Stage-Stratified Prognosis of Signet Ring Cell Histology in Patients Undergoing Curative Resection for Gastric Adenocarcinoma
Stage-Stratified Prognosis of Signet Ring Cell Histology in Patients Undergoing Curative Resection for Gastric Adenocarcinoma
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DOI：
10.1245/s10434-013-3466-8
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发表时间：
2014-05-01
影响因子：
3.7
通讯作者：
Strong, Vivian E.
中科院分区：
文献类型：
--
作者：
Bamboat, Zubin M.;Tang, Laura H.;Strong, Vivian E.
印戒细胞（SRC）胃腺癌的预后被认为是很差的，尽管关于非SRC肿瘤预后的研究是相互矛盾的。我们的目的是比较SRC肿瘤的生存期与西方patients.Review前瞻性维护的数据库中的分期匹配的膀胱型肿瘤的队列确定了569例患者接受根治性切除术（R 0）从1990年至2009年。根据Lauren分类将患者分为三个组织学组：SRC（n = 210），肠高或中度分化（WMD，n = 242）疾病和肠低分化（PD，n = 117）疾病。确定患者的人口统计学资料、临床病理学特征和术后结局。当与WMD和PD肿瘤相比时，SRC肿瘤与年轻年龄（63岁SRC对71岁WMD和72岁PD，p < 0.0001）和女性性别（58%SRC对40%WMD和40%PD，p = 0.0003）相关。中位随访时间为115个月。Ia期SRC病变患者的5年疾病特异性死亡率高于分期匹配的卵巢型肿瘤患者（0% SRC vs. 8% WMD和24% PD，p = 0. 001）。相比之下，患有III期疾病的SRC患者的表现显著更差（78%SRC vs. 54%WMD和72%PD，p = 0.001）。在多变量分析中，比较所有三组胃癌的死亡风险，I期SRC最低，III期SRC最高（III期风险比：SRC 1 vs. 0.47 WMD和0.85 PD）。
The prognosis of signet ring cell (SRC) gastric adenocarcinoma is regarded as poor, although studies addressing outcomes in relation to non-SRC tumors are conflicting. Our objective was to compare the survival of SRC tumors with stage-matched intestinal-type tumors in a cohort of Western patients.Review of a prospectively maintained database identified 569 patients undergoing curative resection (R0) from 1990 to 2009. Patients were divided into three histologic groups on the basis of the Lauren classification: SRC (n = 210), intestinal well- or moderately differentiated (WMD, n = 242) disease, and intestinal poorly differentiated (PD, n = 117) disease. Patient demographics, clinicopathologic features, and postoperative outcomes were determined. Stage-stratified disease-specific mortality was calculated and multivariate analysis performed.When compared with WMD and PD tumors, SRC tumors were associated with younger age (63 years SRC vs. 71 years WMD and 72 years PD, p < 0.0001) and with female sex (58 % SRC vs. 40 % WMD and 40 % PD, p = 0.0003). Median follow-up was 115 months. Patients with stage Ia SRC lesions had a better 5-year disease-specific mortality compared with stage-matched intestinal-type tumors (0 % SRC vs. 8 % WMD and 24 % PD, p = 0.001). In contrast, SRC patients with stage III disease fared significantly worse (78 % SRC vs. 54 % WMD and 72 % PD, p = 0.001). On multivariate analysis, the risk of death from gastric cancer comparing all three groups was lowest for SRC in stage I and highest for SRC in stage III disease (stage III hazard ratio: SRC 1 vs. 0.47 WMD and 0.85 PD).When compared with intestinal-type tumors, SRC tumors at early stages are not necessarily associated with poor outcomes.