Sa1665 The Incidence of Lymph Node Metastasis in Cases of Early Gastric Signet Ring Cell Carcinoma is As Low As Early Gastric Differentiated Adenocarcinoma

Abstract Background—Pancreatic signet ring cell carcinoma (SRCC) was an exceedingly rare histological subtype of pancreatic cancer. Previous studies focused on the trends of incidence and independent predictors of pancreatic SRCC. Our objectives of the study was to analyze the prognostic value of lymph node ratio (LNR) and explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic signet ring cell carcinoma.Method—The data diagnosed from January 1, 1990 to December 31, 2016 constituted the study cohort from the Surveillance, Epidemiology, and End Results(SEER) registry. We calculated overall survival (OS) of these patients using Kaplan–Meier analysis and Cox proportional hazards model and used receiver-operating characteristic curve (ROC) analysis to investigate the discriminatory ability of the total number of lymph nodes examined(TNLE) relative to whether lymph node metastasis.Results—The median number of lymph nodes examined among 120 patients of resected pancreatic SRCC was 14 (interquartile range, 6.25 to 20.0).According to the univariate analysis of overall survival(OS) result, age, grade, chemotherapy, LNR and TNLE were significantly different(P<0.05).Multivariate survival analysis showed that LNR and grade were the independent prognostic indicators after pancreatic SRCC resection for OS. TNLE ≥ 8 showed the highest discriminatory power to evaluate whether the lymph node metastasis (AUC 0.656, 95%CI 0.564-0.741, Youden index 0.2533, sensitivity 78.67%, specificity 46.67%, P= 0.003)Conclusion—Our study indicated that LNR was a valuable independent prognostic factor for resected pancreatic SRCC. Regional lymphadenectomy of at least 8 lymph nodes was necessary to stage patients accurately. Enough number lymph nodes examined was necessary for the clinicians to accurately predict the significance of LNR in resected pancreatic SRCC.

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Clinical Features and Risk Factors for Lymph Node Metastasis in Early Signet Ring Cell Gastric Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.630675 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xiaoliang Jin ◽

Wei Wu ◽

Jing Zhao ◽

Shuang Song ◽

Chunli Zhang ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Undifferentiated Carcinoma ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Node Metastasis ◽

Signet Ring ◽

Ring Cell

Signet ring cell carcinoma (SRCC) was previously thought to have a worse prognosis than differentiated gastric carcinoma (DC). However, recent studies have shown that its prognosis is related to staging. Here, we analyzed the clinicopathological features and the rate of lymph node metastasis (LNM) in 2166 patients with gastric cancer (605 early and 1561 advanced cases) who underwent gastrectomy and lymph node dissection (D2) from 2016 to 2019. The LNM rate for early and advanced cases was 18.0% and 74.2%, respectively. Regarding early cases, the LNM rate in SRCC was similar to that in DC (10% vs. 16.1%, p=0.224), and significantly lower than that in undifferentiated carcinoma (UDC; 10% vs. 23.3%, p=0.024). Tumor size, infiltration depth, pathological type, and mixed type were risk factors for LNM in early cases. Regarding intramucosal cases, the LNM rate in SRCC was similar to that in DC (4.3% vs. 3.7%, p=0.852), and significantly lower than that in UDC (11.2%). The LNM rate was significantly higher in submucosal than intramucosal cases (28.1% vs. 6.3%, p<0.001), and in early mixed cases than early pure cases (23.2% vs. 12.4%, p<0.001). Regarding early pure cases, the LNM rate in SRCC was similar to that in DC (9.3% vs. 7.2%, p=0.641), but significantly lower than that in UDC (9.3% vs. 24.7%, p=0.039). In summary, the LNM rate in early SRCC was similar to that in early DC but significantly lower than that in early UDC. Early SRCC fits with the endoscopic submucosal dissection (ESD) indication related to undifferentiated cases, and ESD may be effective. Additionally, the LNM rate was markedly higher for submucosal cases than intramucosal cases, and for mixed cases than pure cases.

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