title: Prognostic significance of signet ring gastric cancer.
abstract: OBJECTIVE
  Studies in Asia have questioned the dictum that signet ring cell carcinoma (SRC) has a worse prognosis than other forms of gastric cancer. Our study determined differences in presentation and outcomes between SRC and gastric adenocarcinoma (AC) in the United States.
  
  
  METHODS
  The National Cancer Institute Surveillance, Epidemiology, and End Results database was reviewed for SRC and AC from 2004 to 2007.
  
  
  RESULTS
  We reviewed 10,246 cases of patients with gastric cancer, including 2,666 of SRC and 7,580 of AC. SRC presented in younger patients (61.9 v 68.7 years; P < .001) and less often in men (52.7% v 68.7%; P < .001). SRC patients were more frequently black (11.3% v 10.9%), Asian (16.4% v 13.2%), American Indian/Alaska Native (0.9% v 0.8%), or Hispanic (23.3% v 14.0%; P < .001). SRC was more likely to be stage T3-4 (45.8% v 33.3%), have lymph node spread (59.7% v 51.8%), and distant metastases (40.2% v 37.6%; P < .001). SRC was more likely to be found in the lower (30.7% v 24.2%) and middle stomach (30.6% v 20.7%; P < .001). Median survival was not different between the two (AC, 14.0 months v SRC, 13.0 months; P = .073). Multivariable analyses demonstrated SRC was not associated with mortality (hazard ratio [HR], 1.05; 95% CI, 0.96 to 1.11; P = .150). Mortality was associated with age (HR, 1.01; 95% CI, 1.01 to 1.02; P < .001), black race (HR, 1.10; 95% CI, 1.01 to 1.20; P = .026), and tumor grade. Variables associated with lower mortality risk included Asian race (HR, 0.83; 95% CI, 0.77 to 0.91; P < .001) and surgery (HR, 0.37; 95% CI, 0.34 to 0.39; P < .001).
  
  
  CONCLUSIONS
  In the United States, SRC significantly differs from AC in extent of disease at presentation. However, when adjusted for stage, SRC does not portend a worse prognosis.
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, 19140, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Adam
authors.initials: A
authors.lastname: Davey
authors.forename: Alliric I
authors.initials: AI
authors.lastname: Willis
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000473:pathology; D000368:Aged; D044466:Asian People; D018279:Carcinoma, Signet Ring Cell / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D014481:United States