Clinicopathological Features and Outcome of Surgical Treatment of 149 Patients with Early (pT1) Gastric Cancer

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Abstract
Controversy exists concerning the definition of, treatment approach to, prognostic factors of and survival data on early gastric cancer. 149 patients who underwent curative gastrectomy for carcinoma between 1972 and 2002 and were classified as having early gastric cancer (T1Nany) were included into a retrospective study. Patients were followed for a median of 5.5 years. We observed an increase in the incidence of early gastric cancer from 7.7% in the 1970s to 22.2% in the 1990s. None of the patients with mucosal tumors had lymph node metastases while 18 (20%) submucosal tumors were node positive. Multivariate analysis of all patients identified depth of tumor infiltration as the only independent risk factor for lymph node metastases. The analysis has shown that none of the clinicopathological features are reliable predictors of nodal status in patients with submucosal invasion. Patients with early gastric cancer had a very good prognosis, 10-year disease-specific survival was 80% or more in all subgroups of patients except for node-positive tumors. Depth of the tumor invasion, lymph node status as well as sex were found to be independent prognostic factors for overall survival. Early gastric cancer has a very good prognosis after standard surgery. Our data support the use of conservative limited surgical procedures for appropriate patients with mucosal gastric cancer. Patients with submucosal lesions require the same treatment approach as those with more advanced gastric cancer unless clinical usefulness of sentinel lymph node biopsy will be established.