Prognosis of signet-ring cell carcinoma after proximal gastrectomy was comparable to total gastrectomy but with better nutrition status

doi:10.4251/wjgo.v18.i5.117410

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May 15, 2026 (publication date) through May 14, 2026

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. May 15, 2026; 18(5): 117410
Published online May 15, 2026. doi: 10.4251/wjgo.v18.i5.117410

Prognosis of signet-ring cell carcinoma after proximal gastrectomy was comparable to total gastrectomy but with better nutrition status

Shun-Da Wang, Ya-Zhou Chang, Shi-Kang Ding, Zhi-Min Bian, Yi-Bin Xie

Shun-Da Wang, Ya-Zhou Chang, Yi-Bin Xie, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Shi-Kang Ding, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China

Zhi-Min Bian, Department of Comprehensive Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Co-first authors: Shun-Da Wang and Ya-Zhou Chang.

Co-corresponding authors: Zhi-Min Bian and Yi-Bin Xie.

Author contributions: Wang SD contributed to study conception and manuscript writing and data analysis; Chang YZ and Ding SK contributed to data collection; Bian ZM and Xie YB contributed to clinical treatment and diagnosis. All authors contributed to the article and approved the submitted version. Wang SD and Chang YZ contributed equally to this work as co-first authors. This manuscript involves multidisciplinary collaboration between surgical and medical oncology. Xie YB and Bian ZM contributed equally to study conception, data interpretation, and manuscript revision. This co-corresponding authorship reflects their complementary expertise and shared responsibility, ensuring the paper’s clinical relevance and scientific rigor. This arrangement is common in complex clinical oncology research.

Supported by Hubei Chen Xiaoping Science and Technology Development Foundation, No. CXPJJH123010-6; and Wu Jieping Medical Foundation, No. 320.6750.14137.

Institutional review board statement: The Ethics Committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 25/191-5137.

Informed consent statement: This retrospective study was approved by the Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and the need for informed consent was waived.

Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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.

Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Yi-Bin Xie, Postdoc, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 18 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. yibinxie@cicams.ac.cn

Received: December 8, 2025
Revised: February 8, 2026
Accepted: March 12, 2026
Published online: May 15, 2026
Processing time: 158 Days and 17.4 Hours

Abstract

BACKGROUND

Currently, there is no consensus on whether proximal gastrectomy (PG) or total gastrectomy (TG) should be used for upper gastric signet-ring cell carcinoma (SRCC), and the long-term oncological outcome and postoperative nutritional status is still debatable.

AIM

To provide evidence for better clinical decisions, oncological safety and nutritional status of SRCC patients post-PG or -TG were compared.

METHODS

Patients who underwent PG or TG at a single institution between June 2014 and June 2018 were included. Inclusion and exclusion criteria were defined, and the endpoint was long-term surgical outcomes, including overall survival (OS), postoperative nutritional status, and complications. Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models.

RESULTS

Those undergoing TG presented with a larger tumor size and later pathological stage compared with the PG group (P < 0.001). Propensity score matching eliminated differences in clinicopathological factors. Finally, 94 PG and 130 TG group members were analyzed. Our findings revealed that there was no significant difference in OS (47.7% vs 53.1%, P = 0.059), complications, and recurrence/relapse incidence between the PG and TG groups. Further, there were no notable differences in nutritional parameters between the TG and PG groups during a 5-year follow-up. However, postoperative malnutrition and anemia were significantly elevated in the TG group compared with the PG group (P = 0.014, P = 0.005, respectively).

CONCLUSION

For SRCC, PG was more aggressively recommended because it manifested similar prognosis and better nutritional status compared with that for TG.

Keywords: Total gastrectomy; Proximal gastrectomy; Signet-ring cell carcinoma; Survival; Nutritional status

Core Tip: The optimal surgical approach for upper gastric signet-ring cell carcinoma (SRCC)-proximal gastrectomy (PG) or total gastrectomy (TG)-remains controversial. This study specifically addressed this gap by comparing the outcomes of PG and TG for SRCC located in the upper stomach. Our results demonstrated that PG offered a prognosis comparable to that of TG while providing superior postoperative nutritional status. Therefore, for patients with upper SRCC, PG represents a viable and favorable surgical option.