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



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.


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.


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.


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.


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



differentiated carcinomas


early gastric cancer


endoscopic submucosal dissection


lymph node metastasis


lymphovascular invasion


lymph node metastasis


signet ring cell carcinoma


undifferentiated carcinomas


Competing Interests

The authors declare that they have no competing interests.


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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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