Minute and small early gastric cancers in a Western population: a clinicopathologic study

Perri, Francesco; Iuliano, R.; Valente, Guido; Angelillo, Italo Francesco; Arrigoni, Arrigo; Campra, D; Recchia, S.; Andriulli, Angelo

doi:10.1016/s0016-5107(05)80006-9

Cited by 14 publications

(8 citation statements)

References 28 publications

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“…Fukutomi and Sakita report that minute lesions accounted for 2.9% of EGC in 1972 and 4.2% in 1980, and small lesions for 6.8% in 1972 and 10.1% in 1980 47. However, in a recent report from Italy, minute lesions accounted for 12% and small lesions for 23% of EGC,5 whereas Chia et al (Australia) report 21% small or minute lesions 43. Thus, it would seem that there is no great difference in the size of lesions detected on separate continents.…”

Section: Histopathologymentioning

confidence: 90%

“…With submucosal invasion, lymph nodes are involved in between 15 and 30%, but with mucosal lesions, lymph node involvement is much less common (0–7%). Furthermore, lymph node invasion is commoner with larger tumours,5 34 46 49 53 76 and possibly with poorly differentiated tumours,34 although this relation is reported less consistently.…”

Section: Histopathologymentioning

confidence: 97%

“…Old age seems to confer worse prognosis,11 36 50 even after multivariate analysis 67. Larger tumour size has been associated with either no difference5 34 or with worse survival rates,37 65 and excavated/depressed tumours have been associated with a better prognosis 2433 39 56 67 …”

Section: Survival and Prognosismentioning

confidence: 99%

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Early gastric cancer in Europe

Everett

Axon

1997

Gut

277

157

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Despite mass population screening and an incidence of EGC in Japan that is at least double that of the West, there seem to be no genuine differences in the clinicopathological features of the disease between the two regions. The macroscopic appearance, size, depth of invasion, frequency of lymph node invasion, and histology of EGC are all remarkably similar in Japan, Europe and America, as are sex and age distributions.Patients with EGC are a number of years younger than those with advanced cancer. This is not surprising: Tsukuma et alfollowed 56 cases of EGC that were not surgically treated and estimated that the median “duration of EGC” before becoming advanced was 37 months.87 This suggests that EGC undergoes a period of slow growth before becoming advanced. Further differences between early and advanced cancers include a higher frequency of synchronous cancers and a longer symptom duration in EGC.Unfavourable prognostic factors in EGC include lymph node invasion, and invasion through the muscularis mucosae, though it is not clear whether these are independent. Repeated attempts have been made to identify other prognostic factors, but no clear pattern has emerged, with the possible exceptions of patient age, tumour size, and the presence of ulceration.The postsurgical outcome of EGC in the West is marginally less favourable than in Japan. In view of the similar clinical and pathological features in the two regions it seems likely, therefore, that this is because of the more aggressive surgical techniques traditionally used in Japan. Conversely, however, EMR has recently emerged as an important technique in Japan. Despite the advantages of low operative mortality and normal function of the postoperative stomach, there are also a number of potential disadvantages. It would seem sensible, therefore, to await the results of long term follow up studies before widespread adoption of EMR in Europe. Nevertheless, this technique should be considered for frail patients unfit for more radical surgery.

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Section: Histopathologymentioning

confidence: 90%

Section: Histopathologymentioning

confidence: 97%

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Early gastric cancer in Europe

Everett

Axon

1997

Gut

277

157

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“…Elucidating the order of stepwise accumulation of mutations and defining the earliest genetic events in tumor development are crucial for understanding pathogenesis and early detection and diagnosis. Regarding GC, studying small‐sized IC (‘minute’ or ‘small’ GC ; miGC) would offer important clues for these issues, as miGC is the earliest neoplasia phase with definite malignant potential. However, the genetic alterations of miGC remain undetermined.…”

Section: Introductionmentioning

confidence: 99%

Initial and crucial genetic events in intestinal‐type gastric intramucosal neoplasia

Rokutan¹,

Abé

Nakamura³

et al. 2019

The Journal of Pathology

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Gastric cancer (GC) is one of the most common and life‐threatening malignancies. The course of disease and tumor aggressiveness vary among GCs, although how early fate is determined and by what factors remains elusive. To solve this question, we collected 43 gastric intramucosal neoplasias (GINs), comprising dysplasia/intraepithelial neoplasia (D/IEN; a premalignant lesion) and minute GC (miGC; ≤10 mm) of intestinal histotype and performed targeted deep DNA sequencing of 67 GC‐related genes derived from large‐scale data. Gastric D/IEN was classified into low or high grade (LG‐D/IEN or HG‐D/IEN). The most frequent mutations in D/IENs included APC (19/25; 76%), ARID2 (6/25; 24%) and MUC6 (5/25; 20%). All LG‐D/IENs had APC mutation (12/12) and APC hotspot mutations affecting R1450 and E1554 were noted in both LG‐D/IEN and HG‐D/IEN. ARID2 mutation always co‐occurred with APC mutation, whose tumor variant allele frequency (TVAF) was higher than that of ARID2 in D/IEN. APC and TP53 mutations were mutually exclusive in D/IEN (p = 0.031 [main cohort], p = 0.025 [expanding cohort]) and TP53‐mutated D/IEN was exclusively HG‐D/IEN (4/4). TP53 mutations were highly recurrent (11/14; 79%) in MLH1‐positive miGCs and were detected even in two microscopic lesions measuring 1 and 3 mm, respectively. Furthermore, TVAF analyses suggested that TP53 mutation is the initial event in the TP53‐mutated miGCs. In contrast, TP53 mutation was absent (0/4) in MLH1‐negative small intramucosal carcinoma (8–24 mm). Advanced GC data suggested that early mutations (APC and TP53) may affect the potential of cancerous progression from D/IEN. This study revealed somatic mutational landscape and initial mutations of GINs, and we report for the first time that TP53 mutations precede other mutations in intestinal‐type GC. Our results also indicate that molecular subtyping based on APC/TP53 mutations would be a high‐priority approach for determining and predicting the malignant potential of GIN, including D/IEN. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

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“…Gastric cancers that penetrate the submucosa are at increased risk of lymph node metastases. Gastric cancer confined to the mucosa has a 0%-5% risk of lymph node metastases, compared to 10%-20% risk if the cancer involves the submucosa [46][47][48][49] . Thus, gastric lesions must meet the following criteria to be candidates for EMR: confined to the mucosa, < 2 cm for elevated lesions, < 1 cm for flat or depressed lesions, cannot be associated with an ulcer or ulcer scar, and cannot have venous or lymphatic involvement [50] .…”

Section: Gastric Malignancymentioning

confidence: 99%

Endoscopic mucosal resection in the upper gastrointestinal tract

Ahmadi¹,

Draganov²

2008

WJG

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Endoscopic mucosal resection (EMR) is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett's esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett's esophagus.

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Minute and small early gastric cancers in a Western population: a clinicopathologic study

Cited by 14 publications

References 28 publications

Early gastric cancer in Europe

Early gastric cancer in Europe

Initial and crucial genetic events in intestinal‐type gastric intramucosal neoplasia

Endoscopic mucosal resection in the upper gastrointestinal tract

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