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

Table 1 Demographic and clinicopathological characteristics of patients with upper gastric signet-ring cell carcinoma who underwent total gastrectomy or proximal gastrectomy, n (%)

Demographic and clinical characteristics		SRCC
Demographic and clinical characteristics		PG (n = 316)	TG (n = 399)	P value
Sex	Male	191 (60.4)	211 (52.9)	0.047^a
	Female	125 (39.6)	188 (47.1)
Age, mean (SD)		56.84 (11.92)	54.80 (11.77)	0.054
BMI, mean (SD)		24.65 (2.93)	23.73 (3.12)	0.273
Surgical approach	Laparotomy	181 (57.3)	215 (53.9)	< 0.001^a
	Laparoscopy	122 (38.6)	166 (41.6)
	Converted to laparotomy	13 (4.1)	18 (4.5)
Neoadjuvant therapy	No	280 (88.6)	283 (70.9)	< 0.001^a
	Yes	36 (11.4)	116 (29.1)
Size, mean (SD)		4.61 (2.85)	6.65 (3.90)	< 0.001^a
Lauren type	Intestinal	21 (6.7)	21 (5.3)	0.001^a
	Mixed	81 (25.6)	85 (21.3)
	Diffuse	214 (67.7)	293 (73.4)
Borrmann type	Superficial	204 (64.5)	112 (28.1)	< 0.001^a
	Ulcerative	112 (35.5)	287 (71.9)
Differentiation	Poorly differentiated	301 (95.3)	395 (99.0)	0.074
	Well differentiated	15 (4.7)	4 (1.0)
Vessel invasion	Negative	127 (40.2)	173 (43.6)	0.047^a
	Positive	189 (59.8)	226 (56.4)
Nerve invasion	Negative	85 (26.9)	90 (20.8)	< 0.001^a
	Positive	231 (73.1)	309 (79.2)
Pathological T-stage	T3-T4	223 (70.1)	346 (86.7)	< 0.001^a
	T1-T2	93 (29.9)	53 (13.3)
Pathological N-stage	Negative	104 (32.9)	108 (27.1)	< 0.001^a
	Positive	212 (67.1)	291 (72.9)
Pathological stage	I	88 (27.8)	66 (16.5)	< 0.001^a
	II	74 (23.4)	53 (13.3)
	III	143 (45.9)	256 (64.2)
IV	11 (2.9)	24 (6.0)

^aP ≤ 0.05.

SRCC: Signet-ring cell carcinoma; BMI: Body mass index; TG: Total gastrectomy; PG: Partial gastrectomy.

Full Size Table

Table 2 Demographics and clinicopathological characteristics of patients with upper gastric signet-ring cell carcinoma who underwent total gastrectomy or proximal gastrectomy after propensity score matching, n (%)

Demographic and clinical characteristics		SRCC
Demographic and clinical characteristics		PG (n = 94)	TG (n = 130)	P value
Sex	Male	52 (55.3)	74 (56.9)	0.939
	Female	42 (44.7)	56 (43.1)
Age, mean (SD)		57.54 (11.82)	52.87 (10.68)	0.115
BMI, mean (SD)		23.71 (3.48)	23.31 (2.96)	0.601
Surgical approach	Laparotomy	48 (51.1)	68 (52.3)	0.338
	Laparoscopy	46 (48.9)	60 (46.2)
	Convert to laparotomy	0 (0.0)	2 (1.5)
Neoadjuvant therapy	No	74 (78.7)	92 (70.8)	0.104
	Yes	20 (21.3)	38 (29.2)
Size, mean (SD)		2.76 (0.82)	2.90 (0.91)	0.118
Lauren	Intestinal	14 (14.9)	15 (11.5)	0.121
	Mixed	24 (25.5)	30 (23.1)
	Diffuse	56 (59.6)	85 (65.4)
Borrmann	Superficial	48 (51.1)	63 (48.4)	0.062
	Ulcerative	46 (48.9)	67 (51.6)
Vessel invasion	Negative	44 (46.8)	74 (56.9)	0.055
	Positive	50 (53.2)	56 (43.1)
Nerve invasion	Negative	40 (42.6)	50 (38.5)	0.061
	Positive	54 (57.4)	80 (61.5)
Pathological T-stage	T3-4	64 (68.1)	92 (70.8)	0.772
	T1-2	30 (31.9)	38 (29.2)
Pathological N-stage	Negative	37 (39.3)	64 (49.2)	0.617
	Positive	57 (60.7)	66 (50.8)
Pathological stage	I	38 (40.2)	46 (35.4)	0.833
	II	20 (21.3)	26 (20.0)
	III	34 (36.3)	54 (41.5)
IV	2 (2.2)	4 (3.1)

SRCC: Signet-ring cell carcinoma; BMI: Body mass index; TG: Total gastrectomy; PG: Partial gastrectomy.

Full Size Table

Table 3 Postoperative complications of patients with upper gastric signet-ring cell carcinoma who underwent total gastrectomy or proximal gastrectomy, n (%)

Complications	PG (n = 94)	TG (n = 130)	P value
Short-complication rate	13 (13.8)	17 (13.1)	0.954
Anastomotic stenosis	2 (2.1)	0 (0.0)	0.036^a
Duodenal stump leakage	0 (0.0)	2 (1.5)	0.505
Anastomotic leakage	0 (0.0)	3 (2.3)	0.211
Intra-abdominal infection	2 (2.1)	6 (4.6)	0.433
Pyloric obstruction	0 (0.0)	0 (0.0)	0.29
Gastroparesis	5 (5.3)	3 (2.3)	0.193
Incision fat liquefaction	2 (2.1)	3 (2.3)	0.803
Fever	2 (2.1)	6 (4.6)	0.433
Pleural effusion	2 (2.1)	2 (1.5)	0.176
Abdominal hemorrhage	0 (0.0)	2 (1.5)	0.118
Long-complication rate	33 (35.1)	44 (33.8)	0.863
Reflux esophagitis	28 (29.8)	19 (14.6)	< 0.001^a
Bile reflux	5 (5.3)	8 (6.2)	0.316
Intestinal obstruction	5 (5.3)	9 (6.9)	0.623
Ascites	3 (3.2)	8 (6.2)	0.568
Malnutrition	0 (0.0)	4 (3.1)	0.014^a
Anemia	0 (0.0)	5 (3.8)	0.005^a
Hepatic insufficiency	2 (2.1)	0 (0.0)	0.276
Hypoproteinemia	5 (5.3)	3 (2.3)	0.193

^aP ≤ 0.05.

TG: Total gastrectomy; PG: Partial gastrectomy.

Full Size Table

Table 4 Univariate and multivariate analyses for prognostic factors in patients with gastric cancer

Variables	Univariate analysis			Multivariate analysis
Variables	Overall survival, (median ± SE, year)	95%CI	P value	Hazard ratio	95%CI	P value
Surgical procedure			0.059
Total gastrectomy	5.251 ± 0.320	4.424-5.677
Proximal gastrectomy	6.093 ± 0.373	5.662-7.124
Age (years old)			0.075
≤ 60	5.499 ± 0.356	4.801-6.798
< 60	5.715 ± 0.322	5.083-6.374
Tumor size			0.323
> 3 cm	5.576 ± 0.344	4.901-6.251
< 3 cm	5.593 ± 0.343	4.921-6.262
Differentiation			0.127
Poor	5.345 ± 0.244	4.868-5.822
Well-moderate	7.286 ± 0.881	5.560-9.013
Lymphatic invasion			< 0.001^a
Present	3.182 ± 0.822	2.602-3.763
Absent	6.421 ± 1.315	5.338-7.392
Perineuronal invasion			0.003^a
Present	3.281 ± 0.434	2.818-3.404
Absent	5.128 ± 1.121	4.277-6.778
T stage			< 0.001^a			< 0.001^a
T1-T2	7.291 ± 0.320	6.664-7.918		3.598	2.582-6.411
> T3	4.002 ± 0.322	3.371-4.632		1
N stage			< 0.001^a
N0	6.782 ± 0.331	17.497-24.059
N1	3.941 ± 6.287	3.378-4.504
Smoke			0.117
Absent	5.135 ± 0.296	4.554-5.715
Present	6.450 ± 0.403	5.661-7.240
Drink			0.475
Absent	5.342 ± 0.296	4.761-5.923
Present	6.007 ± 0.427	5.171-6.843
Hypertension			0.052
Absent	5.983 ± 0.289	5.417-6.549
Present	4.333 ± 0.518	3.318-5.349
CAD			0.318
Absent	5.681 ± 0.272	5.148-6.214
Present	5.976 ± 0.802	4.405-7.548
Neodjuvant therapy			0.954
Absent	5.792 ± 0.300	5.203-6.380
Present	5.339 ± 0.478	4.401-6.773
Adjuvant therapy			0.003
Absent	4.622 ± 0.593	3.521-5.484
Present	5.619 ± 0.324	4.562-6.378
Relapse or metastasis			< 0.001^a			0.001^a
Absent	6.446 ± 0.301	5.587-7.035		2.37	1.523-3.688
Present	3.597 ± 0.377	2.858-4.336		1

^aP ≤ 0.05.

CI: Confidence interval.

Full Size Table

Table 5 A comparison of cancer recurrence between the total gastrectomy and proximal gastrectomy groups, n (%)

Recurrence	Overall	PG (n = 94)	TG (n = 130)	P value
Recurrence rate				0.71
Yes	34 (15.2)	16 (17.0)	18 (13.8)
No	190 (84.8)	78 (83.0)	112 (86.2)
Recurrence site				0.08
Local	5 (2.2)	3 (3.2)	2 (1.5)
Lymph node	11 (4.9)	5 (5.3)	6 (4.6)
Dissemination	10 (4.5)	5 (5.3)	5 (3.8)
Hematogenous	8 (3.6)	3 (3.2)	5 (3.8)

PG: Proximal gastrectomy; TG: Total gastrectomy.

Full Size Table

Citation: Wang SD, Chang YZ, Ding SK, Bian ZM, Xie YB. Prognosis of signet-ring cell carcinoma after proximal gastrectomy was comparable to total gastrectomy but with better nutrition status. World J Gastrointest Oncol 2026; 18(5): 117410
URL: https://www.wjgnet.com/1948-5204/full/v18/i5/117410.htm
DOI: https://dx.doi.org/10.4251/wjgo.v18.i5.117410

Wang SD, Chang YZ, Ding SK, Bian ZM, Xie YB. Prognosis of signet-ring cell carcinoma after proximal gastrectomy was comparable to total gastrectomy but with better nutrition status. World J Gastrointest Oncol 2026; 18(5): 117410 [DOI: 10.4251/wjgo.v18.i5.117410]

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