Clinicopathological, immunohistochemical, and overall-survival associations of poorly cohesive gastric carcinoma stratified by signet ring cell percentage

doi:10.5306/wjco.125097

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. Oct 24, 2026; 17(10): 125097
Published online Oct 24, 2026. doi: 10.5306/wjco.125097

Table 1 Clinicopathological features of poorly cohesive carcinoma and non-poorly cohesive carcinoma, n (%)

		Non-PCC	PCC	P value
n		1218	374
Age, mean (SD)		64.75 (10.19)	59.87 (11.84)	< 0.001
Sex	Female	323 (26.5)	176 (47.1)	< 0.001
Sex	Male	895 (73.5)	198 (52.9)
Stage	I	337 (28.0)	104 (28.6)	0.016
	II	232 (19.3)	54 (14.8)
	III	606 (50.3)	187 (51.4)
	IV	29 (2.4)	19 (5.2)
T	T1	240 (19.9)	68 (18.7)	0.216
	T2	161 (13.3)	57 (15.7)
	T3	81 (6.7)	15 (4.1)
	T4	725 (60.1)	224 (61.5)
N	N0	492 (40.4)	140 (37.5)	0.006
	N1	187 (15.4)	44 (11.8)
	N2	225 (18.5)	59 (15.8)
	N3	314 (25.8)	130 (34.9)
M	M0	1175 (97.591)	353 (94.892)	0.016
M	M1	29 (2.409)	19 (5.108)

Missing data: Age, 0; sex, 0; stage, 24 (1.51%). Percentages are based on the total cohort (n = 1592). PCC: Poorly cohesive carcinoma.

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Table 2 Clinicopathological features of defined subtypes within poorly cohesive carcinoma, n (%)

		SRC	SRC/PCC-NOS	PCC-NOS	P value
n		70	171	133
Age, mean (SD)		60.39 (11.09)	58.30 (12.76)	61.62 (10.75)	0.048
Sex	Female	37 (52.9)	95 (55.6)	44 (33.1)	< 0.001
Sex	Male	33 (47.1)	76 (44.4)	89 (66.9)
Site	Upper	6 (8.8)	12 (7.2)	25 (19.1)	0.024
	Middle	30 (44.1)	79 (47.6)	49 (37.4)
	Lower	32 (47.1)	75 (45.2)	57 (43.5)
Stage	I	35 (51.5)	44 (26.3)	25 (19.4)	< 0.001
	II	12 (17.6)	24 (14.4)	18 (14.0)
	III	19 (27.9)	86 (51.5)	82 (63.6)
	IV	2 (2.9)	13 (7.8)	4 (3.1)
T	T1	28 (41.2)	28 (16.8)	12 (9.3)	< 0.001
	T2	9 (13.2)	27 (16.2)	21 (16.3)
	T3	2 (2.9)	8 (4.8)	5 (3.9)
	T4	29 (42.6)	104 (62.3)	91 (70.5)
N	N0	45 (64.3)	54 (31.8)	41 (30.8)	< 0.001
	N1	6 (8.6)	22 (12.9)	16 (12.0)
	N2	7 (10.0)	25 (14.7)	27 (20.3)
	N3	12 (17.1)	69 (40.6)	49 (36.8)
M	M0	67 (97.1)	155 (92.3)	123 (96.9)	0.135
M	M1	2 (2.9)	13 (7.7)	4 (3.1)

Missing data: Age, 0; sex, 0; stage, 10 (2.7%). Percentages are based on the total cohort (n = 374). SRC: Signet ring carcinoma; PCC-NOS: Poorly cohesive carcinoma-not otherwise specified.

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Table 3 Lymph node burden among defined subgroups of poorly cohesive carcinoma, n (%)

		SRC	SRC/PCC-NOS	PCC-NOS	P value
Total examined LNs, n		1624	4327	3434
Examined LNs per case, n		23.20	25.30	25.82
Examined LNs, n	D1	1147	2964	2293
	D2	253	736	660
	D3	224	627	481
Total Metastatic LNs		192 (11.8)	1349 (31.2)	1053 (30.7)
Metastatic LNs	D1	159 (13.9)	1004 (33.9)	790 (34.5)	0.0018
	D2	13 (5.1)	159 (21.6)	154 (23.3)
	D3	20 (8.9)	186 (29.7)	109 (22.7)
Metastatic LNs	N1	9 (7.4)	37 (7.4)	26 (7.0)	< 0.001
	N2	37 (20.9)	94 (16.4)	149 (22.8)
	N3	127 (46.2)	1115 (65.7)	784 (59.6)
Metastatic LNs per case, n	N1	1.50	1.68	1.63
	N2	5.28	3.76	5.52
	N3	10.58	16.16	16

SRC: Signet ring carcinoma; PCC-NOS: Poorly cohesive carcinoma-not otherwise specified; LNs: Lymph nodes.

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Table 4 Immunohistochemical characteristics of defined subtypes within poorly cohesive carcinoma

	Evaluable cases		SRC	SRC/PCC-NOS	PCC-NOS	P value
n			70	171	133
CEA, n/N (%)	209	-	6/42 (14.3)	5/89 (5.6)	6/78 (7.7)	0.416
		-/+	4/42 (9.5)	7/89 (7.9)	6/78 (7.7)
		+	26/42 (61.9)	72/89 (80.9)	61/78 (78.2)
		++	1/42 (2.4)	2/89 (2.2)	1/78 (1.3)
		+++	5/42 (11.9)	3/89 (3.4)	4/78 (5.1)
Ki67, mean (SD)	355		0.40 (0.24)	0.52 (0.22)	0.55 (0.20)	< 0.001
HER2, n/N (%)	350	-	44/62 (71.0)	106/162 (65.4)	82/126 (65.1)	0.122
		+	14/62 (22.6)	42/162 (25.9)	25/126 (19.8)
		++	2/62 (3.2)	11/162 (6.8)	18/126 (14.3)
		+++	2/62 (3.2)	3/162 (1.9)	1/126 (0.8)
P53, n/N (%)	260	-	12/47 (25.5)	33/113 (29.2)	26/100 (26.0)	0.244
		-/+	3/47 (6.4)	9/113 (8.0)	2/100 (2.0)
		+	16/47 (34.0)	33/113 (29.2)	23/100 (23.0)
		++	5/47 (10.6)	11/113 (9.7)	10/100 (10.0)
		+++	11/47 (23.4)	27/113 (23.9)	39/100 (39.0)
EGFR, n/N (%)	111	-	3/18 (16.7)	13/45 (28.9)	9/48 (18.8)	0.545
		-/+	1/18 (5.6)	4/45 (8.9)	2/48 (4.2)
		+	14/18 (77.8)	28/45 (62.2)	37/48 (77.1)
MLH1, n/N (%)	63	-	0/7 (0.0)	0/32 (0.0)	4/24 (16.7)	0.031
MLH1, n/N (%)	63	+	7/7 (100.0)	32/32 (100.0)	20/24 (83.3)
MSH2, n/N (%)	63	+	7/7 (100.0)	32/32 (100.0)	24/24 (100.0)
MSH6, n/N (%)	63	-	0/7 (0.0)	0/32 (0.0)	1/24 (4.2)	0.438
MSH6, n/N (%)	63	+	7/7 (100.0)	32/32 (100.0)	23/24 (95.8)
PMS2, n/N (%)	63	-	0/7 (0.0)	0/32 (0.0)	4/24 (16.7)	0.031
PMS2, n/N (%)	63	+	7/7 (100.0)	32/32 (100.0)	20/24 (83.3)
PD-1, n/N (%)	38	-	6/6 (100.0)	13/15 (86.7)	14/17 (82.4)	0.546
PD-1, n/N (%)	38	+	0/6 (0.0)	2/15 (13.3)	3/17 (17.6)
PD-L1, n/N (%)	171	CPS < 1	21/23 (91.3)	68/78 (87.2)	51/70 (72.9)	0.035
PD-L1, n/N (%)	171	CPS ≥ 1	2/23 (8.7)	10/78 (12.8)	19/7 (27.1)

Data are presented as n/N (%), where N represents the number of evaluable cases within each subtype group. Immunohistochemistry markers were not available for all patients; analyses based on evaluable cases were exploratory. SRC: Signet ring carcinoma; PCC-NOS: Poorly cohesive carcinoma-not otherwise specified; CEA: Carcinoembryonic antigen; EGFR: Epidermal growth factor receptor; MLH1: MutL homolog 1; MSH: MutS homolog; PMS2: Postmeiotic segregation increased 2; PD-1: Programmed death protein 1; PD-L1: Programmed death protein ligand 1; CPS: Combined positive score.

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Table 5 Clinicopathological features of signet ring carcinoma, signet ring carcinoma/poorly cohesive carcinoma-not otherwise specified, and poorly cohesive carcinoma-not otherwise specified after propensity score matching, n (%)

		Before PSM					After PSM
		SRC	SRC/PCC-NOS	PCC-NOS	P value	SMD	SRC	SRC/PCC-NOS	PCC-NOS	P value	SMD
n		70	171	133			56	56	56
Sex	Female	37 (52.857)	95 (55.556)	44 (33.083)	< 0.001	0.309	27 (48.214)	29 (51.786)	29 (51.786)	0.909	0.048
Sex	Male	33 (47.143)	76 (44.444)	89 (66.917)			29 (51.786)	27 (48.214)	27 (48.214)
Age	< 60	28 (40.000)	82 (47.953)	53 (39.850)	0.581	0.144	26 (46.429)	25 (44.643)	25 (44.643)	0.984	0.094
	60-74	36 (51.429)	74 (43.275)	65 (48.872)			27 (48.214)	27 (48.214)	26 (46.429)
	≥ 75	6 (8.571)	15 (8.772)	15 (11.278)			3 (5.357)	4 (7.143)	5 (8.929)
Stage	I	35 (51.471)	44 (26.347)	25 (19.380)	< 0.001	0.580	27 (48.214)	26 (46.429)	25 (44.643)	0.995	0.080
	II	12 (17.647)	24 (14.371)	18 (13.953)			8 (14.286)	8 (14.286)	10 (17.857)
	III	19 (27.941)	86 (51.497)	82 (63.566)			19 (33.929)	20 (35.714)	19 (33.929)
	IV	2 (2.941)	13 (7.784)	4 (3.101)			2 (3.571)	2 (3.571)	2 (3.571)

PSM: Propensity score matching; SRC: Signet ring carcinoma; PCC-NOS: Poorly cohesive carcinoma-not otherwise specified; SMD: Standardized mean difference.

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Citation: Zheng YH, Wang YY, Wang SC, Wang CJ, Shen YY, Cui JZ, Liu SM, Zhang YH, Zeng XQ, Zhao EH. Clinicopathological, immunohistochemical, and overall-survival associations of poorly cohesive gastric carcinoma stratified by signet ring cell percentage. World J Clin Oncol 2026; 17(10): 125097
URL: https://www.wjgnet.com/2218-4333/full/v17/i10/125097.htm
DOI: https://dx.doi.org/10.5306/wjco.125097

Zheng YH, Wang YY, Wang SC, Wang CJ, Shen YY, Cui JZ, Liu SM, Zhang YH, Zeng XQ, Zhao EH. Clinicopathological, immunohistochemical, and overall-survival associations of poorly cohesive gastric carcinoma stratified by signet ring cell percentage. World J Clin Oncol 2026; 17(10): 125097 [DOI: 10.5306/wjco.125097]

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