Signet-ring cell carcinoma of the stomach: Impact on prognosis and specific therapeutic challenge

Table 4 Incidence of lymph node metastasis in early gastric cancer (according with Gotoda et al[81])

Depth of invasion	Tumor size	Grade of differentiation	Ulcerated versus not ulcerated tumor	Incidence of LNM	Recommended treatment
Mucosal	< 2 cm	Well differentiated	Not ulcerated	0%	EMR
		Poorly differentiated	Not ulcerated	0%	ESD (Asia)/surgery (Western)
		Well differentiated	Ulcerated	0%	ESD
		Poorly differentiated	Ulcerated	2%	Surgery
	2-3 cm	Well differentiated	Not ulcerated	0%	ESD
		Poorly differentiated	Not ulcerated	1.7%	Surgery
		Well differentiated	Ulcerated	0%	ESD
		Poorly differentiated	Ulcerated	2.4%	Surgery
	> 4 cm	Well differentiated		1.7%	Surgery
		Poorly differentiated		7.3%	Surgery
Submucosal (sm1)	< 3 cm	Well differentiated		5.6%	ESD/Surgery
		Poorly differentiated		NC	Surgery
	> 3 cm	Well differentiated		2.6%	Surgery
		Poorly differentiated		6.5%	Surgery
Submucosal (sm2)	< 3 cm	Well differentiated		19%	Surgery
		Poorly differentiated		NC	Surgery
	> 3 cm	Well differentiated		27%	Surgery
		Poorly differentiated		NC	Surgery

ESD: Endoscopic submucosal dissection.