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Journal of Gastrointestinal Surgery

, Volume 19, Issue 11, pp 1958–1965 | Cite as

Risk Factors for Lymph Node Metastasis in Early Gastric Cancer with Signet Ring Cell Carcinoma

  • Chun Guang Guo
  • Dong Bing ZhaoEmail author
  • Qian Liu
  • Zhi Xiang Zhou
  • Ping Zhao
  • Gui Qi WangEmail author
  • Jian Qiang Cai
Original Article

Abstract

Background

Gastrectomy was reported to be an excessive approach for early gastric cancer with signet ring cell carcinoma. This study was conducted to explore the feasibility of endoscopic submucosal dissection for early gastric with signet ring cell carcinoma.

Methods

Data from 1067 patients who underwent gastrectomy for early gastric cancer were collected retrospectively. The association between the clinicopathological factors and the lymph node metastasis was analyzed by univariate and multivariate logistic regression analyses.

Results

Lymph node metastasis was confirmed in 17.2 % (184/1067) of patients. Meanwhile, the incidence of lymph node metastasis with each histology type was 13.1 % (26/198), 9.8 % (34/347), and 23.8 % (124/522) for signet ring cell carcinoma, differentiated carcinomas, and undifferentiated carcinomas, respectively. Signet ring cell carcinoma occurs more in women and young patients, with a higher predominance for mucosa. Various factors—including sex, tumor size, depth of tumor, and lymphovascular invasion—were found to be associated with lymph node metastasis for signet ring cell carcinoma (P < 0.05). Multivariate analysis revealed that tumor size (7.489, 95 % CI 2.025–27.701) and lymphovascular invasion (18.434, 95 % CI 3.256–104.359) were independent risk factors for lymph node metastasis (P < 0.05). Further analysis reveals there was no positive lymph node in patients with signet ring cell carcinoma when tumor confined to mucosa, size ≤2 cm and without lymphovascular invasion and ulceration.

Conclusions

Given the low risk of lymph node involvement, we recommend that endoscopic submucosal dissection be safely applied for early gastric signet ring cell carcinoma when tumor confined to mucosa, size ≤2 cm, and without lymphovascular invasion and ulceration.

Keywords

Gastric cancer Signet ring cell carcinoma Lymph node metastasis Endoscopic submucosal dissection 

Abbreviations

DCs

differentiated carcinomas

EGC

early gastric cancer

ESD

endoscopic submucosal dissection

LNM

lymph node metastasis

LVI

lymphovascular invasion

LNM

lymph node metastasis

SRC

signet ring cell carcinoma

UDCs

undifferentiated carcinomas

Notes

Competing Interests

The authors declare that they have no competing interests.

References

  1. 1.
    Kubota H, Kotoh T, Masunaga R, Dhar DK, Shibakita M, Tachibana M, Kohno H, Nagasue N. Impact of screening survey of gastric cancer on clinicopathological features and survival: retrospective study at a single institution. Surgery 2000;128:41–47.CrossRefPubMedGoogle Scholar
  2. 2.
    Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 2005;23:4490–4498.CrossRefPubMedGoogle Scholar
  3. 3.
    Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006;41:929–942.CrossRefPubMedGoogle Scholar
  4. 4.
    Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, Fujisaki J, Sano T, Yamaguchi T. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 2009;12:148–152.CrossRefPubMedGoogle Scholar
  5. 5.
    Li C, Kim S, Lai JF, Oh SJ, Hyung WJ, Choi WH, Choi SH, Zhu ZG, Noh SH. Risk factors for lymph node metastasis in undifferentiated early gastric cancer. Ann Surg Oncol 2008;15:764–769.CrossRefPubMedGoogle Scholar
  6. 6.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113–123.CrossRefGoogle Scholar
  7. 7.
    Kim JY, Kim YY, Kim SJ, Park JC, Kwon YH, Jung MK, Kwon OK, Chung HY, Yu W, Park JY, Lee YK, Park SS, Jeon SW. Predictive factors for lymph node metastasis in signet ring cell gastric cancer and the feasibility of endoscopic submucosal dissection. J Gastric Cancer 2013;13:93–97.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Hirasawa T, Fujisaki J, Fukunaga T, Yamamoto Y, Yamaguchi T, Katori M, Yamamoto N. Lymph node metastasis from undifferentiated-type mucosal gastric cancer satisfying the expanded criteria for endoscopic resection based on routine histological examination. Gastric Cancer 2010;13:267–270.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee JH, Choi MG, Min BH, Noh JH, Sohn TS, Bae JM, Kim S. Predictive factors for lymph node metastasis in patients with poorly differentiated early gastric cancer. Br J Surg 2012;99:1688–1692.CrossRefPubMedGoogle Scholar
  10. 10.
    Tong JH, Sun Z, Wang ZN, Zhao YH, Huang BJ, Li K, Xu Y, Xu HM. Early gastric cancer with signet-ring cell histologic type: risk factors of lymph node metastasis and indications of endoscopic surgery. Surgery 2011;149:356–363.CrossRefPubMedGoogle Scholar
  11. 11.
    Gronnier C, Messager M, Robb WB, Thiebot T, Louis D, Luc G, Piessen G, Mariette C, group-FRENCH Fw. Is the negative prognostic impact of signet ring cell histology maintained in early gastric adenocarcinoma? Surgery 2013;154:1093–1099.CrossRefPubMedGoogle Scholar
  12. 12.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101–112.CrossRefGoogle Scholar
  13. 13.
    Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17:3077–3079.CrossRefPubMedGoogle Scholar
  14. 14.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000;3:219–225.CrossRefPubMedGoogle Scholar
  15. 15.
    Strong VE, Yoon SS. Extended lymphadenectomy in gastric cancer is debatable. World J Surg 2013;37:1773–1777.CrossRefPubMedGoogle Scholar
  16. 16.
    Kwee RM, Kwee TC. Predicting lymph node status in early gastric cancer. Gastric Cancer 2008;11:134–148.CrossRefPubMedGoogle Scholar
  17. 17.
    Gotoda T, Kusano C, Moriyasu F. Future perspective of gastric cancer endotherapy. Ann Transl Med 2014;2:25.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Kim BS, Oh ST, Yook JH, Kim BS. Signet ring cell type and other histologic types: differing clinical course and prognosis in T1 gastric cancer. Surgery 2014;155:1030–1035.CrossRefPubMedGoogle Scholar
  19. 19.
    Ha TK, An JY, Youn HK, Noh JH, Sohn TS, Kim S. Indication for endoscopic mucosal resection in early signet ring cell gastric cancer. Ann Surg Oncol 2008;15:508–513.CrossRefPubMedGoogle Scholar
  20. 20.
    Lee JH, Choi IJ, Kook MC, Nam BH, Kim YW, Ryu KW. Risk factors for lymph node metastasis in patients with early gastric cancer and signet ring cell histology. Br J Surg 2010;97:732–736.CrossRefPubMedGoogle Scholar
  21. 21.
    Kwon KJ, Shim KN, Song EM, Choi JY, Kim SE, Jung HK, Jung SA. Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach. Gastric Cancer 2014;17:43–53.CrossRefPubMedGoogle Scholar
  22. 22.
    Wilcox R, Perpich M, Noffsinger A, Posner MC, Cooper K. Hereditary diffuse gastric cancer: multidisciplinary case report with review of the literature. Patholog Res Int 2011;2011:845821.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Lehnert T, Erlandson RA, Decosse JJ. Lymph and blood capillaries of the human gastric mucosa. A morphologic basis for metastasis in early gastric carcinoma. Gastroenterology 1985;89:939–950.PubMedGoogle Scholar
  24. 24.
    Camargo MC, Goto Y, Zabaleta J, Morgan DR, Correa P, Rabkin CS. Sex hormones, hormonal interventions, and gastric cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2012;21:20–38.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Matsui M, Kojima O, Kawakami S, Uehara Y, Takahashi T. The prognosis of patients with gastric cancer possessing sex hormone receptors. Surg Today 1992;22:421–425.CrossRefPubMedGoogle Scholar
  26. 26.
    Yamao T, Shirao K, Ono H, Kondo H, Saito D, Yamaguchi H, Sasako M, Sano T, Ochiai A, Yoshida S. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer 1996;77:602–606.CrossRefPubMedGoogle Scholar
  27. 27.
    Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, Omae M, Kubota M, Ishiyama A, Hirasawa T, Chino A, Inamori M, Yamamoto Y, Yamamoto N, Tsuchida T, Tamegai Y, Nakajima A, Hoshino E, Igarashi M. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 2012;44:122–127.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Chun Guang Guo
    • 1
  • Dong Bing Zhao
    • 1
    Email author
  • Qian Liu
    • 1
  • Zhi Xiang Zhou
    • 1
  • Ping Zhao
    • 1
  • Gui Qi Wang
    • 2
    Email author
  • Jian Qiang Cai
    • 1
  1. 1.Department of Abdominal Surgery, Cancer HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
  2. 2.Department of Endoscopy, Cancer HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina

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