Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 687-698
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.687
Impact of Alcian blue and periodic acid Schiff expression on the prognosis of gastric signet ring cell carcinoma
Juan Lin, Zhu-Feng Chen, Guo-Dong Guo, Xin Chen
Juan Lin, Zhu-Feng Chen, Guo-Dong Guo, Xin Chen, Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Juan Lin, Guo-Dong Guo, Xin Chen, Department of Pathology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Zhu-Feng Chen, Department of Internal Medicine, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Co-first authors: Juan Lin and Zhu-Feng Chen.
Author contributions: Lin J, Chen ZF, Guo GD, and Chen X contributed to this study; Lin J, Chen ZF, and Chen X contributed to the conception and design of this study; Guo GD collected data; Chen ZF performed the statistical analysis; Lin J conducted the test operations, then drafted and wrote the manuscript; Chen X supervised the entire study; and all authors read and approved the final manuscript.
Supported by the Startup Fund for Scientific Research of Fujian Medical University, No. 2020QH1170.
Institutional review board statement: This study involving human participants was approved by the Ethics Committee of Fujian Provincial Hospital. Approved ID number K2022-09-063.
Informed consent statement: Participants gave informed consent to participate in the study before taking part.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Chen, MBBS, Chief Doctor, Department of Pathology, Fujian Provincial Hospital, No. 134 East Street, Fuzhou 350001, Fujian Province, China. cxc1210@fjmu.edu.cn
Received: November 27, 2023
Peer-review started: November 27, 2023
First decision: December 18, 2023
Revised: December 27, 2023
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: March 15, 2024
Processing time: 99 Days and 20.3 Hours
Abstract
BACKGROUND

The Alcian blue (AB) and periodic acid Schiff (PAS) stains are representative mucus markers in gastric signet ring cell carcinoma (SRCC). They are low-cost special staining methods used to detect acidic mucus and neutral mucus, respectively. However, the clinical importance of the special combined AB and PAS stain is unclear.

AIM

To investigate AB expression, PAS expression and the AB-to-PAS (A/P) ratio in gastric SRCC patients and to assess patient prognosis.

METHODS

Paraffin-embedded sections from 83 patients with gastric SRCC were stained with AB and PAS, and signet ring cell positivity was assessed quantitatively. Immunohistochemical staining for Ki67, protein 53 (P53) and human epidermal growth factor receptor 2 (HER2) was performed simultaneously. The cancer-specific survival (CSS) rate was estimated via Kaplan-Meier analysis. Cox proportional hazards models were used for univariate and multivariate survival analyses.

RESULTS

Kaplan-Meier survival analysis revealed that the 3-year CSS rate was significantly greater in the high-PAS-expression subgroup than in the low-PAS-expression subgroup (P < 0.001). The 3-year CSS rate in the A/P ≤ 0.5 group was significantly greater than that in the A/P > 0.5 group (P = 0.042). Univariate Cox regression analysis revealed that the factors affecting prognosis included tumor diameter, lymph node metastasis, vessel carcinoma embolus, tumor stage, the A/P ratio and the expression of Ki67, P53 and the PAS. Cox multivariate regression analysis confirmed that low PAS expression [hazard ratio (HR) = 3.809, 95% confidence interval (CI): 1.563-9.283, P = 0.003] and large tumor diameter (HR = 2.761, 95%CI: 1.086-7.020, P = 0.033) were independent risk factors for poor prognosis.

CONCLUSION

A/P > 0.5 is potentially a risk factor for prognosis, and low PAS expression is an independent risk factor in the prognosis of gastric SRCC. PAS expression and the A/P ratio could help in predicting the clinical prognosis of patients with SRCC.

Keywords: Alcian blue; Periodic acid-Schiff; Prognosis; Gastric; Signet ring cell carcinoma

Core Tip: Through retrospective analysis of 83 patients with gastric signet ring cell carcinoma (SRCC) and paraffin-embedded sections from 83 patients were stained with Alcian blue (AB), periodic acid Schiff (PAS), Ki67, protein 53, and human epidermal growth factor receptor 2, we confirmed that AB to PAS (A/P) ratio > 0.5 is a potential risk factor for the prognosis and low PAS expression is an independent risk factor for the prognosis of gastric SRCC. PAS expression and A/P ratio could help in predicting the clinical prognosis of SRCC patients. However, our study had a limited sample size this and further follow-up studies are still needed.