title: Risk Factors for Lymph Node Metastasis in Early Gastric Cancer with Signet Ring Cell Carcinoma.
abstract: BACKGROUND
  Gastrectomy was reported to be an excessive approach for early gastric cancer with signet ring cell carcinoma. This study was conducted to explore the feasibility of endoscopic submucosal dissection for early gastric with signet ring cell carcinoma.
  
  
  METHODS
  Data from 1067 patients who underwent gastrectomy for early gastric cancer were collected retrospectively. The association between the clinicopathological factors and the lymph node metastasis was analyzed by univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  Lymph node metastasis was confirmed in 17.2 % (184/1067) of patients. Meanwhile, the incidence of lymph node metastasis with each histology type was 13.1 % (26/198), 9.8 % (34/347), and 23.8 % (124/522) for signet ring cell carcinoma, differentiated carcinomas, and undifferentiated carcinomas, respectively. Signet ring cell carcinoma occurs more in women and young patients, with a higher predominance for mucosa. Various factors-including sex, tumor size, depth of tumor, and lymphovascular invasion-were found to be associated with lymph node metastasis for signet ring cell carcinoma (P < 0.05). Multivariate analysis revealed that tumor size (7.489, 95 % CI 2.025-27.701) and lymphovascular invasion (18.434, 95 % CI 3.256-104.359) were independent risk factors for lymph node metastasis (P < 0.05). Further analysis reveals there was no positive lymph node in patients with signet ring cell carcinoma when tumor confined to mucosa, size ≤2 cm and without lymphovascular invasion and ulceration.
  
  
  CONCLUSIONS
  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.
authors: Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17, South of Panjiayuan, Chaoyang District, Beijing, 100021, China. dr.guocg@gmail.com.
authors: Chun Guang
authors: CG
authors: Guo
authors: Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17, South of Panjiayuan, Chaoyang District, Beijing, 100021, China. dbzhao2003@sina.com.
authors: Dong Bing
authors: DB
authors: Zhao
authors: Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17, South of Panjiayuan, Chaoyang District, Beijing, 100021, China.
authors: Qian
authors: Q
authors: Liu
authors: Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17, South of Panjiayuan, Chaoyang District, Beijing, 100021, China.
authors: Zhi Xiang
authors: ZX
authors: Zhou
authors: Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17, South of Panjiayuan, Chaoyang District, Beijing, 100021, China.
authors: Ping
authors: P
authors: Zhao
authors: Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17, South of Panjiayuan, Chaoyang District, Beijing, 100021, China. wangguiq@126.com.
authors: Gui Qi
authors: GQ
authors: Wang
authors: Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.17, South of Panjiayuan, Chaoyang District, Beijing, 100021, China.
authors: Jian Qiang
authors: JQ
authors: Cai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000556:secondary* / Q000601:surgery*; D004210:Dissection; D055088:Early Detection of Cancer; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Endoscopic submucosal dissection; Gastric cancer; Lymph node metastasis; Signet ring cell carcinoma