Abstract
Background
The aim of this study was to compare the clinicopathological characteristics of an early signet ring cell carcinoma (SRC) with an early undifferentiated carcinoma (mucinous, poorly differentiated adenocarcinoma) and early differentiated carcinoma (well or moderately differentiated tubular adenocarcinoma, papillary adenocarcinoma) and find indications for endoscopic mucosal resection (EMR) in early SRC.
Methods
1520 patients with early gastric cancer (EGC), who underwent a curative gastrectomy, were analyzed retrospectively. Among them, 388 patients with SRC were compared with 253 patients with undifferentiated carcinoma (UDC) and 879 with a differentiated carcinoma (DC).
Results
SRC was more common in young female patients than UDC. SRC had a tendency to be confined to the mucosa, with smaller size than UDC. The lymph node metastasis rate for SRC was lower than that for UDC, but similar to that of DC. Multivariate analysis revealed lymph node metastasis (LNM) to be associated with the depth of invasion, tumor size, histological type, and lymphatic involvement. SRC had no LNM in the case of a mucosal tumor, smaller than 2cm, and in the absence of lymphatic involvement. The prognosis of SRC was more favorable than UDC.
Conclusions
Early SRC has different characteristics from early UDC. In view of the lower rate of lymph node metastasis and better prognosis, we suggest that EMR can be performed on patients with early SRC limited to the mucosa, less than 2cm in size, and with no lymphatic involvement.
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References
Hyung WJ, Noh SH, Lee JH, et al. Early gastric carcinoma with signet ring cell histology. Cancer 2002;94:78–83
Kunisaki C, Shimada H, Nomura M, et al. Therapeutic strategy for signet ring cell carcinoma of the stomach. Br J Surg 2004;91:1319–24
Japanese Gastric Cancer A. Japanese classification of gastric carcinoma - 2nd English edition. Gastric Cancer 1998;1:10–24
Ishikawa S, Togashi A, Inoue M, et al. Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type, depth of wall invasion, and lymph node metastasis. Gastric Cancer 2007;10:35–8
Kitamura K, Yamaguchi T, Taniguchi H, et al. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 1997;64:42–7
Shimada Y. JGCA (The Japan Gastric Cancer Association). Gastric cancer treatment guidelines. Jpn J Clin Oncol 2004;34:58
Kim JP, Kim SC, Yang HK. Prognostic significance of signet ring cell carcinoma of the stomach. Surg Oncol 1994;3:221–7
Maehara Y, Sakaguchi Y, Moriguchi S, et al. Signet ring cell carcinoma of the stomach. Cancer 1992;69:1645–50
Otsuji E, Yamaguchi T, Sawai K, et al. Characterization of signet ring cell carcinoma of the stomach. J Surg Oncol 1998;67:216–20
Yokota T, Ishiyama S, Saito T, et al. Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. Lancet Oncol 2003;4:423–8
Yasuda K. Early gastric cancer: diagnosis, treatment techniques and outcomes. Eur J Gastroenterol Hepatol 2006;18:839–45
Ono H. Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes. Eur J Gastroenterol Hepatol 2006;18:863–6
Abe N, Mori T, Takeuchi H, et al. Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer. Am J Surg 2005;190:496–503
Takiguchi S, Sekimoto M, Fujiwara Y, et al. Laparoscopic lymph node dissection for gastric cancer with intraoperative navigation using three-dimensional angio computed tomography images reconstructed as laparoscopic view. Surg Endosc 2004;18:106–10
Scheibl K, Schreyer AG, Kullmann F, et al. Magnetic resonance imaging gastrography: evaluation of the dark lumen technique compared with conventional gastroscopy in patients with malignant gastric disease. Invest Radiol 2005;40:164–72
Kim HJ, Kim AY, Oh ST, et al. Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology 2005;236:879–85
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Ha, T.K., An, J.Y., Youn, H.K. et al. Indication for endoscopic mucosal resection in early signet ring cell gastric cancer. Ann Surg Oncol 15, 508–513 (2008). https://doi.org/10.1245/s10434-007-9660-9
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DOI: https://doi.org/10.1245/s10434-007-9660-9