Prognostic Significance of Signet Ring Gastric Cancer
Prognostic Significance of Signet Ring Gastric Cancer
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DOI：
10.1200/jco.2012.42.6635
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发表时间：
2012-10-01
影响因子：
45.3
通讯作者：
Willis, Alliric I.
中科院分区：
文献类型：
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作者：
Taghavi, Sharven;Jayarajan, Senthil N.;Willis, Alliric I.
目的亚洲的研究质疑印戒细胞癌(SRC)比其他形式的胃癌预后更差的论断。我们的研究确定了美国SRC和胃腺癌(AC)的表现和预后的差异。患者和方法回顾了美国国家癌症研究所监测、流行病学和最终结果数据库中SRC和AC的数据。SRC出现在较年轻的患者(61.9比68.7岁；P<；.001)，较少出现在男性(52.7%比68.7%；P<；.001)。SRC患者更多的是黑人(11.3%比10.9%)、亚裔(16.4%比13.2%)、美国印第安人/阿拉斯加原住民(0.9%比0.8%)或西班牙裔(23.3%比14.0%；P<；.001)。SRC更有可能是T3-4期(45.8%vs33.3%)，有淋巴结转移(59.7%vs51.8%)和远处转移(40.2%vs37.6%；P<；.001)。SRC多见于下胃(30.7%vs24.2%)和中胃(30.6%vs20.7%；P<；.001)。中位生存期在两组间无差异(AC为14.0个月，SRC为13.0个月；P=0.073)。多变量分析显示SRC与死亡率无关(危险比[HR]，1.05；95%CI，0.96至1.11；P=.150)。死亡率与年龄(HR，1.01；95%CI，1.01至1.02；P<；.001)、黑人种族(HR，1.10；95%CI，1.01至1.20；P=.026)和肿瘤分级有关。与较低死亡风险相关的变量包括亚洲种族(HR，0.83；95%CI，0.77至0.91；P<；.001)和手术(HR，0.37；95%CI，0.34至0.39；P<；.001)。结论在美国，SRC和AC在发病时的疾病程度上存在显著差异。然而，当调整分期时，SRC并不预示着更差的预后。临床电话：30：3493-3498。(C)2012年美国临床肿瘤学会
PurposeStudies 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.Patients and MethodsThe National Cancer Institute Surveillance, Epidemiology, and End Results database was reviewed for SRC and AC from 2004 to 2007.ResultsWe 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).ConclusionIn 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. Clin Oncol 30: 3493-3498. (C) 2012 by American Society of Clinical Oncology