EARLY GASTRIC-CARCINOMA WITH FOCAL ADVANCED CANCER - A PARTICULAR SUBTYPE OF GASTRIC-CARCINOMA

Early gastric cancer (EGC) is defined as a carcinoma limited to the mu cosa or mucosa and submucosa, irrespective of whether metastasis to ly mph nodes has occurred. EGC presents a much more favorable prognosis t han advanced gastric carcinoma (AGC), with a 5-year survival rate betw een 88% and 96% for EGC versus 45% to 50% for AGC. Moreover, some gast ric cancers appear as a more or less extended EGC with focal AGC (fAGC ). The purpose of this study was to analyze prognostic factors in this intermediate group of tumors. From 1981 to 1992, among the 615 gastre ctomy specimens with carcinoma examined at the Institute of Pathology of the University of Lausanne, only 19 tumors corresponded to the crit eria of EGC with fAGC. Clinicopathologic features were studied, and a cytophotometric DNA analysis was performed. Our results show a 5-year survival rate for EGC with fAGC of 61% (11 of 18 patients alive), inte rmediate between that of EGC and AGC. No significant correlations were found between the most known predictive factors and prognosis. Most t umors analyzed (16 of 19) showed a diploid DNA content in the superfic ial as well as in the invasive areas. Contrary to the findings in the literature, which show a high-ploidy DNA pattern in most AGC, our case s show low-ploidy DNA even in the invasive portion of the tumors. In c onclusion, we show that EGC with focal AGC represents a gastric cancer with an intermediate prognosis and, therefore, must be considered as a specific subtype of gastric carcinoma. Copyright (C) 1998 by W.B. Sa unders Company.