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

Guo, Chun Guang; Zhao, Dong; Liu, Qian; Zhou, Zhibo; Zhao, Ping; Wang, Gui Qi; Cai, Jian

doi:10.1007/s11605-015-2915-z

Cited by 35 publications

(43 citation statements)

References 27 publications

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“…However, recent clinicopathology studies have shown contrasting evidence for intramucosal signet ring cell carcinoma that arises in the isthmus/neck of a gastric unit and is more common in young women, distal stomach with flat and depressed growth patterns [27,28,29,30,31]. A significantly better 5-year overall survival rate has been reported in patients with early signet ring cell carcinoma than in those with non-signet ring cell carcinoma at the same stage [32,33].…”

Section: Low Risk Of Nodal Metastasis For Intramucosal Signet Ring Cementioning

confidence: 99%

“…A significantly better 5-year overall survival rate has been reported in patients with early signet ring cell carcinoma than in those with non-signet ring cell carcinoma at the same stage [32,33]. Compared to well-differentiated intestinal-type early adenocarcinoma, intramucosal signet ring cell carcinoma has been found to have a similar incidence of submucosal spread, lymphovascular invasion, and nodal metastasis [30,31]. Since Hyung et al [27] reported a very low (1.6%, 3/185) rate of nodal metastasis for signet ring cell carcinoma at the pT1a stage, a number of studies have confirmed this finding (Table 1) [27,28,29,30,31,32,33,34,35,36,37,38,39].…”

Section: Low Risk Of Nodal Metastasis For Intramucosal Signet Ring Cementioning

confidence: 99%

“…Compared to well-differentiated intestinal-type early adenocarcinoma, intramucosal signet ring cell carcinoma has been found to have a similar incidence of submucosal spread, lymphovascular invasion, and nodal metastasis [30,31]. Since Hyung et al [27] reported a very low (1.6%, 3/185) rate of nodal metastasis for signet ring cell carcinoma at the pT1a stage, a number of studies have confirmed this finding (Table 1) [27,28,29,30,31,32,33,34,35,36,37,38,39]. The average frequency of nodal metastasis (based on the data listed in Table 1) is only 4.2% for intramucosal signet ring cell carcinoma, over 5-fold less for signet ring cell carcinoma with submucosal invasion (23%), which has been confirmed by logistic regression analysis of nodal metastasis frequency in early signet ring cell carcinoma between intramucosal and submucosal invasion [39,40].…”

Section: Low Risk Of Nodal Metastasis For Intramucosal Signet Ring Cementioning

confidence: 99%

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Clinicopathology of Early Gastric Carcinoma: An Update for Pathologists and Gastroenterologists

Huang¹,

Zou

2016

Gastrointest Tumors

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Background: The WHO defines early gastric carcinoma (EGC) as invasive carcinoma up to the submucosal layer, regardless of nodal metastasis. The recent study results indicate that EGC varies in location, histology, nodal metastasis, and prognosis. Summary: The heterogeneity in EGC may be related to various types of epithelial stem cells. The most important stem cells include Lgr5⁺ cells at the base of a gastric unit in the antrum-pylorus-cardia, Mist1⁺ cells at the isthmus/Troy⁺ cells at the base in the corpus-fundus, and Sox2⁺ cells at the base in almost all regions. Dysregulation of these cells along with environmental factors transform stem cells in different regions into malignancy in genetically susceptible populations. Key Message: The 2 most vulnerable regions for EGC have been found along the lesser curvature: the cardia in elderly patients and antrum-angularis in mid-aged and elderly patients. Most hereditary early-onset gastric carcinomas are concentrated in the corpus-fundus of young women. By histology, the most common EGC type is tubular adenocarcinoma in many growth patterns, starting in the neck of a gastric unit. Worse prognosis has been found in early papillary, compared to tubular, adenocarcinoma, related to deeper penetration, more lymphovascular invasion, and more liver and nodal metastases. Contrary to the common belief, intramucosal signet ring cell carcinoma demonstrates low risk of nodal metastasis, comparable to early intestinal-type EGC. Practical Implications: The overall risk for nodal metastasis in EGC is low but significant. It is urgent to organize multicenter studies on risk of nodal metastasis in EGC in order to establish more reliable clinical practice guidelines to treat EGC patients.

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Section: Low Risk Of Nodal Metastasis For Intramucosal Signet Ring Cementioning

confidence: 99%

Section: Low Risk Of Nodal Metastasis For Intramucosal Signet Ring Cementioning

confidence: 99%

Section: Low Risk Of Nodal Metastasis For Intramucosal Signet Ring Cementioning

confidence: 99%

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Clinicopathology of Early Gastric Carcinoma: An Update for Pathologists and Gastroenterologists

Huang¹,

Zou

2016

Gastrointest Tumors

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“…Several variables associated with LNM have been reported previously, including sex, [20] depth of invasion, [7] macroscopic type, [8] tumor size, [9] and LVI. [6] In both this cohort and Japanese series, SRC histology tends to spread more superficially instead of invading deeply.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, endoscopic submucosal dissection (ESD) has been indicated for early gastric SRC to maintain the quality of life in East Asia. [6,9] However, most studies only focused on identifying predictive factors associated with LNM, and failed to provide a quantified risk of LNM for individuals. [6–10] Moreover, the clinical performance between different treatment strategies has not been assessed yet.…”

Section: Introductionmentioning

confidence: 99%

A nomogram for predicting the likelihood of lymph node metastasis in early gastric signet ring cell carcinoma

et al. 2016

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Treatment algorithm has not been established for early gastric cancer with signet ring cell carcinoma (SRC), which has a reported low rate of lymph node metastasis (LNM) similar to differentiated cancer. A cohort of 256 patients with early gastric SRC at our center between January 2002 and December 2015 were retrospectively reviewed. Multivariate logistic regression analysis was used to determine the independent factors of LNM. A nomogram for predicting LNM was constructed and internally validated. Additional external validation was performed using the database from Cancer Institute Ariake Hospital in Tokyo (n = 1273). Clinical performance of the model was assessed by decision analysis of curve. The overall LNM incidence was 12.9% (33/256). The multivariate logistic model identified sex, tumor size, and LVI as covariates associated with LNM. Subsequently, a nomogram consisted of sex, tumor size, and depth of invasion was established. The model showed qualified discrimination ability both in internal validation (area under curve, 0.801; 95% confidence interval [CI], 0.729–0.873) and in external dataset (area under curve, 0.707; 95% CI, 0.657–0.758). Based on the nomogram, treatment algorithm for early gastric SRC was proposed to assist clinicians in making better decisions. We developed a nomogram predicting risk of LNM for early gastric SRC, which should be helpful for patient counseling and surgical decision-making.

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Concurrent lymphovascular and perineural invasion after preoperative therapy for gastric adenocarcinoma is associated with decreased survival

Blumenthaler

Newhook

Ikoma

et al. 2021

Journal of Surgical Oncology

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Background and Objectives We sought to evaluate the impact of lymphovascular invasion (LVI) and perineural invasion (PNI) on survival outcomes in gastric cancer patients treated with preoperative therapy. Methods Patients with gastric cancer treated with preoperative therapy and potentially curative resection were stratified according to the presence of LVI, PNI, or both. Kaplan–Meier and Cox regression analyses were used to evaluate the impact on overall survival (OS) and disease‐free survival (DFS). Results The study included 281 patients, of whom 93 (33%) had LVI, 69 (25%) had PNI, 51 (18%) had both LVI and PNI, and 170 (61%) had neither. LVI and PNI were each associated with higher ypT and ypN categories and more positive lymph nodes (all p < .001), associations that were emphasized with both factors present. On multivariable analyses, ypN (p < .001) and concurrent LVI/PNI (hazard ratio [HR]: 2.62; 95% confidence interval [CI]: 1.55–4.45; p = .001) were predictive of OS and DFS (ypN: p < .001; both LVI/PNI: HR: 2.27; 95% CI: 1.34–3.82; p = .002). Conclusions Gastric cancer patients with concurrent LVI and PNI after preoperative therapy have more advanced disease and worse survival outcomes than patients with neither or only one of these factors.

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

Abstract: 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.

Cited by 35 publications

References 27 publications

Clinicopathology of Early Gastric Carcinoma: An Update for Pathologists and Gastroenterologists

Clinicopathology of Early Gastric Carcinoma: An Update for Pathologists and Gastroenterologists

A nomogram for predicting the likelihood of lymph node metastasis in early gastric signet ring cell carcinoma

Concurrent lymphovascular and perineural invasion after preoperative therapy for gastric adenocarcinoma is associated with decreased survival

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