Background: Gastric signet-ring cell carcinoma (GSRCC) is associated with a poor prognosis, and the effectiveness of neoadjuvant chemotherapy (NAC) in improving survival outcomes remains inconclusive. This study aimed to evaluate the impact of NAC on survival in patients with GSRCC.Methods: This retrospective cohort study included GSRCC patients from two databases: the National Cancer Center (n = 1289) and SEER (n = 1773), all of whom underwent radical surgery between January 2011 and January 2018. The primary endpoint was overall survival (OS) after surgery. Kaplan–Meier survival curves were generated, and multivariate Cox regression analyses were performed to adjust for confounding factors. Additionally, subgroup analyses were conducted to assess the potential survival benefits of NAC in specific patient subsets.Results: NAC use was limited, with 24.6% (436/1773) of patients in the SEER cohort and 22.6% (292/1289) of patients in the NCC cohort receiving NAC. The median follow-up duration was 30 months (range: 8–131 months; IQR: 24–70 months). In the SEER cohort, the 3-year and 5-year survival rates were 47.4% and 41.3%, respectively, whereas in the NCC cohort, they were 82.4% and 73.9%. Multivariate analysis identified race, tumor size, cTNM stage, pT stage, and pN stage as independent predictors of survival in the SEER cohort (allp< 0.05). In the NCC cohort, age, tumor size, and cTNM stage were significant predictors (p< 0.05). NAC did not demonstrate a significant OS benefit in either cohort (SEER:p= 0.653; NCC:p= 0.139). Subgroup analyses focusing on mid/distal tumor locations and cTNM stages II/III indicated a significant trend towards improved survival with NAC (allp< 0.001).Conclusions: NAC showed limited efficacy in unselected GSRCC patients. However, its selective application in patients with mid/distal tumors or locally advanced tumors (cTNM II/III) may offer potential survival benefits. Further studies are needed to explore tailored NAC strategies as a means to improve outcomes in this highly aggressive cancer.
背景：胃印戒细胞癌预后较差，新辅助化疗能否改善其生存结局尚无定论。本研究旨在评估新辅助化疗对胃印戒细胞癌患者生存的影响。 方法：本回顾性队列研究纳入来自国家癌症中心（1289例）及SEER数据库（1773例）的胃印戒细胞癌患者，所有患者均于2011年1月至2018年1月期间接受根治性手术。主要终点为术后总生存期。研究采用Kaplan-Meier法绘制生存曲线，通过多因素Cox回归分析校正混杂因素，并开展亚组分析评估新辅助化疗在特定患者亚群中的潜在生存获益。 结果：新辅助化疗使用率较低，SEER队列中24.6%（436/1773）、国家癌症中心队列中22.6%（292/1289）的患者接受了新辅助化疗。中位随访时间为30个月（范围：8-131个月；四分位距：24-70个月）。SEER队列的3年及5年生存率分别为47.4%和41.3%，而国家癌症中心队列分别为82.4%和73.9%。多因素分析显示，在SEER队列中种族、肿瘤大小、临床TNM分期、病理T分期及病理N分期均为独立生存预测因素（均p<0.05）；在国家癌症中心队列中，年龄、肿瘤大小及临床TNM分期具有显著预测价值（p<0.05）。新辅助化疗在两个队列中均未显示显著的总生存获益（SEER：p=0.653；国家癌症中心：p=0.139）。针对中/远端肿瘤及临床II/III期患者的亚组分析显示，新辅助化疗具有改善生存的显著趋势（均p<0.001）。 结论：新辅助化疗在未经筛选的胃印戒细胞癌患者中疗效有限，但对中/远端肿瘤或局部进展期（临床II/III期）患者的选择性应用可能带来潜在生存获益。未来需进一步研究探索个体化新辅助化疗策略，以改善这种高侵袭性癌症的临床结局。
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