Early gastric carcinoma with signet ring cell histology

There has been much controversy surrounding the biologic behavior and prognosis of early stage gastric signet ring cell carcinoma (SRC). To clarify the biologic behavior of early stage gastric SRC (early SRC), we compared the clinicopathologic features and prognosis of early SRC with other histologic types.

A total of 933 patients with early gastric carcinoma who had undergone gastrectomy from 1987 to 1995 were retrospectively analyzed. Among them, 263 patients with SRC were compared to 670 patients with other histologic types.

Younger patients more often had SRC than non-SRC. Additionally, the proportion of females was greater in SRC than in non-SRC. Signet ring cell carcinoma had a larger proportion of mucosa-confined lesions and a lower rate of lymph node metastasis than non-SRC. Even after stratifying the clinicopathologic characteristics, SRC showed a lower rate of lymph node metastasis than non-SRC. When the lymph node metastasis rate was compared between SRC and undifferentiated histology other than SRC, SRC demonstrated a lower lymph node metastasis rate. Multivariate analysis showed that SRC histology was a negative independent risk factor for lymph node metastasis in early gastric carcinoma. The prognosis of SRC was significantly better than that of non-SRC (P = 0.0104).

Early gastric carcinoma with SRC is a distinct type of gastric carcinoma in terms of clinicopathologic features and prognosis. The favorable prognosis and lower rate of lymph node metastasis in early SRC suggest that the patients with early gastric carcinoma with SRC could be candidates for less invasive surgeries for an improved quality of life.