DUKES A-TUMOR - NEW CRITERIA FOR EARLY GASTRIC-CANCER

Dukes' classification for colorectal cancer is easy to remember and ac curate in estimating survival. The Japanese definition of early gastri c cancer have some problems, since it includes node-positive cases sho wing a worse prognosis. The aim of this study was to clarify whether o r not Dukes' A tumor can be used as new criteria for early gastric can cer. Using 217 patients who underwent radical gastrectomy and lymph no de dissection for primary gastric adenocarcinoma, long-term results an d cumulative survival rates after operation were examined. Patients co nsisted of three groups: Group 1, 20 patients with node-negative tumor invading down to the muscularis propria, Group 2, 175 patients with n ode-negative tumor limited to the mucosa or submucosa, and Group 3, 22 patients with node-positive tumor limited to the mucosa or submucosa. The 10-year survival rates for Group 1, Group 2, and Group 3 patients were 94.7%, 96.9%, and 85.1%, respectively. The survival rate of Grou p 3 patients was significantly lower than that of Group 1 and Group 2 patients (p<0.05). The prognosis of patients with Dukes' A tumor (Grou p 1 plus Group 2) was excellent, showing 10-year survival rate of 96.6 %. Mucosal or submucosal cancer brought a poor prognosis when there wa s lymph node metastasis. Early gastric cancer would better be defined as a Dukes' A tumor which includes node-negative tumor not beyond the muscularis propria.