Early Gastric Cancer Twenty-eight-Year Experience

Abstract

A retrospective study of early gastric cancer (60 patients) was performed to evaluate its diagnosis and treatment. Ninety-five per cent of patients presented with nonspecific gastrointestinal symptoms and 53.3% had been treated for presumed benign disease for up to 48 months before diagnosis. Fiberoptic endoscopy detected these lesions more accurately than radiologic examination. The disease-free 5-year survival rate after resection was 76.4%. Survival showed no significant correlation with sex, tumor site, macroscopic appearance, extent of gastric resection, or histopathologic type. Tumors larger than 1.5 cm in diameter, invasion of submucosa, or lymph node metastasis resulted in significantly lower survival rates. Three of eight patients with nodal metastasis survived 5 or more years, including one who had second-echelon deposits. A high index of suspicion may permit more frequent detection. Extended lymphadenectomy (R2) is recommended to achieve the highest possible cure rate.

Early gastric cancer: Report of 58 cases

“…Similar to findings in other European [14] and in North-American [28] and Japanese [10,25,34] series, we found that most lesions (63.8%) were of the depressed or excavated types. Also, as reported previously [8,14], protruded tumors (type I and IIa) were mostly differentiated intestinal type carcinomas (72%), whereas depressed or excavated types displayed both diffuse and intestinal patterns.…”

“…Recurrence rates of 16% [14,28] and 34% [32] have been reported in Western countries, significantly higher than that reported by Japanese authoris [35,36].…”

“…A previous history of peptic ulcer is not uncommon [6,14,22,28] and may explain the duration of symptoms before diagnosis. In the present series, a high percentage of the carcinomas (24.1%) were at the edge of a peptic ulcer.…”

“…Approximately 90% of EGCs are reported to be nodenegative [24,25,28]. The incidence of lymph node metastasis in patients with EGC has been reported as varying from 1.9% to 7% in patients with intramucosal cancer and from 7.4% to 20.9% in patients with submucosal cancer.…”

Gene expression analysis of early and advanced gastric cancers

“…Conversely, AGC progressively penetrates the muscularis propria or the subserosa, the serosa and the adjacent structures (Kajitani, 1981;Wang et al, 1997). In EGC, prognosis is favorable, after gastrectomy and lymph node dissection, accounting for 5-and 10-year survival rates of 90 and 85-90%, respectively, compared with 20-30% in AGC (Lawrence and Shiu, 1991;Dicken et al, 2005). Therefore, great attention has been directed to early detection in countries where gastric carcinoma is prevalent, such as Japan and Korea (Henderson, 1990;Parkin, 2004).…”