The Risk Factors Of Lymph Node Metastasis For Early Gastric Distal Signet Ring Cell Carcinoma And Its Indications Of Radical Surgery

Objective:To investigate the risk factors of lymph node metastasis for early distal gastric signet ring cell cancer.Furthermore,to integrate related risk factors and to analyze indications of surgery for early distal gastric signet ring cell cancer.Method:From March.2013 to Nov.2018,a total of 91 early gastric cancer patients who accepted radical gestrectomy and regional lymph node dissection(D1+or D2),who were proved postoperatively for early distal gastric signet ring cell tumors in the first affiliated hospital of Soochow university were enrolled in this study.According to postoperative pathological diagnosis,we gathered datas of lymph node metastasis in each patient in turn,which included the total number of lymph nodes checked and the number of lymph nodes metastasized,we also collected clinical basic characteristics,such as gender,age,smoking history,BMI,family history,pathological features(maximum diameter of tumor,number of lesions,depth of invasion,macroscopic type,lymphovascular invasion,and ulcer).The datas were analyzed by single factor and multi-factor analysis in order to observe the correlation between the clinicopathological features and lymph node metastasis,so it could initially evaluated that possible risk factors and surgical indications for LNM in early distal signet ring cell carcinoma of the stomach.Results:All 91 patients included 40 males and 51 females.10 patients suffered from lymph node metastasis,which accounted for 11.0%.Gender,age,smoking history,BMI,family history,macroscopic type and ulcer were showed a negative relationship with LMN in univariate analysis.But it showed a positive relationship between maximum diameter of tumor(χ2=5.631,P=0.025),depth of invasion(χ2=4.389,P=0.016),number of lesions(χ2=5.615,P=0.023),and lymphovascular invasion(χ2=22.500,P=0.001)and LNM of early distal gastric signet ring cell cancer.The multivariate analysis revealed that maximum diameter of tumor(P=0.012),depth of invasion(P=0.015),and lymphovascular invasion(P<0.001)were independent risk factors of lymph node metastasis.In study of surgical indications,it showed that no LNM occurred in 39 patients with limited mucosal layer,tumor maximum diameter<2cm and negative lymphovascular invasion,and no LNM happened in 7 patients with submucosal infiltration,tumor maximum diameter<2cm and no vascular invasion,and all other groups presented various levels of LNM.Conclusions:1.Maximum diameter of tumor,depth of invasion,number of lesions,and lymphovascular invasion may have a positive correlation with LNM of early distal gastric signet ring cell cancer..2.Tumor maximum diameter≥2 cm,submucosal tumors,and lymphovascular invasion may be independent risk factors for LNM in early distal gastric signet ring cell cancer.3.Radical surgery will be necessary in cases of early distal gastric signet ring cell cancer that satisfying one of the following criterias:tumor diameter≥2 cm and lymphovascular invasion.Single factor of submucosal tumors may not be an absolute indication for surgery.