J Gastric Cancer.  2013 Jun;13(2):93-97.

Predictive Factors for Lymph Node Metastasis in Signet Ring Cell Gastric Cancer and the Feasibility of Endoscopic Submucosal Dissection

• 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

Abstract

PURPOSE
Endoscopic submucosal dissection has recently been practiced on a differentiated type of early gastric cancer. However, there is no clear evidence for endoscopic treatments of signet ring cell carcinoma. The aim of this study is to identify the predictive clinicopathological factors for lymph node metastasis in signet ring cell carcinoma for assisting endoscopic submucosal dissection trials.
MATERIALS AND METHODS
A total of 186 patients with early signet ring cell carcinoma who underwent radical curative gastrectomy between January 2001 and September 2009 were enrolled in this study. Retrospective reviews of their medical records are being conducted. Several clinicopathologic factors were being investigated in order to identify predictive factors for lymph nodes metastasis: age, gender, tumor size, type of operation, tumor location, gross type, ulceration, Lauren's classification, depth of invasion, and lymphatic invasion.
RESULTS
The lymph node metastasis rate for signet ring cell carcinoma was 4.3% (n=8). Of the 186 lesions with early signet ring cell carcinoma, 91 (48.9%) tumors were larger than 15 mm in size and 40 (21.5%) showed submucosal invasions in the resection specimens. In multivariate analysis, only the lymphatic invasion (P<0.0001) showed an association with lymph node metastasis. To evaluate cutoff values for tumor sizes in the presence of lymph node metastasis, early signet ring cell carcinomas with lymphatic invasions were excluded. In the absence of lymphatic invasion, mucosal cancer with tumor sizes <15 mm had no lymph node metastasis.
CONCLUSIONS
Endoscopic submucosal dissection can be performed on patients with early signet ring cell carcinoma limited to the mucosa and less than 15 mm.

Keyword

Stomach neoplasms; Carcinoma, signet ring cell; Endoscopic submucosal dissection; Lymph node metastasis; Predictive factor

MeSH Terms

Carcinoma, Signet Ring Cell
Gastrectomy
Humans
Lymph Nodes
Medical Records
Mucous Membrane
Multivariate Analysis
Neoplasm Metastasis
Retrospective Studies
Stomach Neoplasms
Ulcer

Reference

1. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006. 41:929–942.

2. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001. 48:225–229.

3. Abe N, Watanabe T, Suzuki K, Machida H, Toda H, Nakaya Y, et al. Risk factors predictive of lymph node metastasis in depressed early gastric cancer. Am J Surg. 2002. 183:168–172.

4. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma - 2nd English edition. Gastric Cancer. 1998. 1:10–24.

5. Park YD, Chung YJ, Chung HY, Yu W, Bae HI, Jeon SW, et al. Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach. Endoscopy. 2008. 40:7–10.

6. Maehara Y, Sakaguchi Y, Moriguchi S, Orita H, Korenaga D, Kohnoe S, et al. Signet ring cell carcinoma of the stomach. Cancer. 1992. 69:1645–1650.

7. Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Akiyama H. Therapeutic strategy for signet ring cell carcinoma of the stomach. Br J Surg. 2004. 91:1319–1324.

8. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011. 14:113–123.

9. Kim DH, Jung HY. Expansion of indication for endoscopic SD in early gastric cancer. J Gastric Cancer. 2010. 10:49–54.

10. Hyung WJ, Noh SH, Lee JH, Huh JJ, Lah KH, Choi SH, et al. Early gastric carcinoma with signet ring cell histology. Cancer. 2002. 94:78–83.

11. Kim DY, Park YK, Joo JK, Ryu SY, Kim YJ, Kim SK, et al. Clinicopathological characteristics of signet ring cell carcinoma of the stomach. ANZ J Surg. 2004. 74:1060–1064.

12. Kim HM, Pak KH, Chung MJ, Cho JH, Hyung WJ, Noh SH, et al. Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions. Surg Endosc. 2011. 25:3087–3093.

13. Ishikawa S, Togashi A, Inoue M, Honda S, Nozawa F, Toyama E, 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. 10:35–38.

14. Kunisaki C, Takahashi M, Nagahori Y, Fukushima T, Makino H, Takagawa R, et al. Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer. Endoscopy. 2009. 41:498–503.

15. 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.

16. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. 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.

17. Kang HY, Kim SG, Kim JS, Jung HC, Song IS. Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc. 2010. 24:509–516.

18. Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, et al. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy. 2012. 44:122–127.