Deciphering prognostic markers in gastric signet ring cell carcinoma: Human epidermal growth factor receptor 2 and other key factors.

[BACKGROUND] Gastric signet ring cell carcinoma (SRCC) is a rare, aggressive subtype of gastric cancer characterized by poor prognosis and distinctive biological behavior. Despite advances in gastric cancer treatment, SRCC remains difficult to diagnose early and manage effectively due to its infiltrative pattern and molecular variability. Reliable prognostic markers are critical to guide clinical management.

[AIM] To investigate the prognostic factors, including human epidermal growth factor receptor 2 (HER2) expression, associated with survival outcomes in patients with gastric SRCC.

[METHODS] A retrospective analysis of 100 cases diagnosed between 2015 and 2019 was conducted, assessing demographic, clinical, and pathological data. HER2 expression was analyzed using immunohistochemistry, and survival outcomes, including overall survival and disease-free survival, were examined.

[RESULTS] With a median follow-up of 43 months, the median patient age was 50 years, and males exhibited a higher mortality rate ( = 0.0107). Elevated serum carbohydrate antigen 19-9 and carcinoembryonic antigen levels were significantly associated with increased mortality ( = 0.00149 and = 0.00163, respectively). Advanced tumor-node-metastasis stage and lymphovascular invasion were strong predictors of poor outcomes ( < 0.001 and = 0.019). HER2 positivity correlated with higher mortality ( = 0.00882) but was not significantly linked to recurrence ( = 0.53). Surgical treatment significantly improved survival compared with non-surgical approaches ( = 0.0226).

[CONCLUSION] These findings highlight the aggressive nature of SRCC with advanced disease stage, elevated tumor markers, and lymphovascular invasion contributing to poor outcomes. HER2 expression, though infrequent, may indicate worse prognosis, reinforcing the role of surgical intervention in survival improvement.