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.	日本胃癌研究会. 胃癌取扱い规约. 東京: 金原出版株式会社, 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. 从中国胃肠肿瘤外科联盟相关数据分析我国早期胃癌诊治现状和发展趋势. 中国实用外科杂志, 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.	徐惠绵, 黄宝俊. 早期胃癌治疗的有关问题. 实用肿瘤杂志, 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. 早期胃癌淋巴结转移与临床病理特征的关系. 中华胃肠外科杂志, 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.	Hölscher AH, Drebber U, Mönig SP, et al. Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg, 2009, 250(5): 791-797.
19.	周平红. 早期胃癌内镜治疗利与弊. 中国实用外科杂志, 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.	叶再生, 魏晟宏, 林振孟, 等. 胃癌手术标本中脉管癌栓的临床意义. 中华普通外科杂志, 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. 日本胃癌研究会. 胃癌取扱い规约. 東京: 金原出版株式会社, 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. 从中国胃肠肿瘤外科联盟相关数据分析我国早期胃癌诊治现状和发展趋势. 中国实用外科杂志, 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. 徐惠绵, 黄宝俊. 早期胃癌治疗的有关问题. 实用肿瘤杂志, 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. 早期胃癌淋巴结转移与临床病理特征的关系. 中华胃肠外科杂志, 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. Hölscher AH, Drebber U, Mönig SP, et al. Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg, 2009, 250(5): 791-797.
19. 周平红. 早期胃癌内镜治疗利与弊. 中国实用外科杂志, 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. 叶再生, 魏晟宏, 林振孟, 等. 胃癌手术标本中脉管癌栓的临床意义. 中华普通外科杂志, 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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