Emory University School of Medicine, Atlanta, GA, USA.
The Winship Cancer Institute, Emory University, Atlanta, GA, USA.
J Gastrointest Surg. 2018 Apr;22(4):569-577. doi: 10.1007/s11605-017-3500-4. Epub 2018 Jan 8.
The incidence, survival, and propensity for nodal metastasis in early-stage gastric signet ring cell carcinoma have not been defined in the United States. These data are critical determinants for treatment allocation.
Cases of gastric signet ring cell carcinoma were extracted from the national SEER database for the years 2004-2013. Age-standardized incidence was derived. Survival was calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify predictors of nodal metastasis. Exclusion criteria included neoadjuvant radiotherapy and lack of histologic or nodal data.
A total of 10,624 cases were initially identified. The analysis cohort included 506 cases with early T-stage N0M0 disease following exclusions. The incidence was 0.094 per 100,000 person-years. The 5-year survival rate was 82.8%. Tumor stage (p < 0.001) and size (p < 0.001) were independent predictors of nodal metastasis. The incidence of nodal involvement for T1a tumors <2 cm was 5.4% (p < 0.004).
The incidence of potentially resectable signet ring gastric carcinoma has not changed significantly over the past decade. While presenting with predominantly high-grade histology, early T-stage disease has a high survival rate. Small T1a tumors have low rates of nodal metastasis, suggesting that an endoscopic resection could be considered in this subset.
在美国，早期胃印戒细胞癌的发病率、生存率和淋巴结转移倾向尚未确定。这些数据是治疗分配的关键决定因素。
从 2004 年至 2013 年的国家 SEER 数据库中提取胃印戒细胞癌病例。得出年龄标准化发病率。使用 Kaplan-Meier 方法计算生存率。进行单因素和多因素分析，以确定淋巴结转移的预测因素。排除标准包括新辅助放疗和缺乏组织学或淋巴结数据。
最初确定了 10624 例病例。分析队列包括排除后具有早期 T 期 N0M0 疾病的 506 例。发病率为每 100,000 人年 0.094 例。5 年生存率为 82.8%。肿瘤分期（p<0.001）和大小（p<0.001）是淋巴结转移的独立预测因素。肿瘤大小<2cm 的 T1a 肿瘤的淋巴结受累发生率为 5.4%（p<0.004）。
在过去十年中，潜在可切除的印戒细胞胃癌的发病率没有明显变化。尽管主要表现为高级别组织学，但早期 T 期疾病的生存率较高。小 T1a 肿瘤淋巴结转移率低，提示在这一亚组中可以考虑内镜下切除。
