| Background and ObjectiveSignet-ring cell carcinoma cells(SRCC)are rich in cytoplasm,full of mucus,and the nucleus is squeezed to one side of the cytoplasm,showing"signet ring"shape,featuring poor tissue differentiation,low degree of differentiation,high degree of malignancy,high aggressiveness and rapid progression.Diagnosis rate of gastric SRCC is not high,and it is generally found at the advanced stage.Some studies have shown that early gastric SRCC is mostly confined to the mucosa with less infiltration of lymph nodes and a good prognosis,while patients with advanced gastric SRCC have a poor prognosis compared with other types of carcinoma.However,the differences of the overall survival rate of patients with gastric SRCC and non gastric-SRCC is not statistically significant.Previous conclusions on the prognosis of gastric SRCC are not consistent.The SEER database(surveillance,epidemiology,and end results)is the cancer data recorded by the National Cancer Institute(NCI),with its large sample size,wide population coverage,and high data accuracy,providing good data support for clinical studies of oncology.In this paper,the clinicopathological features and prognosis of gastric SRCC and non gastric SRCC were analyzed and discussed with the help of the multi-center,large-sample SEER database,and the differences in the prognosis of early gastric carcinoma were analyzed,so as to provide reference for clinical treatment and prognosis judgement.Data and MethodTo collect the clinical data of patients diagnosed with gastric carcinoma from 2010 to2015 by SEER database,and to divide those patients into group SRCC and group non-gastric SRCC in accordance with their histologic types.The data,including gender,age,race,original sites,degree of differentiation,TNM stage,tumor size,detection of lymphatic gland,surgical treatment and chemotherapy,were included to carry out the study.SPSS 23.0 was used to analyze the data.The difference between relevant clinical data was compared.The count data was expressed as n(%),and the x2 test was used for the comparison between the two groups.Grade variables:degree of differentiation and TNM stage were compared by using the non-parametric test.The Kaplan-Meier method was used to calculate survival rate,the univariate analysis was performed by the Log-Rank test,and the survival curve was drawn.Cox regression model was used to analyze the influencing factors related to the prognosis.P≤0.05 was considered as statistical significance.ResultThe comparison between the two groups in clinicopathologic features of patients with gastric carcinoma showed that there were statistically significant differences in gender,age,race,primary site,degree of differentiation,TNM stage,tumor size,detection of lymphatic gland,surgical treatment and chemotherapy conditions(P<0.05).The clinicopathologic features of the two groups of patients with early gastric carcinoma showed that the proportion of early gastric SRCC mucosa(T1a)was higher than that of non-gastric SRCC,and the proportion of submucosa(T1b)was lower than that of non-gastric SRCC.The positive rate of early gastric SRCC lymph node test was lower than that of non-gastric SRCC.When the tumor was confined to the mucosa,the proportion of positive lymph nodes in SRCC patients was lower than that in non-gastric SRCC patients,and the proportion of tumor diameter≤2cm was higher than that in non-gastric SRCC patients(P<0.05).When the tumor infiltrated into the submucosa,the proportion of positive lymph nodes in SRCC patients was higher than that in non-gastric SRCC patients(P<0.05).The univariate analysis showed that the factors influencing the lifetime of patients with gastric SRCC included age,race,primary site,TNM stage,tumor size,detection of lymphatic gland and surgical treatment;the factors influencing the lifetime of patients with non-gastric SRCC included race,primary site,degree of differentiation,TNM stage,tumor size,detection of lymphatic gland and surgical treatment.The multivariate Cox regression analysis showed that age(HR:1.417,95%CI:1.273～1.578,P<0.05),TNM stage(HR:1.606,95%CI:1.155～1.559,P<0.05),tumor size(HR:1.297,95%CI:1.09～1.417,P<0.05),detection of lymphatic gland(HR:1.729,95%CI:1.497～1.996,P<0.05)and surgical treatment(HR:0.245,95%CI:0.228～0.284,P<0.05)were independent risk factors influencing the prognosis of patients with gastric SRCC.As for patients with gastric SRCC at early stage,depth of infiltration(T1)(HR:1.773,95%CI:1.64～1.943,P<0.05),tumor size(HR:3.171,95%CI:2.057～4.889,P<0.05)and detection of lymphatic gland(HR:13.859,95%CI:7.205～26.659,P<0.05)were independent risk factors influencing the prognosis.The overall prognosis of patients with gastric SRCC was lower than that of patients with non-gastric SRCC.There were statistically significant differences between those rates(X~2=12.311,P<0.05).The overall prognosiss of patients with early gastric SRCC was lower than that of patients with non-gastric SRCC,and the difference was statistically significant(X~2=2.184,P<0.05).Survival analysis of SEER database chemotherapy data for patients with early gastric carcinoma showed that:the prognosis of chemotherapy patients was lower than that of non chemotherapy patients(X~2=4.399,P<0.05).According to the different depth of infiltration,stratified analysis showed that the prognosis of chemotherapy patients in the mucosal layer and submucosa was lower than that of patients without chemotherapy(X~2=4.950,P<0.05;X~2=4.691,P<0.05).According to the hierarchical analysis of lymph node test,the prognosis of chemotherapy patients was better than that of non chemotherapy patients when the lymph node test was positive(X~2=4.379,P<0.05);when the lymph node test was negative,there was no significant difference in prognosis of chemotherapy patients(X~2=0.367,P=0.545).Conclusion1.The proportion of gastric SRCC mucosa at early stage is higher than that of non-gastric SRCC.When limited to the mucosa,the proportion of positive lymph nodes in patients with SRCC is lower than that in patients with non-gastric SRCC,and the proportion of tumor diameter≤2cm is higher than that in patients with non-gastric SRCC.When the tumor infiltrates into submucosa,the proportion of lymph node metastasis in patients with gastric SRCC is higher than that in patients with non-gastric SRCC.2.In patients with early gastric carcinoma,the prognosis of gastric SRCC is better than that of non-gastric SRCC,and the prognosis of chemotherapy patients with early gastric cancer has not been significantly improved.Stratified analysis of early gastric carcinoma shows that chemotherapy can improve the prognosis of patients with positive lymph nodes.3.The overall prognosis of patients with gastric SRCC is lower than that of patients with non-gastric SRCC. |
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