to be found in the SRC group. The survival for SRC patients was better than non-SRC patients in stage I. Univariate and multivariate analyses identified age, tumor site, larger tumor size, advanced T classification, advanced N classification, advanced TNM stage, and surgery of primary site as independent prognostic indicators. Then an OS nomogram was formulated.

SRC had distinct clinicopathological characteristics. The nomogram provided an accurate tool to evaluate the prognosis of SRC.

• carcinoma
• nomograms
• prognosis
• signet ring cell
• stomach neoplasms

• adenocarcinoma
• gastric cancer
• histopathology
• signet ring cell carcinoma

To obtain the optimal treatment effect of endoscopic resection (ER) in early gastric carcinoma (EGC), a well-established indication for post-ER surgery is needed. In addition, accurate prediction of lymph node metastasis (LNM) is necessary to achieve this goal. Here, we present modified tumor budding (mTB), which excludes signet ring cells from conventional tumor budding (TB) as a novel predictor for LNM. Conventional TB and mTB were the most predictive independent factors for LNM. Furthermore, mTB was superior to TB in predicting LNM (p = 0.0004–0.0008). In conclusion, mTB significantly enhanced the predictive power of LNM, which could be a novel indicator for determining post-ER surgery.

Endoscopic resection (ER) is a minimally invasive treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis (LNM). Recently, tumor budding (TB) has emerged as a potential predictor of LNM in EGC. We assessed the clinical significance of modified TB (mTB) that excludes the signet ring cell component and compared several TB assessment methods. Two hundred and eighty-nine patients with EGC at Uijeongbu St. Mary’s Hospital from 2010 to 2021 were enrolled. In univariate analysis, age, size, depth of invasion, tumor type, histologic type, Lauren classification, lymphatic invasion, venous invasion, poorly differentiated carcinoma (“not otherwise specified” predominant), and TB were significantly associated with LNM. Multivariate regression analysis showed that mTB (difference area under the curve [dAUC] = 0.085 and 0.087) was superior to TB (dAUC = 0.054 and 0.057) in predicting LNM. In addition, total TB counts on representative slide sections (dAUC = 0.087 and 0.057) in assessing TB and mTB and the ITBCC method (dAUC = 0.085) in mTB were superior to the presence or absence method (dAUC = 0.042 and 0.029). The mTB significantly increases LNM prediction ability, which can provide important information for patients with EGC.

• assessment method
• early gastric cancer
• endoscopic resection
• lymph node metastasis
• modified tumor budding
• surgical indication
• tumor budding

• MicroRNA 339 (miRNA-339)
• ZNF689
• gastric cancer (GC)
• invasion
• proliferation

Signet ring cell carcinoma (SRCC) of the stomach is a rare type of cancer with a slowly rising incidence. It tends to be more difficult to detect by pathologists, mainly due to its cellular morphology and diffuse invasion manner, and it has poor prognosis when detected at an advanced stage. Computational pathology tools that can assist pathologists in detecting SRCC would be of a massive benefit. In this paper, we trained deep learning models using transfer learning, fully-supervised learning, and weakly-supervised learning to predict SRCC in Whole Slide Images (WSIs) using a training set of 1,765 WSIs. We evaluated the models on two different test sets (n = 999, n = 455). The best model achieved a ROC-AUC of at least 0.99 on all two test sets, setting a top baseline performance for SRCC WSI classification.

• deep learning
• gastric cancer
• multiple-instance learning
• signet ring cell carcinoma
• transfer learning
• weakly-supervised learning

• Area Under Curve
• Carcinoma, Signet Ring Cell/classification
• Carcinoma, Signet Ring Cell/diagnosis
• Carcinoma, Signet Ring Cell/pathology
• Computational Biology
• Deep Learning
• False Negative Reactions
• False Positive Reactions
• Humans
• ROC Curve
• Stomach Neoplasms/classification
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/pathology
• Supervised Machine Learning

• Chemoradiotherapy
• Esophageal cancer
• Esophagectomy
• Neoadjuvant
• Pathological response

• gastric adenocarcinoma
• histologic response
• neoadjuvant therapy
• perioperative therapy
• treatment effect grade

The purpose of this study was to explore the prognostic factors of oesophageal signet ring cell (SRC) carcinoma and to construct a nomogram for predicting the outcome of SRC carcinoma of oesophagus.

A total of 968 cases of oesophageal SRC carcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2016. Cases were divided into training cohort and validation cohort. Univariate and multivariable Cox analyses was performed to select the predictors of overall survival (OS for the nomogram. The performance of nomogram was validated with Harrell’s concordance index (C-index), calibration curves and decision curve analysis (DCA).

The 1- and 5-year OS in the training cohort were 0.446 and 0.146, respectively, and the 1- and 5-year OS in the validation cohort were 0.459 and 0.138. The independent prognostic factors for establishing the nomogram were marital status, invasion of the surrounding tissue, lymph node metastasis, distant metastasis, surgery and chemotherapy. The Harrell’s c-index value of the training cohort and validation cohort were 0.723 and 0.708. In the calibration curves, the predicted survival probability and the actual survival probability have a considerable consistency. DCA indicated the favourable potential clinical utility of the nomogram.

A nomogram to predict the OS of patients with oesophageal SRC carcinoma was established. The validation of the nomogram fully demonstrates its great performance.

• Oesophageal cancer
• nomogram
• signet ring cell (SRC)

Background: Primary pancreatic signet ring cell carcinoma (PPSRCC) is a rare (<1%) poorly reported histopathological variant of pancreatic cancer with ill-defined treatment guidelines. Herein, we describe a case of nonmetastatic PPSRCC in a 45-year-old female.

Presentation: A 45-year-old female presented with 3 weeks of abdominal pain radiating to her back. Other pertinent positives included a 20-pound (9.1-kilogram) weight loss and jaundice, with a known 30-pack-year smoking history. CT scan revealed a 4.6 × 3.6 cm hypoattenuating mass in the head of the pancreas (HOP) with dilatation of the common bile duct. Total bilirubin at presentation was elevated, and a biliary stent was placed endoscopically. Subsequent endoscopic ultrasonography revealed a periampullary ulcerated mass involving the HOP and second portion of the duodenum, with pathology revealing poorly differentiated adenocarcinoma with mucinous background and focal signet ring cells. A classic pancreatoduodenectomy (Whipple procedure) was performed. Final pathology revealed a poorly differentiated (G3) pT3/pN2/pM0 PPSRCC with 11 of 16 positive specimen lymph nodes. The tumor had evidence of both KRAS and TP53 mutations and expressed an MUC1+/MUC2-/MUC5AC+ immunophenotype. Medical oncology recommended a 6-month course of adjuvant modified-dose FOLFIRINOX therapy.

Conclusion: This report highlights the need for further research into the pathogenesis of gastrointestinal signet ring cell carcinoma to identify and study therapeutic targets that can eventually be translated to PPSRCC treatment. Given the paucity of PPSRCC, adjuvant therapy candidates follow the current literature on more common pancreatic cancer subtypes to guide treatment.

• adenocarcinoma
• adjuvant therapy
• epidemiology
• pancreatic cancer
• pancreatoduodenectomy
• signet ring cell carcinoma

• ADC
• SRCC
• adenocarcinoma
• biomarkers
• gastric cancer
• microbiome
• personalized therapy
• signet-ring cell carcinoma

• Acidobacteria/genetics
• Acidobacteria/isolation & purification
• Adenocarcinoma/genetics
• Adenocarcinoma/microbiology
• Adenocarcinoma/pathology
• Bacteroidetes/genetics
• Bacteroidetes/isolation & purification
• Carcinoma, Signet Ring Cell/genetics
• Carcinoma, Signet Ring Cell/microbiology
• Carcinoma, Signet Ring Cell/pathology
• Female
• Fusobacteria/genetics
• Genetic Heterogeneity
• Humans
• Male
• Microbiota/genetics
• Precision Medicine
• Prognosis
• Proteobacteria/genetics
• Proteobacteria/isolation & purification
• RNA, Ribosomal, 16S/genetics
• Stomach Neoplasms/genetics
• Stomach Neoplasms/microbiology
• Stomach Neoplasms/pathology

Background: Limited evidence and contradictory results have been reported regarding the impact of signet ring cell carcinoma (SRC) and mucinous gastric cancer (MGC) classifications on the prognosis of gastric cancer (GC).

Results: Information on 6017 patients and 266 patients was extracted from the SEER database and our hospital records, respectively. We found that patients with MGC had a better survival rate than those with SRC (P=0.012), but in the early stage, MGC was a risk factor for a poor prognosis. After PSM, for both patients from the SEER database and our hospital, the prognosis of patients with SRC was poorer than that of patients with MGC (P<0.05), but patients with MGC in early-stage GC showed poorer survival. Additionally, SRC was demonstrated to be a risk factor in the multivariate competing risk regression model for cancer-specific survival.

Conclusion: Patients with SRC may have a worse prognosis than those with MGC, but for early-stage GC, patients with SRC have a better prognosis than those with MGC.

Method: Patients from the SEER database and from our hospital diagnosed with SRC or MGC were included in a Cox regression analysis, multivariate competing risk model and propensity score matching (PSM) analysis.

• SEER
• competing risk regression model
• mucinous gastric cancer
• propensity score matching
• signet ring cell carcinoma

To explore the clinical and pathological features of gastric signet ring cell carcinoma, and evaluate the survival impact of preoperative radiotherapy on these patients.

The Surveillance, Epidemiology, and End Results database was used to extract eligible patients from 2004 to 2015. The patients were divided into those with and without preoperative radiotherapy. The categorical variables were described by chi-square tests. The patients’ survival was compared between the 2 groups by Kaplan-Meier method with log-rank tests. Cox proportional hazard model was adopted to identify prognostic factors of cancer-specific survival.

Totally 4771 patients were recruited, of whom 218(4.6%) patients received preoperative radiotherapy, while 4553(95.4%) patients didn’t receive this treatment. Survival analysis of the entire cohort demonstrated that preoperative radiotherapy improved both cancer-specific survival and overall survival (p < 0.001) of the patients. Cox proportional hazard models identified age >60, tumor size >50 mm, TNM stage II-IV as independent risk factors for poor prognosis (HR > 1, p < 0.05). Notably, preoperative radiotherapy was identified as an independent protective factor for favorable prognosis (HR < 1, p < 0.05). Subgroup survival analysis showed that preoperative radiotherapy exerted significant survival benefits for the stages III and IV patients.

In this population-based study, preoperative radiotherapy is associated with significant survival benefits for the patients with advanced gastric signet ring cell carcinoma. Hence preoperative radiotherapy is feasible for these patients.

• gastric signet ring cell carcinoma
• preoperative radiotherapy
• survival

• Crohn’s disease
• Gastric signet ring cells carcinoma
• Lymphoma
• Rituximab

• ASCO/CAP
• Gastric cancer
• HER2
• ISH

Signet ring cell adenocarcinomas (SRCCs) are a rare histological subtype of adenocarcinomas with a poor prognosis, typically due to advanced disease at diagnosis. A signet ring cell, mimicking its moniker, contains abundant intracytoplasmic mucin that pushes the nucleus to the periphery. In these cancers, this cell feature comprises more than 50% of the tumor. Despite predilection for the gastrointestinal tract, and in particular the stomach, primary SRCCs are also described in other sites, typically in case reports. This literature, however, lacks a standardized overview of the SRCC disease entity. Using a retrospective cohort approach, we summarize the clinicodemographic and mortality outcomes of SRCCs in thirteen primary sites, comprising 95% of all SRCCs in the Surveillance, Epidemiology, and End Results Program (SEER), a population-level cancer database covering nearly one-third of the United States population. SRCCs general trends compared to matching nonvariant adenocarcinomas are earlier age of onset, with initial presentation favoring higher rates of regional or distant disease presentation and poor tumor differentiation. After multivariable analysis, SRCCs typically have worse overall survivals, but substantial variances exist depending on tumor location. Identifying SRCCs at earlier disease stages is likely the single most important intervention to improving outcomes for these patients.

• CDH1
• E-cadherin
• cancer
• chemotherapy
• diffuse type
• histopathology
• radiotherapy
• surgery

• gastrointestinal tract
• metastasis
• secondary tumours

• Gastric cancer
• histology type
• prognostic factor
• signet ring cell carcinoma
• survival

• Breast cancer
• Clinicopathological characteristics
• Prognosis
• Signet ring cell carcinoma
• Treatment

Preoperative prognostic nutritional index (PNI) has been widely used for the clinical evaluation of patients with cancer. The present study assessed the prognostic value of preoperative PNI in patients after gastric cancer (GC) radical surgery. The clinical case and follow-up data of 170 patients undergoing GC radical surgery were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to compare the predictive ability of each inflammatory index: The PNI, neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR). The correlation between the preoperative PNI and overall survival (OS) was also analyzed via Kaplan-Meier (K-M) curves and multivariate Cox regression analyses. The results revealed that the optimal PNI cut-off was 46.030. According to this cut-off value, the whole sample was divided into PNI <46.030 (low PNI group) and PNI ≥46.030 (high PNI group). These groups were comprised of 102 and 68 cases, respectively. The area under the curve value of the PNI was 0.725, which was greater than that of traditional inflammatory indices, including the NLR and LMR. K-M survival analysis revealed that the 5 year survival rate of patients in the low PNI group was significantly lower than that of patients in the high PNI group (P<0.01). Univariate analysis and Cox multiple regression model analysis demonstrated that the T stage, N stage, pathological grade and PNI were independent risk factors for the 5 year survival rate after radical gastrectomy (P<0.05). In conclusion, the preoperative PNI is an independent risk factor for 5 year survival after radical gastrectomy and has clinical value for the prognostic evaluation of patients with GC.

• gastric cancer
• lymphocyte-to-monocyte ratio
• neutrophil-to-lymphocyte ratio
• prognostic nutritional index
• risk factor analysis
• survival analysis