Indication for endoscopic mucosal resection in early signet ring cell gastric cancer

Ha, Tae Kyung; An, Jungsuk; Youn, Hyeong-Chul; Noh, Jae Hyung; Sohn, Tae Sung; Kim, S.

doi:10.1245/s10434-007-9660-9

Cited by 113 publications

(86 citation statements)

References 16 publications

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“…In early gastric cancer (mostly described in Asian countries), it is clearly established that the prognosis of the SRC type is better than that of the non-SRC type [8,10,18,19,32], probably because the SRC-type tumor is more frequently confined to the mucosa and shows a lower rate of lymph node metastasis [18,32]. This observed better survival may be related to the younger age of patients with SRC gastric cancer [20].…”

Section: Discussionmentioning

confidence: 99%

“…For early gastric cancer (described by the Japanese Endoscopy Society as gastric cancer that does not extend beyond the submucosa, whatever the lymph node status [17]), the prognosis of the SRC type has been reported to be better than that of non-SRC adenocarcinoma in four recent studies [7,12,18,19], but this could be biased by the tendency of patients with SRC to be younger [20]. For advanced gastric cancer, the clinicopathological characteristics and prognosis are again controversial.…”

Section: Introductionmentioning

confidence: 99%

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Is signet-ring cell carcinoma a specific entity among gastric cancers?

et al. 2015

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Background The prognosis and chemoresistance of signet-ring cell (SRC) gastric adenocarcinoma have been reported and debated, and the utility of perioperative chemotherapy for such a tumor has been questioned. This study was performed to assess the impact of the SRC type on survival following resection of gastric adenocarcinoma, and to assess whether the prognostic factors (including perioperative chemotherapy) for non-SRC adenocarcinoma differed from those for SRC adenocarcinoma. Methods 1799 cases of adenocarcinoma that were consecutively treated from 1997 to 2010 in 19 French centers by subtotal or total gastrectomy were included in a retrospective study. A D2 lymphadenectomy was performed for antropyloric tumors, and a modified D2 for upper tumors. SRC adenocarcinoma was diagnosed based on the presence of isolated carcinoma cells containing mucin. Results A total gastrectomy was performed in 979 (54.4 %) patients. SRC adenocarcinoma was diagnosed in 899 (50 %) patients. Patients with an SRC tumor were more frequently female, younger, and malnourished, had lower ASA scores, and had larger tumors than non-SRC patients. Median survival in patients with non-SRC carcinoma was 51 months, as compared to 26 months in patients with SRC carcinoma (p \ 0.001). At multivariate analysis, SRC type remained an independent adverse prognostic factor (HR = 1.182). Factors that were prognostic in the SRC subgroup but not in the non-SRC subgroup were age [60 years, linitis, and involvement of adjacent organs. In contrast to non-SRC tumors, pre-and postoperative chemotherapy did not significantly impact on survival following resection of SRC adenocarcinoma. On behalf of the FREGAT (French Eso-GAstric Tumours) working group-FRENCH (Fédération de Recherche en Chirurgie).Electronic supplementary material The online version of this article (doi:10.1007/s10120-015-0564-2) contains supplementary material, which is available to authorized users. Conclusion In comparison to non-SRC adenocarcinoma, the SRC type has a worse prognosis, different prognostic factors, and is only poorly sensitive to perioperative chemotherapy. Non-SRC and SRC adenocarcinomas should be considered different entities in future therapeutic trials.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is signet-ring cell carcinoma a specific entity among gastric cancers?

et al. 2015

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“…Therefore, an expanded set of criteria for ER has been proposed. The upper limit of the 95% CI calculated from these early studies, however, was too broad for clinical use, because of the small sample size in those studies [24][25][26][27][28][29][30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Gotoda²,

et al. 2009

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“…However, others reported no significant differences [3] or a poorer prognosis [4][5][6]. In addition, studies that compared SRC with the other cell types in early gastric cancer (EGC) found that SRC had lower lymph node metastasis with better prognosis than other cell types and suggested endoscopic resection for the treatment of signet ring cell-type EGC patients [7]. However, these results are not confirmed, and others suggest that EGC with SRC should be treated by gastrectomy with lymph node dissection rather than endoscopic treatment [3,5,8].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach

et al. 2013

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Background Signet ring cell carcinoma (SRC) of the stomach is a histological type based on microscopic characteristics. Although the distinctive clinicopathological features of SRC have been reported, results are inconsistent and survival outcomes are uncertain. Methods We retrospectively studied 769 patients with gastric carcinoma who underwent gastrectomy in our institute from 1999 to 2009. Among them, 326 patients (42.4 %) had early gastric cancer (EGC) and 443 patients (57.6 %) had advanced gastric cancer (AGC). Sex, age, tumor location, macroscopic type, tumor size, microscopic invasion, and survival rate were compared between patients with SRC, differentiated-, and undifferentiated-type gastric carcinomas. Results Fifty-one patients (15.6 %) had SRC in EGC; there were significant differences in sex, age, location, macroscopic type, and size between SRC and the differentiated histological type. However, there was no difference between SRC and undifferentiated-type gastric carcinoma, except for the macroscopic type. Fifty-seven patients (12.9 %) had SRC in AGC. Sex, age, location, size, macroscopic type, perineural invasion, N stage, and hepatic metastasis were significantly different between SRC and the differentiated histological type. Undifferentiated-type gastric carcinoma differed in sex, macroscopic type, and hepatic metastasis. The overall survival rate differed between SRC and other cell types (P \ 0.001). Among all the study patients, age [hazard ratio (HR) 1.013, P = 0.041] and tumor, node, and metastasis (TNM) stage (HR 2.350, P \ 0.001) were important factors for predicting survival. Omitting patients with palliative resection or metastases, TNM stage was still an important factor for survival (HR 2.077, P \ 0.001). Conclusions Patients with SRC showed similar clinicopathological features with undifferentiated histology. The survival of patients with SRC reflected a better prognosis in patients with undifferentiated gastric carcinoma. However, when narrowing the patients to those with EGC only, survival in EGC patients exhibited no difference between histological types. Among AGC patients, SRC patients had a worse prognosis than other cell types.

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Indication for endoscopic mucosal resection in early signet ring cell gastric cancer

Abstract: Early SRC has different characteristics from early UDC. In view of the lower rate of lymph node metastasis and better prognosis, we suggest that EMR can be performed on patients with early SRC limited to the mucosa, less than 2cm in size, and with no lymphatic involvement.

Cited by 113 publications

References 16 publications

Is signet-ring cell carcinoma a specific entity among gastric cancers?

Is signet-ring cell carcinoma a specific entity among gastric cancers?

Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the stomach

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