Gastric Cancer

, Volume 22, Issue 4, pp 751–758 | Cite as

Effect of double-layer structure in intramucosal gastric signet-ring cell carcinoma on lymph node metastasis: a retrospective, single-center study

  • Katsuyuki Murai
  • Kohei Takizawa
  • Tadakazu ShimodaEmail author
  • Shougo Fujii
  • Takashi Sugino
  • Masao Yoshida
  • Noboru Kawata
  • Masaki Tanaka
  • Naomi Kakushima
  • Masanori Terashima
  • Hiroyuki Ono
Original Article



Among all types of gastric cancer (GC), signet-ring cell carcinoma (sig-GC) accounts for 4–17% of cases. The prognosis of early sig-GC is relatively good, with the 5-year survival rate at 99.7%. However, the correlation between histological features and lymph node metastasis (LNM) among pT1a (M) sig-GC remains unclear. Sig-GC often exhibits a double-layer structure (DLS) in the intramucosal layer, demonstrating functional differentiation into the normal gastric gland. Assumedly, the loss of the differentiation makes the DLS deranged, accounting for the occurrence of submucosal invasion and LNM. This study aimed to assess the proportion of DLS, to elucidate the correlation between histological features (including DLS) and LNM status, and to determine the LNM-negative condition in pT1a (M) sig-GC.


We reviewed the pathological data of 310 patients with 310 intramucosal sig-GCs who received gastrectomy with lymph node dissection. Immunohistochemistry was performed on all specimens to evaluate the presence of DLS. Furthermore, we review the clinicopathological features, including tumor size, lymphovascular invasion (LVI), ulceration (UL), and DLS results, and then statistically analyze the correlation between these features and LNM status.


Overall, 129 pT1a (M) sig-GCs (42%) were DLS present. The univariate analysis revealed that “Tumor size > 20 mm”, “UL present”, and “DLS absent” were significant risk factors of LNM. The multivariate logistic regression analysis revealed only “DLS absent” as statistically significant.


“DLS absent” is a risk factor of LNM detected by the multivariate analysis. In pT1a (M), LVI absent, UL absent, tumor size > 20 mm, sig-GC, no LNM occurred in “DLS present” cases.


Stomach neoplasms Signet-ring cell carcinoma Lymph node metastasis Double-layer structure 


Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical standards

All procedures were followed in accordance with the ethical standards of the Institutional Review Board of Shizuoka Cancer Center (approval number: 27-J111) and with the Helsinki Declaration of 1964 and later versions. Informed consent from enrolled patients was waived by the requirement of the approving authority.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Katsuyuki Murai
    • 1
    • 2
  • Kohei Takizawa
    • 2
  • Tadakazu Shimoda
    • 1
    Email author
  • Shougo Fujii
    • 1
  • Takashi Sugino
    • 1
  • Masao Yoshida
    • 2
  • Noboru Kawata
    • 2
  • Masaki Tanaka
    • 2
  • Naomi Kakushima
    • 2
  • Masanori Terashima
    • 3
  • Hiroyuki Ono
    • 2
  1. 1.Division of PathologyShizuoka Cancer CenterShizuokaJapan
  2. 2.Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
  3. 3.Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan

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