Gastric cancer is a major malignant disease. The development of new diagnos
tic techniques and mass screening have led to increased detection rates of
patients with early-stage gastric cancer in Japan. However, after curative
resection of early gastric cancer, there are various types of recurrences,
and residual occult disease and distant micrometastasis precede death. The
growth and metastatic potential of cancer cells are closely related to the
postoperative outcome, and patients at risk for cancer-related death after
surgery have to be closely monitored to prevent tumor recurrence. The biolo
gical behavior of cancer cells should be determined in patients with early
gastric cancer and with a less favorable prognosis to detect potential earl
y recurrences in the liver. Two types of growth patterns have been found in
early gastric cancer: the superficially spreading (Super) type and the pen
etrating (Pen) type, and the clinicopathological and biological characteris
tics of each type have been extensively determined. A subtype of the Pen-ty
pe gastric cancer, which is progressing expansively with complete destructi
on of the muscularis mucosae (Pen A type) has a less favorable prognosis du
e to early recurrences in the liver. These clinical cancer types are closel
y related to chromosomal instability in DNA aneuploidy and p53 overexpressi
on, and vascular endothelial growth factor activation induced tumor angioge
nesis, vascular invasion and hematogenous metastasis. Thus, patients with P
en-A-type cancer showing expansive tumor growth had a poorer postoperative
outcome and a hematogenous-related recurrence of the cancer. Antiangiogenic
approaches in a postoperative setting may prove to be effective in prevent
ing tumor recurrence and improving the prognosis for these patients. Copyri
ght (C) 2001 S. Karger AG, Basel.