Recurrence Of Early Gastric Cancer Research Articles

Predictive factors for metachronous recurrence of early gastric cancer after endoscopic treatment.

Since endoscopic treatment has been evaluated and become established as treatment for early gastric cancer, metachronous recurrence has become a major problem. In this report, predictive factors for recurrence were studied using the Kaplan-Meier method and Cox's proportional hazards regression model in 76 patients who received endoscopic treatment. There were 48 men and 28 women age 69.6 +/- 8.3 years (mean +/- standard deviation), 5 of whom had synchronous multiple lesions and 71 who had a single lesion found during the initial endoscopic treatment. In all patients, periodic follow-ups were performed by endoscopy for more than 2 years after treatment. Helicobacter pylori infection was assessed in 55 of the 76 patients, and proved positive in 43 and negative in 12. Metachronous recurrence was detected significantly more frequently in patients whose synchronous multiple lesions were found during the initial treatment. In addition, age affected the recurrence positively. However, gender and H. pylori infection had no significant relationship with metachronous recurrence.

Clinicopathological features of early gastric cancer: results of 100 cases from a rural general hospital.

To evaluate 100 patients with early gastric cancer from the point of view of early detection, clinicopathological variables, and long term results. Retrospective study. Rural general hospital, Japan. 100 patients with early gastric cancer (confined to the epithelium, lamina propria, or submucosa) out of a total of 197 who had gastric cancers resected for cure between May 1986 and April 1996. Subtotal gastrectomy (n = 87), total gastrectomy (n = 8), proximal gastrectomy (n = 2), and local wedge resection (n = 3). Histopathological features and outcome. The mean annual incidence of early gastric cancer was 51% (range 35%-70%). 16/59 patients with mucosal cancer (37%) and 18/41 with submucosal cancer (44%) presented with symptoms of the disease. The diagnosis was made in 62 by endoscopy, and in only 2 by upper gastrointestinal radiographic examination. None of the 59 with mucosal cancer had lymphatic invasion, and only 1 had a lymph node metastasis. Among the 41 with submucosal cancer, however, 15 had lymphatic invasion (37%), 13 had venous invasion (32%), and 2 had lymph node metastases (5%). 83 patients were alive with no sign of recurrence at the time of writing (median follow up 62 months, range 12-136). One patient with a tumour that produced alpha-fetoprotein died of hepatic metastases 23 months after subtotal gastrectomy. 9 patients developed second cancers, and 6 died of these with no signs of recurrence of early gastric cancer. The overall 5 and 10 year survival rates were 82% and 66%, and the corresponding disease-specific survival rates for 85 patients were both 98%. Excellent long term results can be achieved in the treatment of early gastric cancer, even in a non-specialist centre. Patients with early gastric cancer should have their alpha-fetoprotein concentration measured, and be examined for the presence of other malignant disease both before and after treatment of the gastric cancer.

Impact of lymph node metastasis on survival with early gastric cancer.

The impact of lymph node metastasis on the survival of early gastric cancer (EGC) cases remains controversial. A retrospective study of 621 patients with EGC undergoing gastrectomy with lymphadenectomy during the period 1966-1993 was performed to evaluate the influence of node involvement on long-term outcomes. Lymph node metastasis was observed in 63 cases (10.1%). Two groups, EGC with and without node involvement, were compared with respect to long-term results and various clinicopathologic factors. The median observation period was 123 months. EGC cases without metastatic nodes had significantly better outcomes than those with node involvement in terms of overall survival as well as survival excluding deaths due to diseases unrelated to the primary EGC. Survival rates for EGC patients with node involvement did not, however, differ significantly according to the number of metastatic nodes. Three factors-submucosal invasion, large tumor size, and recurrence-were significantly related to lymph node metastasis. Age, sex, family history of malignancy, histologic type, and multiple occurrence of gastric cancer were unrelated to the prevalence of node involvement. The frequency of recurrence in EGC cases without node involvement was low (1.8%, 10 of 558). Recurrence was not, however, exceptional in those with metastatic nodes (9.5%, 6 of 63). EGC patients with lymph node metastasis, even with only a single positive node, constitute a high risk group for EGC recurrence.

Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature.

The outcome of surgical treatment for early gastric cancer (EGC) generally is considered to be satisfactory. Although a small percentage of patients experience disease recurrence, the absolute number of such instances is too small for assessment of risk factors. The authors investigated the follow-up records of 1475 patients with EGC treated at the National Cancer Center, Tokyo, with special reference to cancer recurrence. In addition, 20 Japanese reports on this subject were reviewed. Excluding operative deaths and patients with noncurative operations, 20 (1.4%) patients died of recurrent disease. The death rate associated with other causes (6.6%), including other malignant diseases, surpassed that associated with disease recurrence. Late recurrence (after 5 years) was seen in seven patients. By combining the data of patients reported in 20 articles in the literature, the authors estimated a recurrence rate for EGC of at least 1.9%, exclusive of cancers arising in the gastric stump. The incidence of recurrence was significantly higher in submucosal (3.6%), node-positive (10.7%), and histologically differentiated carcinomas (2.3%) than in mucosal, node-negative, and undifferentiated groups, respectively. Analysis of 123 instances of recurrent disease, the details of which had been reported, revealed that hematogenous metastasis was the most common mode of recurrence. The mean survival period of patients with recurrent disease was 40 months, and 23% of patients died more than 5 years after surgery. It is rare for EGC to recur, even in patients with tumors with a comparatively high risk of recurrence. Long-term follow-up of patients with positive nodes for hematogenous spread might facilitate early detection of disease recurrence.

Clinicopathologic evaluation of recurrence in early gastric cancer.

Five hundred ninety-two patients with early gastric cancer underwent surgical resection from 1970 to 1986 in our hospital, and 13 died from a recurrence of their disease. A careful analysis of these 13 patients suggests that carcinomas which invaded to the submucosa tend to recur more often than those confined to the mucosa. Well differentiated and papillary adenocarcinomas characterized by protruded or elevated lesions tend to recur earlier than poorly differentiated or signet-ring cell carcinomas characterized by depressed or excavated lesions. However, both types recurred from hematogenous metastases, with the liver being the most common site. Therefore, the macroscopic and histological features presently used to characterize early gastric cancer do not provide sufficient information to accurately predict which patients are at most risk for recurrence.

Recurrence of early gastric cancer

We investigated the postoperative deaths and recurrence among 673 patients with early gastric cancer who had undergone gastric resection at the National Kyushu Cancer Center Hospital from March 1972 to December 1988. The mode and time of recurrence were assessed with reference to the clinicopathological findings at initial surgery. Fifteen patients (2.2%) died of cancer recurrence, and 18 patients (2.7%) developed recurrence (3 patients are currently alive after reoperation). A comparison of modes of recurrence revealed that the incidence of hematogenous recurrence was the highest with nine cases, followed by recurrence in the remnant stomach in three cases and by local, lymph node, and peritoneal recurrences in two cases each. Twelve patients developed recurrence within 5 years after operation (early recurrence) and six patients after 5 years (late recurrence). Cases positive for cancer cell invasion into intralesional veins at initial surgery had a significantly higher recurrence rate than negative cases (P less than 0.001). Thus, venous invasion was the most important factor for the development of recurrence in the patients with early gastric cancer.

Recurrence of early gastric cancer

We have reviewed 1,585 cases of early of gastric cancer to investigate recurrent cases following a curative resection. Sixteen of these patients experienced a recurrence: 14 highly - graded and 2 low - graded differentiated adenocarcinomas. Of the recurrences observed 14 were submucosal (87.5%) and 2 were mucosal (12.5%) cancers. According to the macroscopic appearance of the primary lesions, 12 primaries were composed of some elevated component. In particular, the mixed type, elevated and depressed, was significantly frequent in lymph node metastases and microvessel invasions (p< 0.02 – 0.001). In conclusion highly - graded adenocarcinomas of the stomach invading a submucosal layer with its surface being elevated and depressed has a high potential of recurrence.

早期胃癌の術後再発症例の検討

早期胃癌の術後再発症例の検討

Lymph and blood capillaries of the human gastric mucosa: A morphologic basis for metastasis in early gastric carcinoma

The distribution of lymph and blood capillaries has been studied by light and transmission electron microscopy in 16 endoscopic and surgical specimens of human gastric mucosa and submucosa. Four specimens were completely normal, seven showed mild gastritis, and five showed severe gastritis. On light microscopy, no definite distinction could be made between small mucosal lymph and blood capillaries. The distinction was achieved only by transmission electron microscopy where lymph capillaries could be identified by the presence of anchoring filaments and the demonstration of open gaps and overlapping endothelial cell processes, as well as by the absence of a basement membrane and “fenestrations” typical of the endothelial cells of blood capillaries. Although large lymph vessels were observed in the submucosa, lymph capillaries were found only in the deep lamina propria adjacent to and within the muscularis mucosae. The upper and middle levels of the lamina propria of the gastric mucosa contained no lymph capillaries. The entire mucosa showed a rich supply of blood capillaries, many of which were adjacent to the basal lamina of gastric glands and the surface epithelium. These morphologic findings correlate with clinicopathologic observations on early gastric cancer. The particularly low incidence of lymph node metastases in the subtype of early gastric cancer that remains confined to the mucosa may be explained by the rarity of lymph capillaries in the mucosa. The high percentage of blood-borne metastases in recurrent early gastric cancer may be related to the rich vascularity of gastric mucosa.

Recurrence in early gastric cancer: a pathologic evaluation.

The cause of death in 26 of 220 cases of early gastric carcinoma was studied, particularly in relation to the mode of recurrence. Of the 26, 7 patients died of disease related causes and gross appearance revealed that 4 cases were IIa predominant, 2 were IIc (or +I), and 1 was IIc predominant. Histologic examination indicated that all 7 cases were differentiated-type adenocarcinomas. Two of 7 recurring carcinomas were due to residual carcinoma in the resected stumps and 5 patients had hematogenous metastases, particularly in the liver. Eighteen of the 26 patients died of other causes, in 1 case of unknown causes, and it is interesting that in 5 of the 18 cases, simultaneous or nonsimultaneous double carcinomas at sites other than the stomach were noted. In order to prevent recurrence in early gastric carcinoma, it is important that no carcinoma be left in the resected stump or remnant, and that the prophylaxis be achieved through the administration of adequate amounts of anticancer chemotherapy, in order to prevent hematogenous metastasis, particularly to the liver.