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背景和目的胃癌中印戒细胞(signet-ring cell,SRC)癌的预后及其化疗耐药性已有文献报道并存在争议。对此类肿瘤围手术期化疗的作用仍然存在质疑。本研究意欲评估在接受根治性切除术的SRC癌的预后。同时,比较非SRC癌和SRC癌的预后影响因素(其中包括围手术期化疗)。方法本研究为回顾性研究,参加单位包括法国的19个医疗中心。共纳入接受手术治疗的1799例连续胃腺癌病例,手术方式包括胃次全切除和全胃切除术。对胃窦癌行D2淋巴结清扫,对胃上部癌行改良的D2淋巴结清扫。SRC癌的诊断依据为病灶中存在含黏蛋白的孤立细胞群。结果共979(54.4%)例患者接受全胃切除。共899(50%)例患者诊断为SRC癌。较非SRC癌相比,SRC癌多发于女性、青年及营养不良患者,并ASA评分较低、肿瘤更大。非SRC及SRC癌患者的中位生存期分别为51个月、26个月(P<0.001)。多因素分析表明,SRC癌为胃癌的独立预后不良因素(HR=1.182)。年龄>60岁、皮革胃、邻近脏器侵犯为SRC癌患者预后的不良因素,但不是非SRC胃癌患者的预后因素。相比于非SRC癌患者,术前及术后化疗对接受切除手术的SRC癌患者的预后无显著影响。结论相比于非SRC癌,SRC癌的预后不良、预后影响因素存在差异、围手术期的化疗敏感度差。因此,在将来的治疗相关研究中,非SRC癌及SRC癌应作为不同类型处理。
BACKGROUND & OBJECTIVE: The prognosis and chemotherapy resistance of signet-ring cell (SRC) in gastric cancer have been reported and controversial. The role of perioperative chemotherapy for such tumors remains questionable. This study was designed to assess the prognosis of SRC cancer undergoing radical resection. At the same time, the prognostic factors of non-SRC and SRC cancer were compared (including perioperative chemotherapy). Methods This study was a retrospective study involving 19 medical centers in France. A total of 1799 consecutive cases of gastric adenocarcinoma undergoing surgical treatment were enrolled. Surgical procedures included subtotal gastrectomy and total gastrectomy. D2 lymph node dissection was performed on gastric cancer, and D2 lymph node dissection improved on upper gastric cancer. The diagnosis of SRC cancer is based on the presence of isolated mucin-containing cells in the lesion. Results A total of 979 (54.4%) patients underwent total gastrectomy. A total of 899 (50%) patients were diagnosed with SRC cancer. Compared with non-SRC cancer, SRC cancer is more common in women, adolescents, and malnourished patients with lower ASA score and larger tumors. The median survival of non-SRC and SRC cancer patients was 51 months and 26 months, respectively (P <0.001). Multivariate analysis showed that SRC was an independent prognostic factor for gastric cancer (HR = 1.182). Age> 60 years old, leather stomach, adjacent organs violations of SRC cancer prognosis adverse factors, but not non-SRC gastric cancer prognostic factors. Compared with non-SRC cancer patients, preoperative and postoperative chemotherapy in patients undergoing resection of SRC cancer prognosis had no significant effect. Conclusion Compared with non-SRC cancer, SRC cancer has a poor prognosis and different prognostic factors. Perioperative chemosensitivity is poor. Therefore, non-SRC and SRC cancers should be treated as different types in future treatment-related studies.