The risk factors of lymph node metastasis for early gastric signet ring cell cancer and its indications of radical surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Zhiwei , CHEN Ruyi , JIANG Linhua , SONG Shiduo ,  CHEN Shaoji

Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;

Corresponding?author：

CHEN Shaoji, Email: csjcsj7@163.com

Keywords：

early gastric cancer; signet ring cell cancer; lymph node metastasis; risk factor

DOI：

10.7507/1007-9424.201907100

Video：

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Objective To investigate the risk factors of lymph node metastasis for early distal gastric signet ring cell cancer and indications of radical surgery.Methods From Mar. 2013 to Nov. 2018, a total of 91 early gastric cancer patients who accepted radical gestrectomy and regional lymph node dissection, and proved postoperatively for early distal gastric signet ring cell cancer in the First Affiliated Hospital of Soochow University were enrolled in this study. We collected clinicpathologic characteristics, such as gender, age, maximum diameter of tumor, number of lesions, depth of invasion, macroscopic type, and lymphovascular invasion, to explore the risk factors of lymph node metastasis and further analyze the indication of radical surgery.Results All 91 patients accepted radical gestrectomy and regional lymph node dissection, 10 patients suffered from lymph node metastasis. Univariate analysis showed a positive relationship between maximum diameter of tumor (χ²=5.631, P=0.025), depth of invasion (χ²=4.389, P=0.016), number of lesions (χ²=5.615, P=0.023), and lymphovascular invasion (χ²=22.500, P=0.001) and lymph node metastasis of early distal gastric signet ring cell cancer. The multivariate analysis revealed that maximum diameter of tumor (OR=3.675, P=0.012), depth of invasion (OR=3.886, P=0.015), and lymphovascular invasion (OR=8.711, P<0.001) were independent risk factors of lymph node metastasis.Conclusions The risk of lymph node metastasis of early distal gastric signet ring cell cancer was high in those with tumor diameter≥2 cm, submucosal cancer, and lymphovascular invasion. Radical surgery might be necessary in cases of early distal gastric signet ring cell cancer that satisfying one of the following criteria: tumor diameter≥2 cm and lymphovascular invasion.

Citation： ZHANG Zhiwei, CHEN Ruyi, JIANG Linhua, SONG Shiduo, CHEN Shaoji. The risk factors of lymph node metastasis for early gastric signet ring cell cancer and its indications of radical surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(3): 315-319. doi: 10.7507/1007-9424.201907100 Copy

1.	日本胃癌研究會. 胃癌取扱い規約. 東京: 金原出版株式會社, 1965: 11.
2.	Chiu CT, Kuo CJ, Yeh TS, et al. Early signet ring cell gastric cancer. Dig Dis Sci, 2011, 56(6): 1749-1756.
3.	Sano T. Evaluation of the gastric cancer treatment guidelines of the Japanese Gastric Cancer Association. Gan To Kagaku Ryoho, 2010, 37(4): 582-586.
4.	Hyung WJ, Noh SH, Lee JH, et al. Early gastric carcinoma with signet ring cell histology. Cancer, 2002, 94(1): 78-83.
5.	Zhang M, Zhu G, Zhang H, et al. Clinicopathologic features of gastric carcinoma with signet ring cell histology. J Gastrointest Surg, 2010, 14(4): 601-606.
6.	Zhao X, Cai A, Xi H, et al. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology: a meta-analysis. ANZ J Surg, 2017, 87(12): 981-986.
7.	Gong EJ, Kim do H, So H, et al. Clinical outcomes of endoscopic submucosal dissection for adenocarcinoma of the esophagogastric junction. Dig Dis Sci, 2016, 61(9): 2666-2673.
8.	苗儒林, 李子禹, 季加孚. 從中國胃腸腫瘤外科聯盟相關數據分析我國早期胃癌診治現狀和發展趨勢. 中國實用外科雜志, 2019, 39(5): 419-423.
9.	Kunisaki C, Akiyama H, Nomura M, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol, 2006, 13(3): 363-369.
10.	徐惠綿, 黃寶俊. 早期胃癌治療的有關問題. 實用腫瘤雜志, 2008, 23(3): 193-196.
11.	Huo X, Yuan K, Shen Y, et al. Clinical value of magnetic resonance imaging in preoperative T staging of gastric cancer and postoperative pathological diagnosis. Oncol Lett, 2014, 8(1): 275-280.
12.	Kitagawa Y, Takeuchi H, Takagi Y, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol, 2013, 31(29): 3704-3710.
13.	Miyashiro I, Hiratsuka M, Sasako M, et al. High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302. Gastric Cancer, 2014, 17(2): 316-323.
14.	田大宇, 胡祥. 早期胃癌淋巴結轉移與臨床病理特征的關系. 中華胃腸外科雜志, 2010, 13(10): 778-779.
15.	Wang Z, Ma L, Zhang XM, et al. Risk of lymph node metastases from early gastric cancer in relation to depth of invasion: experience in a single institution. Asian Pac J Cancer Prev, 2014, 15(13): 5371-5375.
16.	Wang Z, Zhang X, Hu J, et al. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology and their impact on the surgical strategy: analysis of single institutional experience. J Surg Res, 2014, 191(1): 130-133.
17.	Tong JH, Sun Z, Wang ZN, et al. Early gastric cancer with signet-ring cell histologic type: risk factors of lymph node metastasis and indications of endoscopic surgery. Surgery, 2011, 149(3): 356-363.
18.	H?lscher AH, Drebber U, M?nig SP, et al. Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg, 2009, 250(5): 791-797.
19.	周平紅. 早期胃癌內鏡治療利與弊. 中國實用外科雜志, 2019, 39(5): 470-472.
20.	Kim H, Kim JH, Park JC, et al. Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers. Oncol Rep, 2011, 25(6): 1589-1595.
21.	葉再生, 魏晟宏, 林振孟, 等. 胃癌手術標本中脈管癌栓的臨床意義. 中華普通外科雜志, 2017, 32(10): 816-819.
22.	Park DJ, Lee HK, Lee HJ, et al. Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery. World J Gastroenterol, 2004, 10(24): 3549-3552.
23.	Jiang CG, Wang ZN, Sun Z, et al. Clinicopathologic characteristics and prognosis of signet ring cell carcinoma of the stomach: results from a Chinese mono-institutional study. J Surg Oncol, 2011, 103(7): 700-703.
24.	Katai H, Sasako M, Fukuda H, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage Ⅰ gastric cancer: a multicenter phase Ⅱ trial (JCOG 0703). Gastric Cancer, 2010, 13(4): 238-244.
25.	Imamura T, Komatsu S, Ichikawa D, et al. Early signet ring cell carcinoma of the stomach is related to favorable prognosis and low incidence of lymph node metastasis. J Surg Oncol, 2016, 114(5): 607-612.
26.	Ha TK, An JY, Youn HK, et al. Indication for endoscopic mucosal resection in early signet ring cell gastric cancer. Ann Surg Oncol, 2008, 15(2): 508-513.

1. 日本胃癌研究會. 胃癌取扱い規約. 東京: 金原出版株式會社, 1965: 11.
2. Chiu CT, Kuo CJ, Yeh TS, et al. Early signet ring cell gastric cancer. Dig Dis Sci, 2011, 56(6): 1749-1756.
3. Sano T. Evaluation of the gastric cancer treatment guidelines of the Japanese Gastric Cancer Association. Gan To Kagaku Ryoho, 2010, 37(4): 582-586.
4. Hyung WJ, Noh SH, Lee JH, et al. Early gastric carcinoma with signet ring cell histology. Cancer, 2002, 94(1): 78-83.
5. Zhang M, Zhu G, Zhang H, et al. Clinicopathologic features of gastric carcinoma with signet ring cell histology. J Gastrointest Surg, 2010, 14(4): 601-606.
6. Zhao X, Cai A, Xi H, et al. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology: a meta-analysis. ANZ J Surg, 2017, 87(12): 981-986.
7. Gong EJ, Kim do H, So H, et al. Clinical outcomes of endoscopic submucosal dissection for adenocarcinoma of the esophagogastric junction. Dig Dis Sci, 2016, 61(9): 2666-2673.
8. 苗儒林, 李子禹, 季加孚. 從中國胃腸腫瘤外科聯盟相關數據分析我國早期胃癌診治現狀和發展趨勢. 中國實用外科雜志, 2019, 39(5): 419-423.
9. Kunisaki C, Akiyama H, Nomura M, et al. Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol, 2006, 13(3): 363-369.
10. 徐惠綿, 黃寶俊. 早期胃癌治療的有關問題. 實用腫瘤雜志, 2008, 23(3): 193-196.
11. Huo X, Yuan K, Shen Y, et al. Clinical value of magnetic resonance imaging in preoperative T staging of gastric cancer and postoperative pathological diagnosis. Oncol Lett, 2014, 8(1): 275-280.
12. Kitagawa Y, Takeuchi H, Takagi Y, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol, 2013, 31(29): 3704-3710.
13. Miyashiro I, Hiratsuka M, Sasako M, et al. High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302. Gastric Cancer, 2014, 17(2): 316-323.
14. 田大宇, 胡祥. 早期胃癌淋巴結轉移與臨床病理特征的關系. 中華胃腸外科雜志, 2010, 13(10): 778-779.
15. Wang Z, Ma L, Zhang XM, et al. Risk of lymph node metastases from early gastric cancer in relation to depth of invasion: experience in a single institution. Asian Pac J Cancer Prev, 2014, 15(13): 5371-5375.
16. Wang Z, Zhang X, Hu J, et al. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology and their impact on the surgical strategy: analysis of single institutional experience. J Surg Res, 2014, 191(1): 130-133.
17. Tong JH, Sun Z, Wang ZN, et al. Early gastric cancer with signet-ring cell histologic type: risk factors of lymph node metastasis and indications of endoscopic surgery. Surgery, 2011, 149(3): 356-363.
18. H?lscher AH, Drebber U, M?nig SP, et al. Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg, 2009, 250(5): 791-797.
19. 周平紅. 早期胃癌內鏡治療利與弊. 中國實用外科雜志, 2019, 39(5): 470-472.
20. Kim H, Kim JH, Park JC, et al. Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers. Oncol Rep, 2011, 25(6): 1589-1595.
21. 葉再生, 魏晟宏, 林振孟, 等. 胃癌手術標本中脈管癌栓的臨床意義. 中華普通外科雜志, 2017, 32(10): 816-819.
22. Park DJ, Lee HK, Lee HJ, et al. Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery. World J Gastroenterol, 2004, 10(24): 3549-3552.
23. Jiang CG, Wang ZN, Sun Z, et al. Clinicopathologic characteristics and prognosis of signet ring cell carcinoma of the stomach: results from a Chinese mono-institutional study. J Surg Oncol, 2011, 103(7): 700-703.
24. Katai H, Sasako M, Fukuda H, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage Ⅰ gastric cancer: a multicenter phase Ⅱ trial (JCOG 0703). Gastric Cancer, 2010, 13(4): 238-244.
25. Imamura T, Komatsu S, Ichikawa D, et al. Early signet ring cell carcinoma of the stomach is related to favorable prognosis and low incidence of lymph node metastasis. J Surg Oncol, 2016, 114(5): 607-612.
26. Ha TK, An JY, Youn HK, et al. Indication for endoscopic mucosal resection in early signet ring cell gastric cancer. Ann Surg Oncol, 2008, 15(2): 508-513.

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The risk factors of lymph node metastasis for early gastric signet ring cell cancer and its indications of radical surgery

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