Growth patterns and prognosis in early gastric carcinoma: Superficially spreading and penetrating growth types

Abstract

One hundred and sixty‐seven cases of early gastric cancer were analyzed in terms of growth patterns and were then classified into the Small mucosal type, the superficially spreading (Super) type and the penetrating growth (Pen) type, the latter further subdivided into the Pen A type growing expansively and the Pen B type deepening infiltratively. The Small mucosal, Super, and Pen B types are characterized by a tendency toward dominant depressed lesions, a low incidence of vessel invasion and lymph node metastasis, and a good prognosis after surgery (about 90% of the patients survived for ten years). In contrast, the Pen A type is characterized by dominant elevated lesions usually comprised of well differentiated carcinoma, a relatively high incidence of vessel invasion and lymph node metastasis and a poor prognosis after surgery (64.8% five‐year survival), due to early recurrence in the form of liver metastasis. Some attention is given to the related surgical approaches.

Clinicopathological features of the superficial spreading type of early gastric cancer

“…According to Yasui et al [19], in Japan, the superficial spreading cancer type of early gastric cancer is defined as cancer which is greater than 25 cm 2 (5 ϫ 5 cm) in size and has characteristics such as diffused appearance, notable histological aggressiveness, and advanced invasion into the lymphatic system. Gastric cancers which have these histological findings generally have poorer prognoses than those without such histological aggressiveness [20]. Thus, the objective of this study was to show that the superficial spreading type of early gastric cancer has a poorer prognosis than that of smallsized cancer.…”

The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015

“…From a macroscopic point of view, EGCs are divided into three main types according to their endoscopic appearance: type 1 (protruding), type 2 (superficial), type 3 (excavated). Kodama's classification should also be mentioned, as it could provide additional prognostic implications [26]. Advanced carcinomas should be classified into four macroscopic types according to the criteria proposed by Borrmann: polypoid, fungating, ulcerated, and infiltrative.…”

Intratumoral neovascularization and growth pattern in early gastric carcinoma

“…3 We reported previously that the growth pattern based on a volumetric analysis is an important prognostic factor in early gastric carcinoma. 4,5 In cases of a widespread lesion within the mucosa or a slight submucosal invasion, favorable results has been achieved. However, when the tumor is minute but is characterized by expansive submucosal invasion, there can be a recurrence in the liver, and the postoperative prognosis is not as favorable.…”