Incidence, Survival, and Predictors of Lymph Node Involvement in Early-Stage Gastric Signet Ring Cell Carcinoma in the US
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The incidence, survival, and propensity for nodal metastasis in early-stage gastric signet ring cell carcinoma have not been defined in the United States. These data are critical determinants for treatment allocation.
Cases of gastric signet ring cell carcinoma were extracted from the national SEER database for the years 2004–2013. Age-standardized incidence was derived. Survival was calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify predictors of nodal metastasis. Exclusion criteria included neoadjuvant radiotherapy and lack of histologic or nodal data.
A total of 10,624 cases were initially identified. The analysis cohort included 506 cases with early T-stage N0M0 disease following exclusions. The incidence was 0.094 per 100,000 person-years. The 5-year survival rate was 82.8%. Tumor stage (p < 0.001) and size (p < 0.001) were independent predictors of nodal metastasis. The incidence of nodal involvement for T1a tumors <2 cm was 5.4% (p < 0.004).
The incidence of potentially resectable signet ring gastric carcinoma has not changed significantly over the past decade. While presenting with predominantly high-grade histology, early T-stage disease has a high survival rate. Small T1a tumors have low rates of nodal metastasis, suggesting that an endoscopic resection could be considered in this subset.
KeywordsGastric cancer Endoscopic submucosal dissection Gastric signet ring carcinoma Gastrectomy Endoscopic mucosal resection
This manuscript was supported in part by a development grant from the Department of Medicine at Emory University School of Medicine. Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Sridevi K. Pokala contributed study concept and design, acquisition of data, statistical analysis and interpretation of data, and drafting of the manuscript. Chao Zhang and Zhengjia Chen contributed statistical analysis. Anthony M. Gamboa contributed acquisition of data and statistical analysis. Sarah L. Cristofaro contributed acquisition of the data. Steven A. Keilin and Qiang Cai contributed interpretation of the data. Field F. Willingham contributed study concept and design, statistical analysis, interpretation of the data, and drafting of the manuscript. All authors contributed to critical manuscript revision.
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