Clinicopathological Analysis of a Superficial Spreading Type of Early Gastric Cancer

Yu, Myoung; Kim, Byung sik; Oh, Sung tae; Yook, Jeung hwan; Lee, Chang hwan

Abstract

PUPOSE: The superficial spreading type of early gastric cancer has different clinicopathologic features from other types of early gastric cancer in terms of its invasiveness and lymph-node metastases. Therefore, we attempted to elucidate the pathological features, surgical procedures and patients prognoses.
MATERIALS AND METHODS
Clinical information was reviewed for patients who had undergone a gastrectomy for gastric cancer during an 8-year period (1995~2002) at Dankook University Hospital and Ulsan University, with an average follow-up of 48 months. Three hundred (300) superficial spreading lesions were analyzed with respect to macroscopic type, lymph-node (LN) metastasis, recurrent pattern, survival rate and method of surgical operation. In addition, the clinicopathological features of the superficial spreading type were compared with those of 739 other patients with small-sized cancer.
RESULTS
In both groups, the IIc-type macroscopic lesion, the elevated subtype to be more specific, occurred most frequently. There was no significant difference in the method of surgery between the groups. The submucosal invasion was 39.8% in small-sized cancer, and 61.7% in superficial spreading cancer (P=0.005). The incidence of LN metastasis was 11.3% in early gastric cancer, 7.8% in small-sized cancer and 20.0% in superficial spreading cancer (P=0.005). The incidence of lymphatic invasion was 4.6% in small-sized cancer and 13.0% in superficial spreading cancer (P=0.009). The incidence of recurrence was 1.4% in small-sized cancer and 3.6% in superficial spreading cancer. The overall 5-year survival rate was 84.8% in superficial spreading cancer and 93.0% in small-sized cancer (P=0.052). The 5-year disease- free survival rate was 94.7% in superficial spreading cancer and 87.5% in small-sized cancer (P=0.053).
CONCLUSION
The superficial spreading type of early gastric cancer tends to be more invasive and to show a higher incidence of lymph-node metastasis than small-sized early gastric cancer. A wide resection with extensive lymph-node dissection seems to be an appropriate treatment for a superficial spreading type of early gastric cancer.