Early gastric cancer: diagnosis, staging, and clinical impact. Evaluation of 530 patients. New elements for an updated definition and classification

Abstract

Background The prevention and early diagnosis of gastric cancer permit clinicians to discover the tumor in the initial phase, during which time it can be completely eradicated, endoscopically or surgically. Since Murakami gave the definition of early gastric cancer (EGC) in 1971, many authors have identified various subtypes of EGC with different morphological characteristics and clinical behaviour. Methods We evaluated retrospectively 530 patients: the median follow-up time was 10.4 months (range 0.3-29.2). All tumors were classified according to the macroscopic and microscopic criteria proposed by the Japanese Society of Gastroenterology and Endoscopy and Lauren, respectively. The infiltrative growth pattern was evaluated according to Kodama's classification. Only tumor-related death was considered as an endpoint of interest for the survival analysis.Results The overall survival rates of our patients were 94 % (95 % CI, 92-96) and 90 % (95 % CI, 87-93) at 5 and 10 years, respectively. Only 44 patients (8.3 %) died of the disease. Kodama's type (p \ 0.0001), lymph node status, both for number and pathological stage according to the 7th Edition of TNM (p \ 0.0001), and depth of infiltration (p = 0.0006) were significant prognostic factors in univariate analysis. The multivariate analysis identified Kodama's PENA type (HR, 3.91; 95 % CI, 2.08-7.33; p \ 0.0001) and lymph node status for more than three positive nodes versus negative nodes (HR, 12.78; 95 % CI, 5.37-30.43; p \ 0.0001) as the only independent prognostic factors in our series. Conclusion Lymph node status, especially when more than three lymph nodes are involved, is the most important prognostic factor in EGC. However, it is also important to evaluate the infiltrative growth pattern of the cancers in their early phase according to Kodama's classification, considering PEN A type lesions to be more aggressive than the other EGC types. Then, we propose new elements for an updated definition and classification of EGC, with an important clinical impact on the treatment of patients.

Clinicopathologic characteristics and resection rates of papillary early gastric cancer removed by endoscopic submucosal dissection

“…However, further studies will be necessary scopic techniques and better knowledge of the problem have led to significant increase in EGC over the past few years [18]. According to different screening programs in Japan and Korea about fifty percent of treated patients had an early tumor stage [6,18]. The prevalence of EGC in Western countries is not really known.…”

“…Determining the most appropriate prevalence of the papillary subtype of EGC in the pathological diagnosis of GC will be important in future [3]. However, further studies will be necessary scopic techniques and better knowledge of the problem have led to significant increase in EGC over the past few years [18]. According to different screening programs in Japan and Korea about fifty percent of treated patients had an early tumor stage [6,18].…”

Histopathology-based prognostic score is independent prognostic factor of gastric carcinoma

“…It might be easily thought out that tumor-related factors such as tumor size, lymphatic invasion, and venous invasion could be an indicator for progressive potential of malignant tumors [1–3]. However, except for stage of the tumor, there have not been any criteria using histopathological tumor-related factors to determine the outcome of the patients with gastric carcinoma.…”

Poorly Differentiated Medullary Phenotype Predicts Poor Survival in Early Lymph Node-Negative Gastro-Esophageal Adenocarcinomas

“…As other authors found grading, lymph vessel invasion and tumor size as prognostic in early tumor stages mainly with lymph node involvement [10–14], employing a more detailed analysis (N0 versus N+) of the tumor, might explain these differences.…”

“…In the search for additional and refined prognostic risk factors in advanced tumor stages, several studies analyzed histomorphological criteria like tumor size, lymphatic vessel invasion, vein invasion, grading, Lauren classification, WHO classification, and MING classification [9–14]. Several studies described molecular markers considered predictive for survival of which we selected for immunohistochemical evaluation and categorized in subgroups: markers for proliferation (Ki-67 [15]), cell cycle regulation (Cyclin E [16–18], p21 [19], TP53 [20]), apoptosis (BAX [21], BCL [22], Survivin [23–25]), cell adhesion (E-cadherin [26–28]), cell differentiation (CDX2) [29], SHH (Sonic hedgehog) [30], TROP2 [31], HIF1A (hypoxia induced factor 1α) [32] and mismatch repair deficiency [33].…”