CLINICOPATHOLOGICAL CHARACTERISTICS OF STAGE-1 GASTRIC-CANCER - COMPARISON OF MACROSCOPIC AND MICROSCOPIC FINDINGS

Background/Aims: Laparoscopic surgery or endoscopic mucosal resection for early stages of gastric cancer have been introduced recently in ma ny regions. In such cases, a precise diagnosis is needed prior to trea tment, since understaging of gastric cancer may lead to treatment fail ure and impairment of curability and prognosis. The clinicopathologica l features of understaged cases in macroscopic Stage 1 gastric cancer have not been clarified yet. Material and Methods: We examined 435 pat ients with intra-operative findings of macroscopic Stage 1 gastric can cer and compared clinicopathological features of 354 patients (Group A ) with both macroscopic and histological stage 1 cancer and 81 patient s (Group B) with macroscopic Stage 1 but histologically proven to be m ore advanced cancer. Results: Among 435 patients with macroscopic Stag e 1, there were 81 (18.6%) with histologically more advanced stages (4 4 of stage 2, 34 of stage 3, and 3 of stage 4). There were no statisti cal differences in age, set, operative procedure, and extend of lymph node dissection. between the groups. Carcinomas in the 81 Group B pati ents tended to have larger tumors (> 4 cm), Located in the middle thir d and along the lesser curvature of the stomach, appeared to be Borrma nn V type (unclassified type) and were histologically more often assoc iated with undifferentiated type, INF-gamma, lymphovascular invasion, lymph node metastasis, and invasion into a layer deeper than submucosa , all of which resulted in significantly poorer prognosis. Conclusions : Pre-operative and intra-operative assessment of the stage for gastri c cancer was not always accurate enough and about one fifth cases with macroscopic Stage 1 gastric cancer were understaged. Thus, we recomme nd gastrectomy plus radical lymphadenectomy (at least D2) for the trea tment of choice, from the points of view of curability and prognosis w hen gastric carcinoma is associated with the above mentioned character istics.