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General and specific prognostic factors of early gastric carcinoma treated with curative surgery.

BACKGROUND/AIMS: In Western countries as well as in Japan, the percentages of early gastric cancer (EGC) have been increasing. This study was performed to clarify the general and specific prognostic factors of EGC. METHODOLOGY: General prognostic factors were evaluated in 601 EGC patients treated with curative surgery, including those who died of unrelated causes, and specific prognostic factors were evaluated in 471 EGC patients, excluding those dying of unrelated causes, using univariate and multivariate analysis. RESULTS: The overall 5- and 10-year survival rates in the EGC patients were 86.7% and 76.6% respectively. In all 601 patients, including those who died of other causes, general prognostic factors, according to multivariate analysis, were sex, age, primary malignant diseases other than the original EGC, depth of invasion, and lymph node metastasis. The specific prognostic factor was lymph node metastasis with a risk ratio of 18.6-fold against patients without lymph node metastasis, according to multivariate analysis. CONCLUSIONS: The worst prognostic factors in all EGC patients were male sex, age 60 years and over, presence of primary malignant disease other than original EGC, submucosal cancer, and lymph node metastasis. Lymph node metastasis was specifically related to EGC recurrence. Thus, lymph node dissection is indispensable for the treatment of early gastric cancer, and the surveillance of other organs or the residual stomach for primary malignancy is particularly important after surgery.

Signet ring cell carcinoma of the stomach: a clinicopathological comparison with the other histological types.

A retrospective analysis was carried out on 93 patients with signet ring cell carcinoma of the stomach operated on between 1985 and 1995, to review the clinicopathologic characteristics from the database of gastric cancer at Sendai National Hospital. The results were compared with those for 590 patients with other types of gastric carcinoma. Women were afflicted as commonly as men in the signet ring cell carcinoma group. These patients tended to be younger and to have larger tumors. The histological type was commonly scirrhous and infiltrative. The survival of patients with signet ring cell carcinoma was worse than that of patients with other types of gastric cancer but the difference was not statistically significant. Patients with early signet ring cell carcinoma had a good prognosis, similar to that of the other groups. However, prognosis of patients with advanced signet ring cell carcinoma was poor compared with patients with other types of this disease. In multivariate analysis, the statistical significant prognostic factors were vascular microinvasion and tumor location. These findings suggest that signet ring cell carcinoma of the stomach should be regarded as a distinct type of gastric cancer.

BACKGROUND AND OBJECTIVES: As there is no consensus regarding the prognosis of patients with signet cell carcinoma of the stomach compared with other types of gastric cancer, we retrospectively studied the clinicopathologic features and prognosis of signet cell carcinoma in comparison with other types of gastric cancer. METHODS: Gastrectomies were performed because of gastric cancer in 1,498 patients between 1970 and 1994. Of the 154 patients diagnosed with signet ring cell carcinoma, 94 had early and 60 had advanced gastric carcinoma. The percentage of patients with an early carcinoma was significantly higher among those with signet ring cell carcinoma compared with those with other gastric carcinoma histologies. RESULTS: The survival of the total group of patients with signet ring cell carcinoma was significantly better than that of patients with other types of gastric carcinoma (P < 0.05). Survival of the subset of patients with early signet ring cell carcinoma was also improved compared with patients with other types of gastric carcinoma (P < 0.05). However, patients with advanced signet ring cell carcinoma had a poor prognosis similar to that of patients with other types of gastric carcinoma.

A retrospective analysis of 3,702 gastric cancer patients operated on between 1981 and 1991 was carried out to compare the clinicopathological features of signet ring cell (SRC) gastric cancer with other cell types. Four hundred and fifty patients (12.2%) had signet ring cell gastric carcinoma. There was a tendency for patients with the signet ring cell gastric cancer to be younger and female, and of the middle-third part of stomach to be involved. The proportion of early gastric cancers in signet ring cell gastric cancers was 43%, which was significantly higher than in the other histological types [33% in well differentiated (WD) type, 23% in moderately differentiated (MD) type, and 13% in poorly differentiated (PD) type]. Early stage signet ring cell gastric carcinomas were less invasive in depth and had less lymph node metastasis. However, signet ring cell gastric cancers in advanced stage were more invasive and had more lymph node metastasis than other cell types. There was no significant difference in five year survival rates (5YSR) among patients with different histological cell types in early stage gastric cancers. But, in advanced gastric cancers, the prognosis for patients with the signet ring cell type was significantly worse than for the other types (SRC, 31.9% 5YSR; WD, 45.1% 5YSR; MD, 38.4% 5YSR; PD, 34.5% 5YSR) (P < 0.05), which can be explained by the finding that advanced gastric cancers with signet ring cell type have a larger tumour size, more lymph node metastasis, a deeper invasive depth and more Borrmann type 4 lesions than other histological types. This study suggests that signet ring cell gastric cancer may have a different biological behaviour.