Aberrant metastatic behavior and particular features of early gastric cancer

Abstract

In this paper, we have focused on the metastatic behavior of EGC and its particularities. The main factors that are currently considered as predictors of the metastatic behavior and that are used in the therapeutic decision (endoscopic resection vs surgical removal) are the tumor size (upper or bellow 2 cm), depth of infiltration, angiolymphatic invasion, the presence or absence of ulceration, and histologic type (undifferentiated vs differentiated carcinomas). However, most of the metastatic cases were published as case reports or case series. This is the reason why a proper estimation of metastatic risk in EGC is not well known. To date, 79 cases presenting bone metastases, three reports of brain metastases, and one EGC that was associated with skin metastasis were published. However, occult metastasis, lymph node micrometastasis, and skip metastasis can also occur and should be identified. Making a synthesis of the literature data that is correlated with our experience, we finally proposed the inclusion of the six Japanese subgrouping system, tumor size, angiolymphatic invasion, and micrometastasis as components of the pTNM staging system, which should be particularly adapted for EGC.

Value and impact factors of multidetector computed tomography in diagnosis of preoperative lymph node metastasis in gastric cancer

“…[ 59 , 60 ] Sentinel node mapping are recommended in patients with EGC who underwent surgical excision to detect possible skip metastasis. [ 61 , 62 ] A single-skip metastasis located along the middle colic artery was unexpectedly detected in sentinel lymph node biopsy of EGC by Bara's group. [ 60 ] Recently, a research showed that LN status (no enlargement of lymph nodes vs swollen lymph nodes) assessed by CT was an independent risk factor for solitary metastatic lymph node, but the specific accuracy in predicting the presence of solitary metastatic lymph node was not mentioned.…”

Impact on long-term survival of the number of lymph nodes resected in patients with pT1N0 gastric cancer after R0 resection

“…In addition to the already known factors such as tumor size, histological characteristics, depth of tumor invasion, and lymphovascular invasion, it was observed that the ethnicities of patients and/or their geographic differences influenced lymph node metastasis and aberrant metastatic behavior of early gastric cancer. [ 19 , 20 ]…”

Small early gastric cancer with synchronous bone metastasis: A case report

“…Only 79 cases of EGC with bone metastasis had been published. The time interval between the diagnosis of EGC and bone metastasis was reported in 47 cases out of 79 cases, and 17 cases (36.2%) involved synchronous bone metastasis (12). Our case of early gastric cancer with synchronous bone metastasis found taking the back pain as an opportunity, was considerably rare.…”

“…In addition, Park et al, reported that the rate of bone metastasis varied depending on the progression of gastric cancer (5). Gurzu et al (12) reviewed the literature on metastasis with early gastric cancer in PubMed from 1983 to 2015. Only 79 cases of EGC with bone metastasis had been published.…”