Early gastric cancer: Prognostic factors in 223 patients

Abstract

A retrospective study of 223 patients treated for early gastric cancer (EGC) is reported, representing 21.2 per cent of the 1051 patients with gastric cancer treated over the same period. Two main types of surgical procedure were used: subtotal resection of the stomach for EGC of the two lower thirds and total gastrectomy for lesions of the upper third. A lymphadenectomy of groups 1 and 2, according to the procedure of the Japanese Research Society for Gastric Cancer (R2 resection), was performed in all patients. The mean duration of follow-up was 7.5 years. Univariate analysis showed a significant difference in survival rates only between patients with and without involved nodes (log rank = 6.05, P = 0.0139). Other prognostic factors were not identified. A bivariate analysis was performed to evaluate the joint effect of node status and the Kodama classification: survival rates for patients with EGC of the penetrating (Pen) A type and node positive falls to around 57 per cent within 6 years. This group of patients has a tumour that should probably be considered as a 'non-early' lesion. To improve the survival of patients with a Pen A, node positive lesion, adjuvant chemotherapy may be appropriate.

Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer

“…Although the overall stage is determined by a combination of T and N stage, our findings may suggest that the overall stage may independently affect the prognosis beyond each of T stage and N stage. Of the six independent variables we observed, one or more were repeatedly observed as risk factors for recurrence in each of the previous studies with a smaller patient population with early-stage GC [12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. In general, metastasis to lymph nodes has been reported to be one of the most significant risk factors for recurrence of early-stage GC [17,29].…”

Combined evaluation of mucin antigen and E-cadherin expression may help select patients with gastric cancer suitable for minimally invasive therapy

“…At present, endoscopic mucosal resection or gastrectomy with limited lymph node dissection is generally chosen for early gastric carcinoma 24,25 . This therapeutic option for gastric cancer depends on preoperative examination, such as endoscopic ultrasonography, to assess the depth of tumour invasion 26,27 . A biological marker that estimates malignant potential at an early stage would help to determine whether minimally invasive surgery is indicated for this malignancy.…”

Abnormal expression of E-cadherin and β-catenin may be a molecular marker of submucosal invasion and lymph node metastasis in early gastric cancer

“…Numerous studies have attempted to predict lymph node metastasis and the depth of wall invasion before initial treatment of patients with gastric cancer. Several conventional clinicopathological factors, such as tumour staging, lymphatic vessel invasion and penetrating type, are known to correlate with lymph node metastasis 21,25,26 . However, these factors cannot be used for predicting lymph node metastasis at the preoperative stage.…”