Prognostic factors of early gastric cancer —Results of long-term follow-up and analysis of recurrent cases—

Abstract

The prognosis of early gastric cancer (EGC) is generally excellent, however, EGC is not an exception to recurrence. In order to know what type of EGC is liable to recur, long-term results were studied in 304 cases of resection. The cumulative 10-year survival rate was poorer in patients with positive lymph nodes than in those with negative nodes (52.8 +/- 15.8 per cent vs 94.1 +/- 2.4 per cent; p less than 0.05). It was also less favorable when the EGC was greater than 5 cm in diameter (61.5 +/- 13.2 per cent vs 92.9 +/- 2.4 per cent; p less than 0.05). Among 50 cases which died postoperatively, six deaths were due to recurrence. A predominant mode of recurrence was hematogenous metastasis (4/6). The characteristics of EGC which recurred later included large cancer (greater than or equal to 5 cm) (6/6), macroscopically combined-type cancer (5/6), cancer of depth invasion to the submucosa (4/6) and histologically differentiated cancer (6/6). Lymph node dissection was not carried out in two of these patients at their primary operation. Adjuvant therapy should be added in the EGC bearing risk factors depicted above. Primary cancer in other organs, either metachronous or synchronous, was found in 13 cases (4.3 per cent). Colonic cancer, in particular, was seen in three, and it was 4.8 times as frequent as the expected number of the general population, calculated using the person-year method.

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].…”

Recurrence of early gastric cancer

“…Several reports [17] claim that there is no significant difference in survival rate between patients with early gastric carcinoma metastasizing to the lymph nodes and those without such metastasis. However, many reports [ 11,23,24] agree that the prognosis for patients with lymph node metastasis is usually not good. After all, patients positive for lymph node metastasis and lymph vascular invasion by cancer cells at initial surgery are more likely to develop lymph node recurrence [12,25].…”

MR imaging of gastric cancer in vitro: accuracy of invasion depth diagnosis

“…For patients with early gastric carcinoma limited to the mucosa, local gastric resection or gastrectomy with dissection of the perigastric lymph nodes may be sufficient to cure the disease because distant metastasis is rare. For small, early gastric carcinoma, endoscopic mucosal resection may also be considered [12][13][14][15]. There have been a few studies regarding magnetic resonance (MR) imaging in vitro of either early or advanced gastric carcinoma [16][17][18].…”

“…Recently, multi-detector row CT has also been applied and has provided promising results [8][9][10][11]. Although the degree of tumor invasion is one of the most important factors both in the staging of gastric carcinoma and in the selection of therapy [12][13][14][15][16], a limitation of these techniques is that layers of the normal gastric wall cannot be clearly visualized separately. For patients with early gastric carcinoma limited to the mucosa, local gastric resection or gastrectomy with dissection of the perigastric lymph nodes may be sufficient to cure the disease because distant metastasis is rare.…”