Background: Gastric signet-ring cell carcinoma (GSRCC) is an aggressive gastric cancer subtype with limited evidence supporting the role of neoadjuvant chemotherapy (NAC). This study evaluated the impact of NAC on overall survival (OS) in a large, population-based cohort.Methods: We analyzed data from the SEER database (2011–2018), identifying patients aged 20–80 years with primary gastric tumors (C16.0–C16.9) and signet-ring cell histology who underwent curative-intent gastrectomy. Patients with metastatic disease, non-curative surgery, clinical Stage I, incomplete staging, or unknown survival were excluded. OS was assessed using Kaplan–Meier analysis and multivariable Cox regression. Subgroup analyses evaluated the interaction of NAC with tumor location and clinical stage.Results: A total of 978 patients met inclusion criteria; 436 (44.6%) received NAC. The 3- and 5-year OS rates were 43.9% and 38.3%, respectively. NAC was not associated with improved OS compared to surgery alone (5-year OS: 39.7% vs. 37.2%; log-rankp= 0.34) and was not an independent prognostic factor in multivariable analysis (p= 0.651). Independent predictors of worse OS included larger tumor size, advanced stage, positive nodal status, and Black race (allp< 0.05). Subgroup analysis indicated a survival benefit from NAC in patients with mid or distal gastric tumors (p< 0.001 for interaction).Conclusions: In this SEER-based analysis, NAC did not improve OS in the overall GSRCC population. However, selected subgroups may derive benefit, supporting a personalized approach to neoadjuvant therapy in GSRCC.
背景：胃印戒细胞癌是一种侵袭性胃癌亚型，目前支持新辅助化疗作用的证据有限。本研究基于大规模人群队列评估了新辅助化疗对总生存期的影响。 方法：我们分析了SEER数据库（2011-2018年）中20-80岁接受根治性胃切除术的原发性胃肿瘤（C16.0-C16.9）伴印戒细胞组织学患者数据。排除转移性疾病、非根治性手术、临床I期、分期不完整或生存状态未知的患者。采用Kaplan-Meier分析和多变量Cox回归评估总生存期，并通过亚组分析评估新辅助化疗与肿瘤位置及临床分期的交互作用。 结果：共978例患者符合纳入标准，其中436例（44.6%）接受新辅助化疗。3年和5年总生存率分别为43.9%和38.3%。与单纯手术相比，新辅助化疗未改善总生存期（5年生存率：39.7% vs. 37.2%；时序检验p=0.34），多变量分析中亦非独立预后因素（p=0.651）。肿瘤体积较大、分期较晚、淋巴结阳性及黑人种族是总生存期较差的独立预测因素（均p<0.05）。亚组分析显示，胃中段或远端肿瘤患者可从新辅助化疗中获得生存获益（交互作用p<0.001）。 结论：本基于SEER数据库的分析表明，新辅助化疗未能改善整体胃印戒细胞癌患者的总生存期。但特定亚组可能获益，这支持对胃印戒细胞癌新辅助治疗采取个体化策略。
Impact of Neoadjuvant Chemotherapy on Survival Outcomes in Gastric Signet-Ring Cell Carcinoma
肿瘤(癌症)患者之家