Signet ring cell gastric carcinoma: A descriptive analysis of a unique county population.

Abstract

32 Background: Signet ring cell type gastric carcinoma (SRCC) is an uncommon epithelial malignancy of the stomach, with data from the United States (US) being particularly scarce. Compared to other gastric carcinoma types, it has a female predominance, younger age at diagnosis, and late presentation, making treatment particularly challenging. Recent reports suggest this disease may be increasing among even younger patients, for reasons which remain unclear. We aimed to examine the occurrence, features, and outcomes of SRCC in a predominantly minority Los Angeles County patient population. Methods: We identified all patients diagnosed with SRCC at Olive View-UCLA Medical Center (OVMC) from 2004-2017. Clinico-demographic, imaging, and pathologic data were reviewed and analyzed and compared descriptively to available Surveillance, Epidemiology, and End Results (SEER) data. Results: Sixty-six cases of SRCC were identified, of which 77% were Latino, 9% White, 6% Armenian, and the remaining 8% other. Mean age at SRCC diagnosis was 52 years, and 37 (56%) of patients were female. H. pylori infection was present in 35% (43% diagnosed by serum antibody, 35% by pathology, 9% by stool antigen, and 13% by combination). Follow-up was available for 91% of patients. Median survival was 1 year, and 5-year survival was 7%, markedly lower than the 31% reported in SEER. Seventy-two percent of patients were deceased or on hospice within 2 years of diagnosis. Conclusions: In this first US study to assess the clinical epidemiology of SRCC in a predominantly minority population: 1) the mean age of diagnosis was younger than reported in previous studies (55-61 years), 2) the proportion of males was high compared to SEER data, and 3) survival was considerably lower than previously reported. Insofar as the patient population in this study serves as a microcosm of surrounding underserved communities, it is likely that SRCC may be more common than expected in this vulnerable patient population, and that significant clinical differences may exist in presentation and outcomes of SRCC. In light of these differences, further research is needed to examine potential environmental and/or genetic risk factors or disparities which may be operational.