Natural history of early gastric cancer: a non-concurrent, long term, follow up study

Tsukuma, Hideaki; Oshima, Akira; Narahara, Hiroyuki; Morii, Takeshi

doi:10.1136/gut.47.5.618

Cited by 196 publications

(137 citation statements)

References 8 publications

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“…Several long-term follow-up clinical studies support the notion that human gastric carcinogenesis is a multistep and multifactorial process (Tsukuma et al, 1983(Tsukuma et al, , 2000Rugge et al, 2003). Progression of low-and high-grade non-invasive neoplastic lesions to invasive adenocarcinoma, and of early gastric lesions to advanced stages has been clinically documented (Tsukuma et al, 1983(Tsukuma et al, , 2000Rugge et al, 2003).…”

Section: Discussionmentioning

confidence: 89%

“…Progression of low-and high-grade non-invasive neoplastic lesions to invasive adenocarcinoma, and of early gastric lesions to advanced stages has been clinically documented (Tsukuma et al, 1983(Tsukuma et al, , 2000Rugge et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical evidence supports the latter contention, as non-concurrent long-term follow-up studies reported that EGCs, for the most part, progress to the advanced stage, leading to death from gastric cancer, if left untreated (Tsukuma et al, 1983(Tsukuma et al, , 2000. However, the molecular alterations that might differentiate EGC from AGC are not known.…”

Section: Introductionmentioning

confidence: 96%

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Gene expression analysis of early and advanced gastric cancers

et al. 2007

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Gastric carcinoma is one of the major causes of cancer mortality worldwide. Early detection results in excellent prognosis for patients with early cancer (EGC), whereas the prognosis of advanced cancer (AGC) patients remains poor. It is not clear whether EGC and AGC are molecularly distinct, and whether they represent progressive stages of the same tumor or different entities ab initio. Gene expression profiles of EGC and AGC were determined by Affymetrix technology and quantitative polymerase chain reaction. Representative regulated genes were further analysed by in situ hybridization (ISH) on tissue microarrays. Expression analysis allowed the identification of a signature that differentiates AGC from EGC. In addition, comparison with normal gastric mucosa indicated that the majority of alterations associated with EGC are retained in AGC, and that further expression changes mark the transition from EGC to AGC. Finally, ISH analysis showed that representative genes, differentially expressed in the invasive areas of EGC and AGC, are not differentially expressed in the non-invasive areas of the same tumors. Our data are more directly compatible with a progression model of gastric carcinogenesis, whereby EGC and AGC may represent different molecular stages of the same tumor. Finally, the identification of an AGC-specific signature might help devising novel therapeutic strategies for advanced gastric cancer.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Gene expression analysis of early and advanced gastric cancers

et al. 2007

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“…When the recurrence is confined to the regional lymph nodes and detected early, with a small number of affected nodes, surgical resection can be an effective and curative treatment. When patients with EGC are left untreated, several studies have reported that approximately 25-64% of the cancers progress to the advanced stage and half of the patients die of gastric cancer progression within 5 years of diagnosis [23,24]. The disease course might be similar in cases of extragastric recurrence.…”

Section: Discussionmentioning

confidence: 99%

Pattern of extragastric recurrence and the role of abdominal computed tomography in surveillance after endoscopic resection of early gastric cancer: Korean experiences

et al. 2017

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Background Although extragastric recurrence after endoscopic resection of early gastric cancer is rare, it is important because of its potentially fatal outcomes. We investigated the patterns of extragastric recurrence after endoscopic resection and evaluated the role of abdominal computed tomography in surveillance. Methods Between July 1994 and June 2014, 4915 patients underwent endoscopic resection of early gastric cancer. Because of follow-up periods of less than 6 months and consecutive surgery within 1 year, 810 patients were excluded. Thus, 4105 patients were retrospectively reviewed. Results The median follow-up period was 37 months (interquartile range 20-59.6 months). The overall incidence of extragastric recurrence was 0.37% (n = 15). In patients who underwent curative resection, the incidence was 0.14% (n = 5). There were three recurrences in the absolute indication group, six in the expanded indication group, and six in the beyond expanded indication group. The median time to extragastric recurrence was 17 months (interquartile range 16.5-43.2 months). Of the 15 extragastric recurrences, 11 were in the regional lymph nodes and 4 were in the liver, adrenal gland, and peritoneum. Sixty percent (9/15) of the extragastric recurrences occurred without intragastric lesions. Eleven recurrences were detected by abdominal computed tomography, and eight patients underwent curative surgery. Conclusions After endoscopic resection of early gastric cancer, regional lymph node recurrence is the predominant extragastric recurrence pattern, which can be detected via abdominal computed tomography and cured by rescue surgery. Abdominal computed tomography should be considered as a surveillance method, especially in patients with an expanded indication.

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“…This finding may reflect the relatively long natural history of gastric adenoma and early gastric cancer. A follow-up study on the natural history of 56 early gastric cancers demonstrated that half of the lesions remained at an early stage of gastric cancer 44 months after diagnosis (9). Another study on gastric adenomas revealed that only 4 out of 27 lesions progressed to early gastric cancers during the median follow-up period of 66 months (10 (7).…”

mentioning

confidence: 99%