Lymph Node Metastasis in Early Signet Ring Cell Carcinoma:Endoscopic Mucosal Resection

Objective:To identify clinicopathological factors predictive of lymph node metastases(LNM)in early signet ring cell carcinoma(SRC),and further to expand the possibility of using endoscopic mucosal resection(EMR)for the treatment of early SRC.Methods:Data from 27 surgically treated patients with early SRC were collected,and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Results:In the univariate analysis,a tumor larger than 3.0 cm,submucosal invasion,and the presence of lymphatic vessel involvement(LVI)were significantly associated with a higher rate of LNM (all P<0.05).In the multivariate model,the presence of LVI was found of to be an independent pathological risk factor for LNM.There was no LNM in 14 patients without the three clinicopathological risk factors(a tumor larger than 3.0 cm,submucosal invasion,and the presence of LVI).Conclusion:EMR alone may be sufficient treatment for intramucosal early SRC if the tumor is less than or equal to 3.0 cm in size,and when LVI is absent upon postoperative histological examination.When specimens show LVI,an additional radical gastrectomy with lymphadenectomy should be recommended.