Comparison between signet-ring cell carcinoma and non-signet-ring cell carcinoma of the stomach: clinicopathological parameters, epidemiological data, outcome, and prognosis—a cohort study of 123 patients from a non-endemic country
Authors: Zaafouri Haithem , Jouini Raja , Khedhiri Nizar , Khanchel Fatma , Cherif Mona , Mesbahi Meryam , Daghmouri Aziz , Mahmoudi Wiem , Akremi Soumaya , Sabbah Meriam , Benzarti Yazid , Hadded Dhafer , Gargouri Dalila , Bader Mourad Ben , Maamer Anis Ben 
Published: July 2022

Background

Signet-ring cell carcinoma of the stomach (SRCC) is a particular gastric cancer entity. Its incidence is increasing. Its diagnosis is pathological; it corresponds to adenocarcinoma with a majority of signet-ring cells component (> 50%).

These histological features give it its aggressiveness characteristics. This has repercussions on the prognostic level and implications for the alternatives of therapy, especially since some authors suggest a potential chemoresistance.

This survey aimed to identify the epidemiological, pathological, therapeutic, and prognostic characteristics of SRCC as a separate disease entity.

Methods

This was a retrospective study of 123 patients admitted for gastric adenocarcinoma to Habib Thameur Hospital in Tunis over 11 years from January 2006 to December 2016. A comparative study was performed between 2 groups: the SRCC group with 62 patients and the non-SRCC (non-signet-ring cell carcinoma of the stomach) with 61 patients.

Results

The prevalence of SRCC in our series was 50%. SRCC affected significantly younger patients (55 vs 62 years;p= 0.004). The infiltrative character was more common in SRCC tumors (30.6 vs 14.8%;p= 0.060), whereas the budding character was more often noted in non-SRCC tumors (78.7 vs 58.1%;p= 0.039). There was no significant difference in tumor localization between both groups. Linitis plastica was noted in 14 patients with SRCC against a single patient with non-SRCC (p= 0.001). The tumor size was more important in the non-SRCC group (6.84 vs 6.39 cm;p= 0.551). Peritoneal carcinomatosis was noted in 4.3% of cases in the SRCC group versus 2.2% of cases in the NSRCC group (p= 0.570). Total gastrectomy was more often performed in the SRCC group (87 vs 56%;p= 0.001). Resection was more often curative in the non-SRCC group (84.4 vs 78.3%;p= 0.063). Postoperative chemotherapy was more commonly indicated in the SRCC group (67.4 vs 53.3%;p= 0.339). Tumor recurrence was more common in the non-SRCC group (35.7 vs 32%;p= 0.776). The most common type of recurrence was peritoneal carcinomatosis in the SRCC group (62.5%) and hepatic metastasis in the non-SRCC group (60%;p= 0.096). The overall 5-year survival in the SRCC group was lower than in the non-SRCC group, with no statistically significant difference (47.1 vs 51.5%;p= 0.715). The overall survival was more important for SRCC in early cancer (100 vs 80%;p= 0.408), whereas it was higher for non-SRCC in advanced cancer (48.1 vs 41.9%;p= 0.635).

Conclusion

Apart from its epidemiological and pathological features, SRCC seems to have a worse prognosis. Indeed, it is diagnosed at a more advanced stage and has a worse prognosis in advanced cancer than non-SRCC. It is therefore to be considered as a particular entity of gastric adenocarcinoma requiring a specific therapeutic protocol where the place of chemotherapy remains to be more investigated.