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

• DOI: 10.1007/s11605-015-2915-z
• Publication Date: 2015-08-24T17:28:58Z
• Authors: Chun Guang Guo; Dong Bing Zhao; Qian Liu; Zhi Xiang Zhou; Ping Zhao; Gui Qi Wang; Jian Qiang Cai
• Keywords: Adult; Aged, 80 and over; Male; Dissection; Middle Aged; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Gastrectomy; Risk Factors; Stomach Neoplasms; Lymphatic Metastasis; Multivariate Analysis; Humans; Lymph Node Excision; Female; Carcinoma, Signet Ring Cell; Early Detection of Cancer; Aged; Retrospective Studies

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.