Clinicopathological characteristics and treatment strategies in early gastric cancer: a retrospective cohort study

Abstract

BackgroundBoth endoscopic and surgical approaches are employed in the treatment of early gastric cancer (EGC). The aim of this study was to establish appropriate treatment strategies for early gastric cancer.MethodsWe retrospectively examined clinicopathological data of EGC patients who had undergone surgery.ResultsA total of 327 patients (204 males and 123 females, mean age 63.2 years) were eligible for inclusion in the study. The median follow-up period was 31 months. Of 161 mucosal (pT1a) tumors, 87 were mainly undifferentiated and 110 had an undifferentiated component. Four patients with pT1a tumors had lymph node metastases; all these tumors were signet-ring cell carcinomas and were macroscopic type 0-IIc with ulceration, and only one of them had lymphatic invasion. Among patients with submucosal tumors, four of 43 patients with pT1b1 tumors and 37 of 123 patients with pT1b2 tumors had nodal metastases. Lymph node metastases were significantly higher in mixed undifferentiated type group than differentiated type group for both groups, pT1a-pT1b1 (p = 0.0251) and pT1b2 (p = 0.0430) subgroups. Only four of 45 patients with nodal metastases were diagnosed preoperatively by computed tomography (sensitivity 8.9%, specificity 96.2%). Nine patients with pT1b tumors had recurrence after surgery, and died. The sites of initial recurrence were liver, bone, peritoneum, distant nodes, and the surgical anastomosis.ConclusionsThe incidence of nodal metastases was approximately 5% in undifferentiated type mucosal (pT1a) tumors, and higher in submucosal (pT1b) tumors. The sensitivity of preoperative diagnosis of nodal metastases in EGC using computed tomography was relatively low in this study. Therefore at present surgery with adequate lymphadenectomy should be performed as curative treatment for undifferentiated type EGC.

The Characteristics, Prognosis, and Risk Factors of Lymph Node Metastasis in Early Gastric Cancer

“…Similarly, EGCs with LNM were found to be more in submucosa invasion and LVI in our study. Besides them, tumor differentiation and histologic types have been demonstrated to predict the likelihood of LNM [ 28 , 29 ]. However, in our study, we failed to found significant differences in the rate of LNM among them, although this trend still existed.…”

Clinicopathological characterisation of small (2cm or less) proximal and distal gastric carcinomas in a Chinese population

“…Perhaps one of the most striking yet unexpected findings is a high overall lymph node metastasis rate of 23%, which is much higher than that reported in Japanese series evaluating early small carcinomas (≤2 cm in size) with poor prognostic indicators (ulcerative gross appearance and undifferentiated carcinoma histology). 34 , 35 In general, the prognosis of PGCs is reported to be worse than that of DGCs. 4 , 36 – 38 This is directly related to the more advanced pT stage, as previously described in Korean and Chinese patients.…”

Lymph node metastasis in early gastric cancer

“…Regarding the degree of cell differentiation, welldifferentiated tumors have a lower rate of metastasis than their moderately differentiated and poorly differentiated counterparts. Accordingly, as for Lauren's classification, the intestinal type tends to have a lower rate of lymph node metastasis than the diffuse one 26 . These data are confirmed in our work and can be seen in Table 5.…”