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State of the art for gastric signet ring cell carcinoma: from classification, prognosis, and genomic characteristics to specified treatments

Authors Machlowska J, Pucułek M, Sitarz M, Terlecki P, Maciejewski R, Sitarz R

Received 25 September 2018

Accepted for publication 10 January 2019

Published 15 March 2019 Volume 2019:11 Pages 2151—2161

DOI https://doi.org/10.2147/CMAR.S188622

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Beicheng Sun


Julita Machlowska,1,* Małgorzata Pucułek,1,* Monika Sitarz,2 Paweł Terlecki,3 Ryszard Maciejewski,1 Robert Sitarz1,3

1Department of Human Anatomy, Medical University of Lublin, Lublin, Poland; 2Department of Conservative Dentistry and Endodontics, Medical University of Lublin, Lublin, Poland; 3Department of Surgery, St. John’s Cancer Center, Lublin, Poland

*These authors contributed equally to this work

Abstract: Gastric cancer (GC) is responsible for 9% of cancer deaths worldwide. Over 950,000 new cases are diagnosed each year, and about 90% of them are in advanced stage, requiring chemotherapy. In Europe there has been research based on pre- and postoperative chemotherapy treatment, using 5-fluorouracil, epirubicin, cisplatin, capecitabine, and docetaxel. Chemotherapy significantly impairs the quality of life of patients; however, the final effects are not always satisfactory. There is scientific evidence that gastric mucus tumors and signet ring cell carcinomas have a pattern of specific signatures, that distinguish them from other gastric cancer subtypes, and may be associated with a poor response to systematic treatment. Signet ring cell carcinoma is less chemosensitive than others, and the increase in the percentage of signet ring cells correlates with resistance to chemotherapy. Perioperative chemotherapy in advanced signet ring cell carcinomas is an independent factor of poor prognosis and survival, which is explained by the toxicity of neoadjuvant treatment. Therefore, curative surgical resection enhanced by standardized lymphadenectomy remains the recommended gold standard in GC therapy. According to presented studies, early detection and aggressive treatments for this subtype of GC is a reasonable approach. This review paper is mostly addressed to physicians who are interested in updating to the state of the art concerning different subtypes of gastric carcinoma.

Keywords: gastric cancer, signet ring cells, CDH1, TP53, advanced stage, gastrectomy, adjuvant chemotherapy

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