title: Differential Prognostic Implications of Gastric Signet Ring Cell Carcinoma: Stage Adjusted Analysis From a Single High-volume Center in Asia.
abstract: The aim of this study was to analyze the clinicopathologic characteristics and prognosis of signet ring cell carcinoma (SRC) according to disease status (early vs advanced gastric cancer) in gastric cancer patients.
  
  
  
  The prognostic implication of gastric SRC remains a subject of debate.
  
  
  
  A retrospective analysis was performed using the clinical records of 7667 patients including 1646 SRC patients who underwent radical gastrectomy between 2001 and 2010. A further analysis was also performed after dividing patients into three groups according to histologic subtype: SRC, well-to-moderately differentiated (WMD), and poorly differentiated adenocarcinoma.
  
  
  
  SRC patients have younger age distribution and female predominance compared with other histologic subtypes. Notably, the distribution of T stage of SRC patients was distinct, located in extremes (T1: 66.2% and T4: 20%). Moreover, the prognosis of SRC in early gastric cancer and advanced gastric cancer was contrasting. In early gastric cancer, SRC demonstrated more favorable prognosis than WMD after adjusting for age, sex, and stage. In contrast, SRC in advanced gastric cancer displayed worse prognosis than WMD. As stage increased, survival outcomes of SRC continued to worsen compared with WMD.
  
  
  
  Although conferring favorable prognosis in early stage, SRC has worse prognostic impact as disease progresses. The longstanding controversy of SRC on prognosis may result from disease status at presentation, which leads to differing prognosis compared with tubular adenocarinoma.
authors.affiliation: *Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA Univerisity, Seongnam, Korea †Yonsei Graduate School, Yonsei University College of Medicine, Seoul, Korea ‡Department of Surgery, Yonsei University College of Medicine, Seoul, Korea §Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea ||Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ¶Department of internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicinem Guri, Korea **Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea ††Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hong Jae
authors.initials: HJ
authors.lastname: Chon
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Chan
authors.initials: C
authors.lastname: Kim
authors.forename: Sohee
authors.initials: S
authors.lastname: Park
authors.forename: Jie-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Chan Hyuk
authors.initials: CH
authors.lastname: Park
authors.forename: Joong Bae
authors.initials: JB
authors.lastname: Ahn
authors.forename: Hyunki
authors.initials: H
authors.lastname: Kim
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Chung
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
authors.forename: Hei-Cheul
authors.initials: HC
authors.lastname: Jeung
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D001208:Asia; D001707:Biopsy, Needle; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D061847:Hospitals, High-Volume; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome