Factor In Early Gastric Cancer Research Articles

Endoscopic characteristics and high-risk background mucosa factors of early gastric cancer after helicobacter pylori eradication: a single-center retrospective study.

Gastric cancer still develops after successful Helicobacter pylori(Hp)eradication. In this study, we aimed to explore the characteristics and risks of mucosal factors. A total of 139 early gastric cancers (EGC) diagnosed in 133 patients after successful eradication from January 2016 to December 2021 were retrospectively included in the Hp-eradication EGC group and 170 EGCs diagnosed in 158 patients were included in the Hp-positive EGC group. We analyzed the clinical, pathological, and endoscopic characteristics between the two groups to identify the features of EGC after Hp eradication. Another 107 patients with no EGC after Hp eradication were enrolled in a Hp-eradication non-EGC group. The background mucosal factors between the Hp-eradication EGC group and the Hp-eradication non-EGC group were compared to analyze the high-risk background mucosal factors of EGC after eradication. In addition, we divided the EGC group after Hp eradication into IIc type and non-IIc type according to endoscopic gross classification to assess the high-risk background factors of IIc-type EGC after Hp eradication. The endoscopic features of EGC after Hp eradication included location in the lower part of the stomach (p=0.001), yellowish color (p= 0.031), and smaller size (p=0.001). The moderate/severe gastric atrophy (GA), intestinal metaplasia (IM) in the corpus, severe diffuse redness, and map-like redness were risk factors for EGC after eradication (p=0.001, p=0.001, p=0.001, and p= 0.005, respectively). The Kyoto classification total score in the EGC group was higher than the non-EGC group (4 vs.3 p<0.001). A multivariate analysis revealed that depressed erosion (OR=3.42, 95% CI 1.35-8.65, p= 0.009) was an independent risk factor for IIc-type EGC after Hp eradication. EGC after eradication are smaller and yellowish lesions located in the lower part of the stomach. The risk background mucosal factors include moderate/severe GA, IM in the corpus, severe diffuse redness, and map-like redness. The Kyoto classification total score of 4 or more after successful eradication treatment might indicate EGC risk. In addition, the IIc-type EGC should be cautioned in the presence of depressed erosion after Hp eradication.

Nomogram established using risk factors of early gastric cancer for predicting the lymph node metastasis

For the prognosis of patients with early gastric cancer (EGC), lymph node metastasis (LNM) plays a crucial role. A thorough and precise evaluation of the patient for LNM is now required. To determine the factors influencing LNM and to construct a prediction model of LNM for EGC patients. Clinical information and pathology data of 2217 EGC patients downloaded from the Surveillance, Epidemiology, and End Results database were collected and analyzed. Based on a 7:3 ratio, 1550 people were categorized into training sets and 667 people were assigned to testing sets, randomly. Based on the factors influencing LNM determined by the training sets, the nomogram was drawn and verified. Based on multivariate analysis, age at diagnosis, histology type, grade, T-stage, and size were risk factors of LNM for EGC. Besides, nomogram was drawn to predict the risk of LNM for EGC patients. Among the categorical variables, the effect of grade (well, moderate, and poor) was the most significant prognosis factor. For training sets and testing sets, respectively, area under the receiver-operating characteristic curve of nomograms were 0.751 [95% confidence interval (CI): 0.721-0.782] and 0.786 (95%CI: 0.742-0.830). In addition, the calibration curves showed that the prediction model of LNM had good consistency. Age at diagnosis, histology type, grade, T-stage, and tumor size were independent variables for LNM in EGC. Based on the above risk factors, prediction model may offer some guiding implications for the choice of subsequent therapeutic approaches for EGC.

Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis

Background: Gastric cancer is a global health problem, and the incidence and geographical distribution of different types of gastric cancer varies. Particularly, noncardiac gastric cancer is more prevalent in East Asia, Central and Eastern Europe, Latin America, and Africa. Infection with Helicobacter pylori, which was discovered in 1982, is a common cause of chronic gastritis, and the association between H. pylori infection and gastric adenocarcinoma is well established.Current Concepts: Gastric cancer is histologically divided into 2 types: intestinal and diffuse. H. pylori infection is considered as the main risk factor for the development of both types of gastric tumors. The most documented course of development of stomach cancer is following cellular metaplasia due to chronic inflammation, damage, and repair. Various molecular alterations caused by H. pylori are identified not only in gastric cancer but also in precancerous lesions. Recently, many studies have attempted to diagnose H. pylori gastritis and precancerous lesions using endoscopy.Discussion and Conclusion: Recent studies have shown that eradication therapy stabilizes or reduces the risk of developing gastric cancer. Therefore, the diagnosis and understanding of gastritis and precancerous lesions caused by H. pylori are the first step in the prevention of gastric cancer.

Prognostic Nomogram for Early Gastric Cancer After Surgery to Assist Decision-Making for Treatment With Adjuvant Chemotherapy.

Background: Most patients with early gastric cancer (EGC) can achieve a better 5-year survival rate after endoscopic resection or surgery. However, indications for adjuvant chemotherapy (ACT) after surgery have not yet been determined. Methods: A total of 4,108 patients with EGC diagnosed in 2004–2016 were retrospectively analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. Of these, 3,521 patients received postoperative ACT and 587 patients did not. Propensity score matching was used to balance the two groups’ confounding factors. Kaplan-Meier method was utilized to perform survival analysis. Log-rank test was used to compare the differences between survival curves. Cox proportional-hazards regression model was used to screen independent risk factors and build a nomogram for the non-ACT group. The X-tile software was employed to artificially divide all patients into low-, moderate-, and high-risk groups according to the overall survival score prediction based on the nomogram. A total of 493 patients with EGC diagnosed between 2010 and 2014 in our hospital were included for external validation. Results: Multivariate analysis found that age, sex, race, marital status, primary site, surgical extent, and metastatic lymph node ratio in the non-ACT group were independent prognostic factors for EGC and were included in the construction of the nomogram. The model C-index was 0.730 (95% confidence interval: 0.677–0.783). The patients were divided into three different risk groups based on the nomogram prediction score. Patients in the low-risk group did not benefit from ACT, while patients in the moderate- and high-risk groups did. External validation also demonstrated that moderate- and high-risk patients benefited from ACT. Conclusion: The study nomogram can effectively evaluate postoperative prognosis of patients with EGC. Postoperative ACT is therefore recommended for moderate- and high-risk patients, but not for low-risk patients.

A nomogram to predict risk of lymph node metastasis in early gastric cancer

Lymph node (LN) metastasis is known as one of the most important prognostic factors for early gastric cancer (EGC) patients. Patients without LNM normally have better prognosis. However, there is no evaluation criteria to accurately assess the possibility of LN metastasis. Therefore, this study aims to establish an effective nomogram for prognosis prediction. In this study, 285 EGC patients from January 2010 to December 2015 were enrolled. Pearson’s Chi-Square (χ2) test (including continuity correction when appropriate) and logistics regression analyses was used to identify the risk factors for LN metastasis. The independent risk factors identified were then incorporated in a nomogram model. The predictive accuracy and discriminative ability of the nomogram were evaluated by receiver operating characteristic curve (ROC) and calibration curve. LN metastasis occurred in 59 (20.7%) EGC patients. And most of these patients were submucosal cancers (48/59). Chi-square test indicated lymphovascular emboli, carbohydrate antigen 19-9 (CA19-9), ulcer, tumor size, tumor infiltration and histological grade were the risk factors, and multivariate logistics analyses confirmed all these six factors were independent risk factors of LN metastasis, which were selected to construct the nomogram. The nomogram proved well calibrated and had good discriminative ability (C-index value: 0.842). The proposed nomogram could result in more-accurate risk prediction for EGC patients.

ASO Visual Abstract: Lymphovascular Invasion—Traditional but Vital and Sensible Prognostic Factor in Early Gastric Cancer

ASO Visual Abstract: Lymphovascular Invasion—Traditional but Vital and Sensible Prognostic Factor in Early Gastric Cancer

Lymphovascular Invasion: Traditional but Vital and Sensible Prognostic Factor in Early Gastric Cancer.

Although patients with early gastric cancer have good prognosis, recurrence after treatment may occur. Lymphovascular invasion (LVI) in gastric cancer has long been suggested as a poor prognostic indicator. This study sought to evaluate the prognostic effect of LVI in patients with early gastric cancer. From 2005 to 2016, 6516 patients with early gastric cancer who underwent radical gastrectomy were analyzed. The patients were categorized according to LVI and lymph node (LN) status. LVI was present in 853 patients (13.1%). Patients with LVI or LN metastasis had more aggressive tumor characteristics than patients without both LVI and LN metastasis. The overall and relapse-free survival in patients with LVI were significantly worse than in patients without LVI. When we compared the survival rate of patients stratified by LVI and LN status, there was a significant overall and relapse-free survival difference between patients without both LVI and LN metastasis compared with those with LVI but without LN metastasis (p < 0.001). The overall and relapse-free survival of patients with LVI but without LN metastasis were similar to those without LVI but with LN metastasis (p = 0.818). Patients with LVI or LN metastasis showed a high frequency of recurrence (p < 0.001). Multivariate analysis showed that LVI and LN status were independent risk factors for relapse-free survival of early gastric cancer patients. Early gastric cancer with LVI is associated with poor prognosis and frequent recurrence. When predicting the prognosis of patients with early gastric cancer, LVI should be considered.

Exploration of endoscopic findings and risk factors of early gastric cancer after eradication of Helicobacter pylori

Aim To explore the endoscopic features and risk factors of early gastric cancer (EGC) after eradication of Helicobacter pylori (H. pylori). Methods A total of 1961 patients who underwent esophago-gastro-duodenoscopy (EGD) with a history of successful H. pylori eradication were enrolled in this multicenter research. Among them, 162 EGC lesions of 132 patients were detected. The endoscopic features and risk factors of post-eradication EGC were explored. Results Severe atrophy (75.3% vs. 16.7%, p value <.01), intestinal metaplasia (96.3% vs. 77.1%, p value <.01), map-like redness (89.5% vs. 65.4%, p value <.01), distinct intermediate zone (IZ) (68.5% vs. 23.4%, p value <.01) and xanthoma (58.0% vs. 17.9%, p value <.01) were significantly more frequent in the CA group (patients with newly detected EGC after eradication of H. pylori) than in the NC group (patients without gastric cancer after eradication of H. pylori). In multivariate analysis, severe atrophy (odds ratio (OR) = 8.08; 95% confidence interval (CI), 3.43–20.0; p value<.01), map-like redness (OR = 1.75; 95% CI, 0.11–5.25; p value = .04), distinct IZ (OR = 2.87; 95% CI, 1.20–6.93; p value = .02) and xanthoma (OR = 2.84; 95% CI, 1.20–7.03; p value=.02) were proved to be risk factors for detection of EGC after eradication of H. pylori. Conclusions Severe atrophy and map-like redness and distinct IZ and xanthoma are risk factors of EGC after eradication of H. pylori.

Laparoscopic gastrectomy for early gastric cancer and the risk factors of lymph node metastasis.

Objective:Lymph node metastasis (LNM) is one of the important prognostic factors of early gastric cancer (EGC). Moreover, LNM is also important when choosing therapeutic intervention for EGC patients. The purpose of this study is to explore the risk factors of LNM in EGC and to discuss the corresponding treatment.Design:We retrospectively reviewed the medical records of 253 patients with EGC who underwent surgical therapy in our department between 2012 and 2015. Univariate analysis and Multivariate Cox regression were used to evaluate the independent risk factors of LNM.Results:LNM was present in 38 cases among 253 patients (15%). Univariate analysis showed an obvious correlation between LNM and tumour location, tumour size, depth of invasion, morphological classification, gross type of the lesion and venous invasion. Multivariate analysis indicated that poorly differentiated carcinoma, submucosal cancer, tumour size ≥2 cm and venous invasion were the independent risk factors for LNM.Conclusion:Tumour size, depth of invasion, morphological classification and blood vessel invasion were predictive risk factors for LNM in EGC. We propose that EGC patients with those risk factors should be accepted gastrectomy with LN dissection.

Precision surgical approach with lymph-node dissection in early gastric cancer.

The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinic-pathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize post-gastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.

Эндоскопические и морфологические факторы прогноза течения раннего рака желудка

Эндоскопические и морфологические факторы прогноза течения раннего рака желудка

Deficiency of hMLH1 and hMSH2 expression is a poor prognostic factor in Early Gastric Cancer (EGC).

Purpose: The aim of the study was to investigate the effect of deficiency of hMLH1 and hMSH2 expression on the prognosis of early gastric cancer (EGC) in Chinese populations.Methods: A total of 160 EGC patients who underwent curative gastrectomy with lymphadenectomy from January 2011 to July 2014 at Xinhua Hospital were evaluated. The expression rates of hMLH1 and hMSH2 were examined using tissues preserved in paraffin blocks by immunohistochemical staining. The clinicopathological characteristics and prognosis of EGC with deficient hMLH1 and hMSH2 were analyzed.Results: On immunohistochemical staining, the loss expression of hMLH1 and hMSH2 were observed in 89 (55.6%) and 45 (28.1%), respectively. The hMLH1 deficiency was associated with the middle third of tumor location (P = 0.041). According to Kaplan-Meier survival analysis and Log-Rank test, the loss expression of hMLH1 and hMSH2 were associated with worse survival than positive hMLH1 (HR = 0.247, 95% CI = 0.078-0.781, P = 0.017) and hMSH2 (HR = 0.174, 95% CI = 0.051-0.601, P = 0.006) in EGC.Conclusion: The main conclusions were as follows: The hMLH1 deficiency was preferred to the middle third of EGC. Lymph node metastasis (LNM) was a prognostic factor of EGC. And the prognosis of EGC patients with deficient mismatch repair (dMMR, mainly including deficient hMLH1 and hMSH2) was obviously worse than proficient mismatch repair (pMMR).

Abstract 4930: Ki-67 serves as a prognostic marker in early gastric cancer, but not in advanced gastric cancer

Abstract Ki-67 protein is a cellular marker for proliferation. The role of Ki-67 as a prognostic factor has not been established in gastric cancer. We previously demonstrated that CD44v plays an important role in EThe present study was performed toinvestigate the significance of Ki-67 expression as a biomarker in early gastric cancer (EGC), but not advanced gastric cancer (AGC). With the study, we foundthat there is correlation between CD44v and Ki67. Here, evaluated the clinical significance with tissue microarray of gastric cancer by performing immunohistochemical staining for Ki-67. Its clinical significance was analyzed with adjustment via the propensity score-matching. The median follow-up duration was 72 months (range: 3 - 120 months). Ki-67 positive group showed worse prognosis than Ki-67-negative group in EGC (5-YSR, 78.9% vs. 92.0%, p = 0.018), but not in advanced gastric cancer (AGC) (5-YSR, 58.5% vs. 59.2%, p = 0.951). Interestingly, in the patients with well-differentiated histology, prognosis for Ki-67-positive group was considerably worse than that for Ki-67-negative group (5-YSR, 67.0% vs. 94.4%, p = 0.012), but not in those with moderately differentiated (p = 0.504) and poorly-differentiated histology (p = 0.905). In this cohort, there was a strong correlation between the proportion of EGC and well-differentiated histology (r = 0.215, p = 0.002). Multivariate analysis also revealed that the positive-Ki- 67 expression serve as a poor prognostic factor in EGC (HR 4.346, 95% CI 1.397 - 13.515, p = 0.011), but not in all the patients (p = 0.171). With bootstrap resampling, we internally validated these results (p = 0.011). In conclusion, this study suggests that Ki-67 expression may be a good biomarker for prognosis prediction for EGC, but not for AGC. [This study was supported by a grant from the National R&amp;D Program for Cancer Control, Ministry for Health, Welfare &amp; Family Affairs, Republic of Korea.(0820050).] Citation Format: Won Sup Lee, Gyung Hyuck Ko, Se-Il Go, Jeong-Hee Lee, Sang-Ho Jeong, Young-Joon Lee, Soon Chan Hong, Woo Song Ha. Ki-67 serves as a prognostic marker in early gastric cancer, but not in advanced gastric cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4930.

Early gastric cancer: diagnosis, staging, and clinical impact. Evaluation of 530 patients. New elements for an updated definition and classification

The prevention and early diagnosis of gastric cancer permit clinicians to discover the tumor in the initial phase, during which time it can be completely eradicated, endoscopically or surgically. Since Murakami gave the definition of early gastric cancer (EGC) in 1971, many authors have identified various subtypes of EGC with different morphological characteristics and clinical behaviour. We evaluated retrospectively 530 patients: the median follow-up time was 10.4 months (range 0.3-29.2). All tumors were classified according to the macroscopic and microscopic criteria proposed by the Japanese Society of Gastroenterology and Endoscopy and Lauren, respectively. The infiltrative growth pattern was evaluated according to Kodama's classification. Only tumor-related death was considered as an endpoint of interest for the survival analysis. The overall survival rates of our patients were 94 % (95 % CI, 92-96) and 90 % (95 % CI, 87-93) at 5 and 10 years, respectively. Only 44 patients (8.3 %) died of the disease. Kodama's type (p < 0.0001), lymph node status, both for number and pathological stage according to the 7th Edition of TNM (p < 0.0001), and depth of infiltration (p = 0.0006) were significant prognostic factors in univariate analysis. The multivariate analysis identified Kodama's PENA type (HR, 3.91; 95 % CI, 2.08-7.33; p < 0.0001) and lymph node status for more than three positive nodes versus negative nodes (HR, 12.78; 95 % CI, 5.37-30.43; p < 0.0001) as the only independent prognostic factors in our series. Lymph node status, especially when more than three lymph nodes are involved, is the most important prognostic factor in EGC. However, it is also important to evaluate the infiltrative growth pattern of the cancers in their early phase according to Kodama's classification, considering PEN A type lesions to be more aggressive than the other EGC types. Then, we propose new elements for an updated definition and classification of EGC, with an important clinical impact on the treatment of patients.

Outcome and Status of Microsatellite Stability in Japanese Atomic Bomb Survivors with Early Gastric Carcinoma

In the decade after the 1945 atomic bombing of Hiroshima, a high incidence of leukemia was observed among atomic bomb survivors. However, the incidence of other cancers gradually increased, while that of leukemia decreased after this period. We evaluated the clinical outcome of early gastric cancer and microsatellite stability over a long-term period in atomic bomb survivors. The results of surgical treatment for early gastric cancer were reviewed for 117 atomic bomb survivors and 394 control patients between 1995 and 2006. In addition, immunohistochemical staining for hMSH2 and hMLH1 expression was performed to evaluate the status of microsatellite stability in 57 atomic bomb survivors and 82 control patients. The long-term survival rate for early gastric cancer in atomic bomb survivors was significantly lower than that in control patients (p<0.01). Multivariable analysis revealed that age and sex were significant and independent prognostic factors for early gastric cancer. Defective hMSH2 and/or hMLH1 expression was also significantly higher in survivors than in control patients (p<0.001). Logistic regression analysis revealed that atomic bomb survivorship was related to defective hMSH2 and/or hMLH1 expression. The prognosis of early gastric cancer in atomic bomb survivors was poor and was related to age and sex, rather than to being an atomic bomb survivor. Furthermore, a higher rate of defective hMSH2 and/or hMLH1 expression was observed in the survivors.

Endoscopic submucosal dissection as a treatment for gastric adenomatous polyps: predictive factors for early gastric cancer

Objective. Endoscopic forceps biopsy (EFB) sampling of gastric adenoma may provide inadequate specimens for a correct diagnosis and lead to inappropriate follow-up strategies for adenomas or missed carcinoma foci. The aim of this study was to determine the diagnostic concordance between an EFB and resected gastric adenomatous polyps by endoscopic submucosal dissection (ESD) and to know the efficacy of ESD for the treatment of gastric adenomatous polyps. Material and methods. Between November 2008 and May 2011, 413 ESDs were carried out at Pusan National University Yangsan Hospital. After exclusion, 282 cases were enrolled. The clinicopathological features, complete resection rate, procedure time, complication rate and associated factors for early gastric cancer (EGC) prediction were analyzed. Results. The mean age was 62.13 ± 8.91 years. Submucosal dissection results showed that the discrepancy rate between endoscopic biopsy and pathology of resected specimens was 32.9% (93/282). Additionally, 71 cases (25.2%) were adenocarcinomas. Among low-grade dysplasia (LGD) from EFB, 23 cases (11.8%) were adenocarcinomas after ESD. Among high-grade dysplasia (HGD) from EFB, 48 cases (55.2%) were adenocarcinomas after ESD. EFB procedure times were longer in the HGD group than in the LGD group (24.90 vs. 29.88 min, p = 0.017). In multivariate analysis, HGD from EFB, surface redness and lesion diameter were the significant predictive factors for EGC. Conclusions. Gastric adenomatous polyps should be removed by endoscopic resection regardless of histopathological type. ESD is a useful method for complete resection of gastric adenomas, regardless of size and location.

Tu1691 Endoscopic Submucosal Dissection as a Treatment for Gastric Adenomatous Polyps: Predictive Factors for Early Gastric Cancer

Gastric adenomatous polyps are true neoplasm with cancerous transformation potential. Endoscopic forceps biopsy (EFB) sampling may provide inadequate specimens for a correct diagnosis and lead an inappropriate follow-up strategy for an adenoma or missed foci of carcinoma. The aim of this prospective study was to know the diagnostic concordance between an EFB and resected tissues of gastric adenomatous polyps by endoscopic submucosal dissection (ESD) technique and to know the efficacy of ESD for the treatment of gastric adenomatous polyp.

Expression of stromal cell-derived factor-1α is an independent risk factor for lymph node metastasis in early gastric cancer

Lymph node metastasis is considered to be a significant prognostic factor for early gastric cancer (EGC). However, no real consensus exists on which patient and/or tumor characteristics are associated with lymph node metastasis. We investigated whether stromal cell-derived factor (SDF)-1α expression correlates with lymph node metastasis in patients with EGC by immunohistochemically examining the expression of SDF-1α in 138 archival tissue specimens of EGC. Of these specimens, 59 (42.8%) and 79 (57.2%) were grouped into SDF-1α-positive and SDF-1α-negative groups, respectively. No significant differences existed with respect to age, gender, tumor location, proportion of tumors >20 mm in size, macroscopic type, depth of invasion or histology between the SDF-1α-positive and -negative groups. However, the SDF-1α-positive group was significantly correlated with lymphovascular invasion and lymph node metastasis. Results of the univariate analyses indicated that lymphovascular invasion, undifferentiated histology and SDF-1α positivity were statistically significant risk factors affecting lymph node metastasis in patients with EGC. Multivariate analyses showed that lymphovascular invasion [hazard ratio (HR), 8.595; 95% confidence interval (CI), 1.694-43.595; P=0.009], undifferentiated histology (HR, 2.965; 95% CI, 1.037-8.471; P=0.043) and SDF-1α positivity (HR, 2.108; 95% CI, 1.316-10.135; P=0.013) were independent risk factors predicting lymph node metastasis in EGC. In conclusion, these results suggest that SDF-1α expression in tumor cells is a predictive marker of lymph node metastasis in EGC.

Long-term survival results and prognostic factors of early gastric cancer.

In spite of the favorable prognosis of early gastric cancer (EGC), recurrence or second primary cancers present in certain patients after curative surgery. It is crucial to identify who are at high risk and when. In the present study, 323 patients with EGC who underwent curative surgery were studied. A total of 22 patients (6.8%) died of recurrence, 9 patients (2.8%) died of a second primary cancer and 65 patients (20.1%) died of comorbid diseases during the 0.3-33 years of follow-up. Among the 22 patients with recurrence, hematogenous metastases were noted in over half of the cases (77.3%, 17/22); of these cases 15 patients had a recurrence within the first decade after surgery. Histological differentiation and nodal status were correlated with recurrence. Among the second primary cancers, remnant gastric, liver, lung and colon were the most common sites, and the second primary cancers primarily occurred in the second decade after surgery (6/9). Multivariate analysis identified nodal status (HR=4.20), vessel involvement (HR=3.40) and histological differentiation (HR=3.52) as independent prognostic factors for disease-free survival. However, gender, age and differentiation were independent influencing factors for overall survival. Comorbid diseases, recurrence and second primary cancers are the main cause of death in EGC patients after curative resection. Thus, treatment of comorbid diseases and a periodic follow-up schedule may contribute to improved prognosis.

The clinical pathology characteristic of 42 example early time stomach cancer

Objective To observe early gastric endoscopy, clinical and pathological features of the pathological diagnosis. Methods 42 cases of early gastric cancer of clinical, endoscopic and pathological features was observed, C-erbB2, P53, Ki-67 expression were detected by immunohistochemical sp method. Results The results of early gastric cancer had no specific, mainly abdominal pain and bloating discomfort, some weight loss loss of appetite, vomiting blood in the stool, etc. , endoscopy showed erosive flat major, 23 cases (54. 8% )protruded in 17 cases (40. 5% ), lesions up to 29 cases of gastric area, gastric angle in 5 cases, 6 cases of gastric body and gastric cardia in 2 patients. Organization type: tubular adenocarcinoma, 24 cases,2 cases of mucinous adenocarcinoma, signet ring cell carcinoma in 7 cases, 9 cases of poorly differentiated adenocarcinoma, 15 cases associated with intestinal metaplasia, dysplasia in 14 cases. Mucosal carcinoma in 26 patients, submucosa in 16 cases, 6 cases with lymph node metastasis. C-erbB-2 expression accounted for 16. 7%(7/42) , Ki-67 expression accounted for 38. 1% (16/42), P53 expression accounted for 30. 9% (13/42).Conclusion The clinical manifestations of early gastric cancer is hidden, non-specific, not enough to cause attention to patients and clinicians. High risk of gastric cancer patients with gastroscopy active on a regular basis to improve the detection rate of early gastric cancer is the key to the early diagnosis of gastric cancer. C-erbB-2 expression is related to lymph node metastasis. Factors of early gastric cancer is a multi-step interaction of multiple genes and more complex process. Key words: Clinical pathology; Early the stomach cancer; Gastrosscope; Immunohistochemical