title: Tumour size is related to the curability of signet ring cell early gastric cancer with endoscopic submucosal dissection: a retrospective single centre study.
abstract: BACKGROUND
  Endoscopic submucosal dissection is applied in selected cases of signet ring cell early gastric cancer. However, factors related to curability of signet ring cell early gastric cancer with this method have not been fully evaluated. Our aim was to evaluate factors related to incomplete resection in signet ring cell early gastric cancer with endoscopic submucosal dissection.
  
  
  METHODS
  A retrospective analysis was performed on a total of 126 consecutive patients with signet ring cell early gastric cancer who had undergone endoscopic submucosal dissection at the Severance Hospital in Korea, between March 2007 and March 2012. The clinical outcomes were reviewed and factors related to incomplete resection were analysed.
  
  
  RESULTS
  Multivariate analysis showed that large tumour size was the only significant factor related to incomplete resection (P=0.006; hazard ratio, 1.040; 95% confidence interval, 1.101-1.084). In addition, large tumour size was the only significant factor related to endoscopic size underestimation (P<0.001; hazard ratio, 1.391; 95% confidence interval, 1.221-1.586). The rate of endoscopic size underestimation was significantly higher in tumours with a size ≥20mm (P<0.001).
  
  
  CONCLUSIONS
  To improve the curability of signet ring cell early gastric cancer with endoscopic submucosal dissection, larger tumours (especially tumour with a size ≥20mm) should be resected with a larger margin.
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea.
authors: Mi Na
authors: MN
authors: Kim
authors: Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Hyun Ki
authors: HK
authors: Kim
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea.
authors: Choong Nam
authors: CN
authors: Shim
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea.
authors: Hyun Jik
authors: HJ
authors: Lee
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea.
authors: Hyuk
authors: H
authors: Lee
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea.
authors: Jun Chul
authors: JC
authors: Park
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea.
authors: Sung Kwan
authors: SK
authors: Shin
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea.
authors: Sang Kil
authors: SK
authors: Lee
authors: Department of Internal Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Seoul, Republic of Korea. Electronic address: leeyc@yuhs.ac.
authors: Yong Chan
authors: YC
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Curability; Early gastric cancer; Endoscopic submucosal dissection; Signet ring cell carcinoma; Tumour size