Factors affecting prognosis in signet ring cell gastric cancers with expanded lymph node dissection; high volume centre experience


  • Serdar Culcu Department of Surgical Oncology, Ankara University School of Medicine, Ankara, Turkey
  • Selim Tamam Department of Surgical Oncology, Ankara University School of Medicine, Ankara, Turkey
  • Ali Ekrem Unal Department of Surgical Oncology, Ankara University School of Medicine, Ankara, Turkey




Gastric cancer, Signet ring cell carcinoma, Gastrectomy


Background: Signet ring cell gastric cancer differs from gastric adenocarcinoma in terms of demographic and clinical features, age, gender, tumour grade and stage. In this study, we aimed to evaluate the clinical features and overall survival of gastric signet ring cell carcinoma and the prognostic factors affecting survival.

Methods: We analysed 138 patients who were operated on with the diagnosis of signet ring cell gastric cancer. The univariant and multivariate hazard ratios of these parameters were analysed and the factors affecting the long-term average survival outcomes were investigated.

Results: We performed Cox regression univariate analysis to investigate the effects of clinicopathological factors on mean survival follow-up in signet ring cell gastric cancer. As age increases, the mean survival follow-up period decreases. This relationship is also statistically significant. Mean survival follow-up for the open technique was lower than for laparoscopic procedures. The mean survival follow-up time of patients with positive perineural invasion (PNI) and lymphovascular invasion (LVI) is lower than patients with negative LVI and PNI. We did not find a significant relationship between the hazard ratios (HRs) of tumour markers and systemic inflammatory response parameters. However, we found a significant relationship between the increase in fibrinogen value and HR.

Conclusions: We investigated the clinicopathological features of nonmetastatic signet ring cell gastric carcinomas and identified predictors of long survival. Age, lymphovascular and perineural invasion, open surgery, higher tumor infiltration, and lymph node involvement were independent predictors of shorter survival times in nonmetastatic signet ring cell gastric cancers.


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Original Research Articles