c1b9330d7a7d66de963a3c97175f68e4 pmc_10647446.pdf 2aad599acfa228afed6336484450fc7bd4796d24 pmc_10647446.pdf b45247a8502dff829f6d5d14be6ddcdc11b5cf324e9f42fa7f44997d4f4471bf pmc_10647446.pdf Title: Clinical Features of Gastric Signet Ring Cell Cancer: Results from a Systematic Review and Meta-Analysis Subject: Background: Conflicting results about the prognostic relevance of signet ring cell histology in gastric cancer have been reported. We aimed to perform a meta-analysis focusing on the clinicopathological features and prognosis of this subgroup of cancer compared with other histologies. Methods: A systematic literature search in the PubMed database was conducted, including all publications up to 1 October 2021. A meta-analysis comparing the results of the studies was performed. Results: A total of 2062 studies referring to gastric cancer with signet ring cell histology were identified, of which 262 studies reported on its relationship with clinical information. Of these, 74 were suitable to be included in the meta-analysis. A slightly lower risk of developing nodal metastases in signet ring cell tumours compared to other histotypes was found (especially to undifferentiated/poorly differentiated/mucinous and mixed histotypes); the lower risk was more evident in early and slightly increased in advanced gastric cancer. Survival tended to be better in early stage signet ring cell cancer compared to other histotypes; no differences were shown in advanced stages, and survival was poorer in metastatic patients. In the subgroup analysis, survival in signet ring cell cancer was slightly worse compared to non-signet ring cell cancer and differentiated/well-to-moderately differentiated adenocarcinoma. Conclusions: Most of the conflicting results in signet ring cell gastric cancer literature could be derived from the lack of standardisation in their classification and the comparison with the different subtypes of gastric cancer. There is a critical need to strive for a standardised classification system for gastric cancer, fostering clarity and coherence in the forthcoming research and clinical applications. Keywords: gastric cancer; signet ring cells; survival; poorly cohesive; pathological classification Author: Mariagiulia Dal Cero, Maria Bencivenga, Drolaiz H. W. Liu, Michele Sacco, Mariella Alloggio, Kelly G. P. Kerckhoffs, Federica Filippini, Luca Saragoni, Mar Iglesias, Anna Tomezzoli, Fátima Carneiro, Heike I. Grabsch, Giuseppe Verlato, Lorena Torroni, Guillaume Piessen, Manuel Pera and Giovanni de Manzoni Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sat Oct 28 11:44:38 2023 CEST ModDate: Sat Oct 28 11:49:51 2023 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 22 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 2745739 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- MHTCFX+VnURWPalladioL Type 1 Custom yes yes no 10 0 TFXEWO+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 CDQRKH+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 PMXARJ+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 AIQCCL+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 81 0 NBGNIB+PalatinoLinotype CID TrueType Identity-H yes yes yes 84 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 90 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 93 0 NBGODB+PalatinoLinotype TrueType MacRoman yes yes no 96 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 108 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 111 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 114 0 NBGODB+PalatinoLinotype TrueType MacRoman yes yes no 117 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 137 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 140 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 143 0 NBGODB+PalatinoLinotype TrueType MacRoman yes yes no 146 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 160 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 163 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 166 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 452 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 455 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 458 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 754 0 NBGNIB+PalatinoLinotype CID TrueType Identity-H yes yes yes 757 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 763 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 766 0 NBGODB+PalatinoLinotype TrueType MacRoman yes yes no 769 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 944 0 NBGNIB+PalatinoLinotype CID TrueType Identity-H yes yes yes 947 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 953 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 956 0 NBGODB+PalatinoLinotype TrueType MacRoman yes yes no 959 0 NBGNHB+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 1161 0 NBGNIB+PalatinoLinotype CID TrueType Identity-H yes yes yes 1164 0 NBGNIC+PalatinoLinotype TrueType WinAnsi yes yes no 1170 0 NBGNIE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 1173 0 NBGODB+PalatinoLinotype TrueType MacRoman yes yes no 1176 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-02-02 02:32:41 CET RepresentationInformation: pmc_10647446.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-02-01 02:44:53 CET Size: 2745739 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 1878 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Search Strategy and Study Selection Destination: subsection.2.1 Item: Title: Analysis of Histopathologic Classification Systems and Definitions of SRCC Destination: subsection.2.2 Item: Title: Statistical Analysis Meta-Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Lymph Node Metastasis Destination: subsection.3.1 Item: Title: Lymphovascular Invasion Destination: subsection.3.2 Item: Title: Survival Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.A. Info: Title: Clinical Features of Gastric Signet Ring Cell Cancer: Results from a Systematic Review and Meta-Analysis Author: Mariagiulia Dal Cero, Maria Bencivenga, Drolaiz H. W. Liu, Michele Sacco, Mariella Alloggio, Kelly G. P. Kerckhoffs, Federica Filippini, Luca Saragoni, Mar Iglesias, Anna Tomezzoli, Fátima Carneiro, Heike I. Grabsch, Giuseppe Verlato, Lorena Torroni, Guillaume Piessen, Manuel Pera and Giovanni de Manzoni Subject: Background: Conflicting results about the prognostic relevance of signet ring cell histology in gastric cancer have been reported. We aimed to perform a meta-analysis focusing on the clinicopathological features and prognosis of this subgroup of cancer compared with other histologies. Methods: A systematic literature search in the PubMed database was conducted, including all publications up to 1 October 2021. A meta-analysis comparing the results of the studies was performed. Results: A total of 2062 studies referring to gastric cancer with signet ring cell histology were identified, of which 262 studies reported on its relationship with clinical information. Of these, 74 were suitable to be included in the meta-analysis. A slightly lower risk of developing nodal metastases in signet ring cell tumours compared to other histotypes was found (especially to undifferentiated/poorly differentiated/mucinous and mixed histotypes); the lower risk was more evident in early and slightly increased in advanced gastric cancer. Survival tended to be better in early stage signet ring cell cancer compared to other histotypes; no differences were shown in advanced stages, and survival was poorer in metastatic patients. In the subgroup analysis, survival in signet ring cell cancer was slightly worse compared to non-signet ring cell cancer and differentiated/well-to-moderately differentiated adenocarcinoma. Conclusions: Most of the conflicting results in signet ring cell gastric cancer literature could be derived from the lack of standardisation in their classification and the comparison with the different subtypes of gastric cancer. There is a critical need to strive for a standardised classification system for gastric cancer, fostering clarity and coherence in the forthcoming research and clinical applications. 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