Abstract
BackgroundThe literature on the prognostic relevance of signet-ring cell (SRC) histology in gastric cancer (GC) is controversial which is most likely related to inconsistent SRC classification based on haematoxylin–eosin staining. We hypothesised that mucin stains can consistently identify SRC-GC and predict GC patient outcome.MethodsWe performed a comprehensive literature review on mucin stains in SRC-GC and characterised the mucin expression in 851 Caucasian GC and 410 Asian GC using Alcian Blue (AB)-Periodic Acid-Schiff (PAS), MUC2 (intestinal-type mucin), and MUC5AC (gastric-type mucin). The relationship between mucin expression and histological phenotype [poorly cohesive (PC) including proportion of SRCs, non-poorly cohesive (non-PC), or mucinous (MC)], clinicopathological variables, and patient outcome was analysed.ResultsDepending on mucin expression and cut-offs, the positivity rates of SRC-GC reported in the literature varied from 6 to 100%. Patients with MUC2 positive SRC-GC or SRC-GC with (gastro)intestinal phenotype had poorest outcome.In our cohort study, PC with ≥ 10% SRCs expressed more frequently MUC2, MUC5AC, and ABPAS (p < 0.001, p = 0.004 and p < 0.001, respectively). Caucasians with AB positive GC or combined ABPAS-MUC2 positive and MUC5AC negative had poorest outcome (all p = 0.002). This association was not seen in Asian patients.ConclusionsThis is the first study to suggest that mucin stains do not help to differentiate between SRC-GC and non-SRC-GC. However, mucin stains appear to be able to identify GC patients with different outcome. To our surprise, the relationship between outcome and mucin expression seems to differ between Caucasian and Asian GC patients which warrants further investigations.
Highlights
Gastric cancer (GC) is a heterogenous disease with respect to epidemiology, morphology, and clinical behaviour
Whilst an expert panel recently proposed cut-offs to enable separating pure signet-ring cell (SRC)-gastric cancer (GC) (≥ 90% SRCs) from GC with an SRC component, a biomarker to unequivocal identify SRC-GC would be of potential great value to clinicians and patients
Our literature review supports the previous suggestion of an expert panel that inconsistent clinicopathological findings can at least partly be explained by differences in the histological haematoxylin–eosin-based classification of SRC-GC together with different cut-off values used for considering a stain positive
Summary
Gastric cancer (GC) is a heterogenous disease with respect to epidemiology, morphology, and clinical behaviour. Several studies investigating the prognostic relevance of SRC histology reported conflicting results [4–8]. The literature on the prognostic relevance of signet-ring cell (SRC) histology in gastric cancer (GC) is controversial which is most likely related to inconsistent SRC classification based on haematoxylin–eosin staining. Methods We performed a comprehensive literature review on mucin stains in SRC-GC and characterised the mucin expression in 851 Caucasian GC and 410 Asian GC using Alcian Blue (AB)-Periodic Acid-Schiff (PAS), MUC2 (intestinal-type mucin), and MUC5AC (gastric-type mucin). PC with ≥ 10% SRCs expressed more frequently MUC2, MUC5AC, and ABPAS (p < 0.001, p = 0.004 and p < 0.001, respectively). Caucasians with AB positive GC or combined ABPAS-MUC2 positive and MUC5AC negative had poorest outcome (all p = 0.002) This association was not seen in Asian patients. The relationship between outcome and mucin expression seems to differ between Caucasian and Asian GC patients which warrants further investigations
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