• Muhammad Rizwan Khan Department of Surgery Aga Khan University & Hospital Stadium Road Karachi - 74800 Pakistan.
  • Najiha Bilal Farooqi
  • Noman Shahzad


Background: Despite many known variables affecting the outcome, little is known about the impact of histology on the location of tumour and outcomes. The objective of our study was to describe pattern of gastric cancer at single centre and association with H. Pylori and Signet ring cell variant with site of tumour in stomach. Methods: This was a cross sectional study conducted at the Department of Surgery of Aga Khan University Hospital, Karachi, Pakistan. A total of 105 patients who underwent surgery for gastric adenocarcinoma were classified to have a proximal, distal or whole stomach cancer. An association was determined between the tumour histology and helicobacter pylori infection with the location of tumour in the stomach. Results: Proximal gastric cancer was present in 27 (25.7%) patients and distal gastric cancer was present in 69 (65.7%) patients. There were 9 (8.6%) patients in whom tumour involved the whole stomach. Fifty-two patients (49.5%) had signet ring cell variant of gastric carcinoma and these patients were more like to have higher grade and advanced stage. Further analysis showed that that odds of proximal gastric tumour to have signet ring cell histopathology was 3.22 as compared to distal gastric tumour (p=0.017). Helicobacter Pylori infection status did not have any significant association with either grade of tumour or stage at the time of presentation. Conclusions: Despite limitations our data suggests that proximal gastric cancer may be biologically different from distal gastric cancers in terms of frequency of signet ring cell histology.Keywords: Gastric cancer; Signet ring cell; Helicobacter pylori; Prognosis; Outcome; H.pylori

Author Biography

Muhammad Rizwan Khan, Department of Surgery Aga Khan University & Hospital Stadium Road Karachi - 74800 Pakistan.

Associate Professor of SurgeryAga Khan University & HospitalStadium Road Karachi - 74800Pakistan.


Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the "different disease" hypothesis. Cancer 2000;88(4):921–32.

Bilici A, Selcukbiricik F. Prognostic significance of the recurrence pattern and risk factors for recurrence in patients with proximal gastric cancer who underwent curative gastrectomy. Tumour Biol 2015;368(8):619–9.

Bamboat ZM, Tang LH, Vinuela E, Kuk D, Gonen M, Shah MA, et al. Stage-stratified prognosis of signet ring cell histology in patients undergoing curative resection for gastric adenocarcinoma. Ann Surg Oncol 2014;21(5):1678–85.

Piessen G, Messager M, Leteurtre E, Jean-Pierre T, Mariette C. Signet ring cell histology is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of tumoural clinical presentation. Ann Surg 2009;250(6):878–87.

Bang YJ, Yalcin S, Roth A, Hitier S, Ter-Ovanesov M, Wu CW, et al. Registry of gastric cancer treatment evaluation (REGATE): I baseline disease characteristics. Asia Pac J Clin Oncol 2014;10(1):38–52.

Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer 2006;118(12):3030–44.

Solcia E, Fiocca R, Luinetti O, Villani L, Padovan L, Calistri D, et al. Intestinal and diffuse gastric cancers arise in a different background of Helicobacter pylori gastritis through different gene involvement. Am J Surg Pathol 1996;20(Suppl 1):S8–22.

Carneiro F, Huntsman DG, Smyrk TC, Owen DA, Seruca R, Pharoah P, et al. Model of the early development of diffuse gastric cancer in E-cadherin mutation carriers and its implications for patient screening. J Pathol 2004;203(2):681–7.

Siman JH, Engstrand L, Berglund G, Forsgren A, Floren CH. Helicobacter pylori and CagA seropositivity and its association with gastric and oesophageal carcinoma. Scand J Gastroenterol 2007;42(8):933–40.

Hansen S, Vollset SE, Derakhshan MH, Fyfe V, Melby KK, Aase S, et al. Two distinct aetiologies of cardia cancer; evidence from premorbid serological markers of gastric atrophy and Helicobacter pylori status. Gut 2007;56(7):918–25.

Daniyal M, Ahmad S, Ahmad M, Asif HM, Akram M, Rehman SU, et al. Risk Factors and Epidemiology of Gastric Cancer in Pakistan. Asian Pac J Cancer Prev 2015;16(12):4821–4.

Postlewait LM, Squires MH, Kooby DA, Poultsides GA, Weber SM, Bloomston M, et al. The Prognostic Value of Signet-Ring Cell Histology in Resected Gastric Adenocarcinoma. Ann Surg Oncol 2015;22(Suppl 3):S832–9.

Yong X, Tang B, Li BS, Xie R, Hu CJ, Luo G, et al. Helicobacter pylori virulence factor CagA promotes tumourigenesis of gastric cancer via multiple signaling pathways. Cell Commun Signal 2015;13:30.

Al-Marhoon MS, Nunn S, Soames RW. Colonization of cagA-positive Helicobacter pylori is significantly greater in infected human males than females. A possible factor in distal gastric cancer gender difference. Saudi Med J 2006;27(6):898–900.