Clinicopathological Analysis of Superficial Spreading and Small-sized Types of Early Gastric Cancer

ABSTRACT

PURPOSE: The superficial spreading type of early gastric cancer has different clinicopathologic features from other types of early gastric cancers in terms of its invasiveness and lymph node metastases. Therefore, the clinicopathological features of the superficial spreading type and the small-sized early gastric cancers, were analyzed, and the influence of those features on the surgical procedures and prognosis was investigated. METHODS: During an 8-year period (1992~1999), 22 superficial spreading early gastric cancers were analyzed with respect to the macroscopic type, lymph node metas tasis, and the surgical procedure, and compared with those of 219 small-sized early gastric cancers. The superficial spreading type was defined as a lesion more than 5 5 cm and small-sized type, as a lesion less than 2 2 cm. The survival rate was analyzed using the Kaplan-Meier method and those patients who died of diseases unrelated to gastric cancer were excluded. Other statistical analyses were performed using the chi-square test. RESULTS: Twenty two out of 369 (6%) early gastric cancers were the superficial spreading type. The incidence of a LN metastasis was 12.3% in early gastric cancer, 8.7% in the small-sized type, and 27.3% in the superficial spreading type. The incidence of a LN metastasis was greater in the superficial spreading type than in the small-sized type (P=0.006). The location of the lesions, the histological type, and the depth of the invasion in the superficial spreading and small-sized early gastric cancers were similar There was difference in the method of surgery and the extent of the lymph node dissection between two groups. CONCLUSION: Because the incidence of a lymph node meta stasis is higher in the superficial spreading type than in the small-sized early gastric cancer, a wide resection with an extensive lymph node dissection appears to be appropriate treatment for the superficial spreading type of early gastric cancer.