1220 Clinical Epidemiology of Gastric Signet Ring Cell Carcinoma in a Safety Net County Setting

Abstract

INTRODUCTION: Signet ring cell carcinoma is a rare but increasingly incident histotype of gastric cancer. Historically, this histotype (GSRC) has been known for its dismal prognosis; however, studies evaluating the clinical features and natural history of GSRC, particularly in the United States (US) and in minority populations, have been lacking. Thus, we examined the occurrence, clinico-demographic characteristics, oncologic features, treatment, and outcomes of GSRC in a predominantly minority county hospital setting and benchmarked them against data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. METHODS: We identified all biopsy-proven GSRC cases at our Los Angeles County hospital (Olive View-UCLA Medical Center) between 2004-2017 through a retrospective histopathology database and prospective endoscopic repository. Pertinent data were collected from medical records with a standardized abstraction sheet and examined using descriptive statistics. Survival (measured as time to death or initiation of hospice) was calculated using the Kaplan-Meier method and compared with the log-rank test. Where applicable, cohort data were compared to SEER data. RESULTS: A total of 63 patients with GSRC were identified, of which 81% were Hispanic. Compared with SEER data, patients in this cohort were younger (mean age at diagnosis 52.6 vs 63.5 years), majority female (57% vs 45%), had higher T staging (T3 and T4 stage in 76.7% vs 60.7%), and more frequent lymph node involvement (89.2% vs 48.5%). Longer survival was seen in patients with lower tumor stage (P = 0.001), H. pylori infection (P = 0.017), and surgical intervention (P < 0.001). Overall median survival was slightly longer in this cohort compared to SEER (12.6 vs 10.0 months). CONCLUSION: Patients with GSRC in this safety net hospital cohort have different clinical characteristics compared to what has been reported in SEER. Patients in our cohort were younger and more often female, and despite having more advanced disease, did not have shorter survival. Further study is needed and underway to better identify protective and risk factors in this population and improve understanding of the etiopathogenesis and natural history of this malignancy.