Abstract
Signet ring cell carcinoma (SRCC) was previously thought to have a worse prognosis than differentiated gastric carcinoma (DC). However, recent studies have shown that its prognosis is related to staging. Here, we analyzed the clinicopathological features and the rate of lymph node metastasis (LNM) in 2166 patients with gastric cancer (605 early and 1561 advanced cases) who underwent gastrectomy and lymph node dissection (D2) from 2016 to 2019. The LNM rate for early and advanced cases was 18.0% and 74.2%, respectively. Regarding early cases, the LNM rate in SRCC was similar to that in DC (10% vs. 16.1%, p=0.224), and significantly lower than that in undifferentiated carcinoma (UDC; 10% vs. 23.3%, p=0.024). Tumor size, infiltration depth, pathological type, and mixed type were risk factors for LNM in early cases. Regarding intramucosal cases, the LNM rate in SRCC was similar to that in DC (4.3% vs. 3.7%, p=0.852), and significantly lower than that in UDC (11.2%). The LNM rate was significantly higher in submucosal than intramucosal cases (28.1% vs. 6.3%, p<0.001), and in early mixed cases than early pure cases (23.2% vs. 12.4%, p<0.001). Regarding early pure cases, the LNM rate in SRCC was similar to that in DC (9.3% vs. 7.2%, p=0.641), but significantly lower than that in UDC (9.3% vs. 24.7%, p=0.039). In summary, the LNM rate in early SRCC was similar to that in early DC but significantly lower than that in early UDC. Early SRCC fits with the endoscopic submucosal dissection (ESD) indication related to undifferentiated cases, and ESD may be effective. Additionally, the LNM rate was markedly higher for submucosal cases than intramucosal cases, and for mixed cases than pure cases.
Highlights
Gastric cancer refers to gastric cancer in which the tumor is limited to the mucosa and submucosa, regardless of lymph node metastasis (LNM)
Our study showed that the LNM rate in early Signet ring cell carcinoma (SRCC) was slightly but non-significantly lower than that in early differentiated carcinoma (DC), but significantly lower than that in early undifferentiated carcinoma (UDC)
We found that the LNM rate in early SRCC was slightly but non-significantly lower than that in early DC, and both LNM rates were significantly lower than that in early UDC (p=0.024 and p=0.036, respectively)
Summary
Gastric cancer refers to gastric cancer in which the tumor is limited to the mucosa and submucosa, regardless of lymph node metastasis (LNM). Lymph Node Metastasis of early gastric cancer with almost no risk of LNM. LNM in early gastric cancer is mainly affected by tumor size, invasion depth, pathological type, and the presence of ulcers [2]. SRCC was considered to be highly malignant with a poor prognosis [5, 6] This was mainly based on cases of advanced SRCC. There are gaps in the literature regarding the difference in the LNM rate between early SRCC and non-SRCC cases and whether early SRCC can be treated with ESD [8,9,10]. We aimed to analyze the risk factors for LNM in early cases, advanced cases, undifferentiated type (comprising poorly differentiated and mucinous carcinoma), and SRCC
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