Abstract
Early gastric carcinoma (EGC) in Chinese patients remains poorly understood and endoscopic therapy has not been well established. Here, we compared endoscopic and clinicopathologic features between early proximal gastric carcinoma (PGC, n = 131) and distal gastric carcinoma (DGC, n = 307) in consecutive 438 EGCs diagnosed with the WHO criteria. By endoscopy, PGCs showed protruding and elevated patterns in 61.9%, while depressed and excavated patterns in 33.6%, which were significantly different from those (32.6% and 64.5%) in DGCs. PGCs were significantly smaller (1.9 cm in average, versus 2.2 cm in DGCs), invaded deeper (22.9% into SM2, versus 13% in DGCs), but had fewer (2.9%, versus 16.7% in DGCs) lymph node metastases. Papillary adenocarcinoma was significantly more frequent (32.1%, versus 12.1% in DGCs), as were mucinous and neuroendocrine carcinomas, carcinoma with lymphoid stroma (6.9%, versus 1.6% in DGCs); but poorly cohesive carcinoma was significantly less frequent (5.3%, versus 35.8% in DGCs). The overall 5-year survival rate was 92.9% in EGCs, and PGC patients showed shorter (42.4 months, versus 48.3 in DGCs) survival. Papillary and micropapillary adenocarcinomas and nodal metastasis were independent risk factors for worse survival in EGCs. EGCs in Chinese were heterogeneous with significant differences in endoscopy and clinicopathology between PGC and DGC.
Highlights
The proportion of EGCs in all gastric cancer resections at our hospital was 13.8%, comparable to that reported in Western countries[17,18,19], but lower than that (>50%) in Japan[2,20], We demonstrate that Chinese patients with EGCs diagnosed with the WHO criteria do have much better 5-year survival rates of over 92% after resection, which is similar to those reported in European and Japanese patients[17,20]
This excellent prognosis does not result from an over-diagnosis of EGC by including cases lacking invasive carcinoma[7,8]
Because of smaller size with fewer nodal metastases in most cases, early PGCs may be more suitable than DGCs for endoscopic resection
Summary
Consecutive surgical and endoscopic resection cases with a final pathologic diagnosis of gastric carcinoma were searched in the electronic pathology databank stored in the Department of Pathology of the Nanjing Drum Tower Hospital in China for the period from January 2005 to December 2012. Each pathology report was investigated for the depth of tumor invasion. Included in the study cohort were cases with invasion of neoplastic glands and/or cells into the lamina propria, muscularis mucosa (pT1a), or the submucosal space (pT1b), as defined by the 2010 WHO classification for EGC1. All histology slides were reviewed again by two pathologists for verification of the EGC diagnosis and the tumor invasion depth. The information on demographics and endoscopic/gross tumor characteristics was gleaned from patient medical records. The study protocol was approved by the Medical Ethics Committee of the Nanjing Drum Tower Hospital
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