The Comparative Study Of Clinicopathological Characteristics And MDCT Findings In Patients With Gastric Signet Ring Cell Carcinoma

Part Ⅰ Clinicopathologic Characteristics and MDCT Findings in Patients with Early Gastric Signet Ring Cell CarcinomaObjective To analyze the clinicopathological features and multidetector computed tomography(MDCT)findings of patients with early stage gastric SRC(early SRC).Methods A retrospective analysis of the clinicopathological features and MDCT features was undertaken for 92 patients with early gastric cancer who had experienced curative gastrectomy or endoscopic biopsy.Among them,25 patients had SRC.Results1.The patients with early SRC(49.80±2.08 y)was much younger than the EGC of the non-signet ring cell adenocarcinoma(59.87±1.49 y)(P<0.01).36.0%of early gastric cancer(EGC)lesions in SRC located in the middle third of the stomach,which were more than NSRC(20.9%),and both of the common macroscopic types of the two groups were depressed(80.0%vs74.6%).Signet ring cell carcinoma had a larger proportion of mucosa-confined lesions(88.0%vs58.2%)(P<0.01).Patients with early gastric SRC had a greater proportion of females than patients with NSRC(60.0%vs38.8%),but there were no statistically significant differences(P=0.069).2.Early NSRC had a little higher rate of lymph node metastasis(20.9%)than SRC(12.0%),and the average number of involved LNs in SRC group were fewer,but there were no statistically significant differences(P=0.462).3.There were no statistically significant differences between the SRC and NSRC groups in terms of thickness of tumor,attenuation of thickened gastric wall,contrast enhancement pattern,degree of enhancement on the MDCT imagings.Conclusion In early gastric cancer,SRC is a distinct type of gastric carcinoma in terms of clinicopathologic characteristics,which may have some value in the treatment strategy and prognosis assessment.But it is difficult for multidetector CT to distinguish SRC from NSRC in the early stage.Part Ⅱ Clinicopathologic Characteristics and MDCT Findings in Patients with Advanced Gastric Signet Ring Cell CarcinomaObjective To analyze the clinicopathological features and multidetector computed tomography(MDCT)findings of patients with advanced stage gastric SRC.Methods A retrospective analysis of the clinicopathological and MDCT features was undertaken for 97 patients with advanced gastric carcinoma who had experienced curative gastrectomy or endoscopic biopsy.Among them,33 patients had SRC.Results1.The patients with SRC was much younger than the non-signet ring cell(56.70±2.17vs62.72±1.37)(P<0.05),but there were no statistically significant differences(P=0.406).SRC was more likely to be associated with pT3/T4 tumor(P<0.05).Tumor locations,JGCA stage,lymph node metastasis,distant metastasis,lymphovascular invasion and perineural invasion were not correlated with operative pathologic classification.2.Compared with NSRC,SRC has a more obvious enhancement(P<0.05).The SRC tumors were thicker(1.71±0.07cm vs 1.46Q0.07cm,P<0.05).The most common type of gross appearance in advanced gastric carcinoma with SRC was diffuse infiltrative(42.4%),whereas the most common in NSRC was the ulcerative type(65.6%)(P<0.05).There were no statistically significant differences between the SRC and NSRC groups in terms of Maximal diameter of tumour,attenuation of thickened gastric wall,contrast enhancement pattern on the MDCT imagings.Conclusion The gastric SRC have certain clinicopathological and MDCT characteristics and can be combined to distinguishing SRC from NSRC tumors.Part Ⅲ The Relationship between MDCT Features and Clinicopathologic Characteristics in Gastric Signet Ring Cell CarcinomaObjective To investigate the relationship between the MDCT features and clinicopathologic characteristics in gastric signet ring cell carcinoma.Methods MDCT was performed preoperatively in 58 patients with pathologically proved gastric signet ring cell carcinoma,and the correlation between MDCT features and clinicopathologic characteristics of SRC was analyzed.Results1.The enhancement degree of SRC tumor was closely related to JGCA stage(P<0.05),pTN staging(P<0.05),macroscopic types(P<0.001)and gender(P<0.05).However,there was no significant correlation between the degree of enhancement and distant metstasis,age of patient and tumor location.The thickness of tumor was associated with JGCA stage(P<0.001),pTN staging(P<0.001)and macroscopic types(P<0.001).The maximal diameter of tumor was associated with tumor location,JGCA stage(P<0.001),pTNM staging(P<0.05)and macroscopic types(P<0.001).2.Receiver operating characteristic analysis(ROC)showed that the accuracy of the maximal diameter of tumor in determining the lymph node metastasis and serosal invasion of SRC tumors was relatively high[area under ROC curve(Az)was 0.87 and 0.86,respectively].Conclusion The enhancement degree,the maximal diameter and the thickness of SRC tumor on MDCT had a certain correlation with pTNM staging of SRC.