The signet ring cell histology is regarded as an independent predictor of poor prognosis in advanced gastric adenocarcinomas, but its biologic behavior in early gastric cancer remains highly controversial.

Our objective was to compare the clinicopathological features and outcomes in patients undergoing curative resection between SRCs and non-SRCs histologic types of early gastric cancer.

Clinicopathologic features and the overall survival rates of 334patients with early gastric cancer undergoing D2 curative resection from January 1994 to December 2008 were retrospectively reviewed and compared according to the histologic type.

Clinicopathologic features were comparable between two groups, except age, ulcer findings and the presence of lymph node metastasis. The incidence of recurrence for SRCs group was significantly lower than that for non-SRCs group (10.4% vs 19.6%; P<0.05). The overall 5-year survival rate was 88.6% in all cases. The overall survival rate of patients in SRCs group was significantly better than that of patients in non-SRCs group (5-year survival, 93.9% vs 85.8%; P=0.027). Multivariable analysis revealed that SRCs subtype, lymphovascular invasion, and lymph node metastasis were independent prognostic factors.

Our analysis revealed that the biological behavior of SRCs was different from other undifferentiated cancer histologic subtypes in early stage. Early gastric cancer with signet ring cell histology had low incidence of lymph node metastasis and a relatively favorable prognosis.