Mucin expression in gastric- and gastro-oesophageal signet-ring cell cancer: results from a comprehensive literature rev
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REVIEW ARTICLE
Mucin expression in gastric‑ and gastro‑oesophageal signet‑ring cell cancer: results from a comprehensive literature review and a large cohort study of Caucasian and Asian gastric cancer K. G. P. Kerckhoffs1 · D. H. W. Liu1 · L. Saragoni2 · R. S. van der Post3 · R. Langer4 · M. Bencivenga5 · M. Iglesias6 · G. Gallo7 · L. C. Hewitt1 · G. E. Fazzi1 · A. M. Vos3 · F. Renaud8 · T. Yoshikawa9 · T. Oshima10 · A. Tomezzoli11 · G. de Manzoni5 · T. Arai12 · R. Kushima13 · F. Carneiro14,15,16 · H. I. Grabsch1,17 Received: 23 March 2020 / Accepted: 14 May 2020 © The Author(s) 2020
Abstract Background The literature on the prognostic relevance of signet-ring cell (SRC) histology in gastric cancer (GC) is controversial which is most likely related to inconsistent SRC classification based on haematoxylin–eosin staining. We hypothesised that mucin stains can consistently identify SRC-GC and predict GC patient outcome. Methods We performed a comprehensive literature review on mucin stains in SRC-GC and characterised the mucin expression in 851 Caucasian GC and 410 Asian GC using Alcian Blue (AB)-Periodic Acid-Schiff (PAS), MUC2 (intestinal-type mucin), and MUC5AC (gastric-type mucin). The relationship between mucin expression and histological phenotype [poorly cohesive (PC) including proportion of SRCs, non-poorly cohesive (non-PC), or mucinous (MC)], clinicopathological variables, and patient outcome was analysed. Results Depending on mucin expression and cut-offs, the positivity rates of SRC-GC reported in the literature varied from 6 to 100%. Patients with MUC2 positive SRC-GC or SRC-GC with (gastro)intestinal phenotype had poorest outcome. In our cohort study, PC with ≥ 10% SRCs expressed more frequently MUC2, MUC5AC, and ABPAS (p
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