Is the signet ring cell histological type a positive prognostic factor for gastric adenocarcinoma after D2 radical gastrectomy?

Background: Previous studies indicated the histological type might have prognostic value in gastric adenocarcinoma patients. The aim of this study was to clarify whether the signet ring cell (SRC) histological type of gastric adenocarcinoma is associated with worse prognosis than pure gastric adenocarcinoma without any mixed histological component (PGA) for patients underwent D2 radical gastrectomy.

Method: By the database of 6205 surgical patients with gastric adenocarcinoma at our department between September 2008 and May 2015, we investigated 133 SRC patients and 2847 PGA patients who underwent D2 radical gastrectomy. The clinic and pathologic data, especially tumor and pathology molecular markers, and 5-year overall survival rate were compared between SRC and PGA. The univariate and multivariate analysis were used to testify the prognosis significance of SRC.

Results: SRC was more frequently found in younger (<50), female patients, lower part of stomach and easy to metastasize lymph nodes. And more positive CA19-9 and less positive EGFR were obtained in SRC. The 5-year survival rate was not different between SRC and PGA after D2 radical gastrectomy, even assessed by T stage. Multivariate analysis showed age, T and N stage, CEA, CA19-9 and CA125 were the independent prognostic factors, not included the SRC histological type.

Conclusion: Although SRC histological type of gastric adenocarcinoma after D2 radical gastrectomy had its own clinic-pathologic characters, especially in molecular tumor and pathological markers, the histological type of SRC was a negative prognostic factor in gastric adenocarcinoma patients after D2 radical gastrectomy.