Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12851-12856
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12851
Clinicopathological characteristics of clinical early gastric cancer in the upper-third stomach
Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji
Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Author contributions: Ichikawa D designed this research; Ichikawa D, Komatsu S, Kosuga T, Konishi H, Okamoto K, Shiozaki A, Fujiwara H and Otsuji E performed this research; Ichikawa D wrote the manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daisuke Ichikawa, MD, PhD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 6028566, Japan. ichikawa@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: March 18, 2015
Peer-review started: March 19, 2015
First decision: April 23, 2015
Revised: May 16, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: December 7, 2015
Abstract

AIM: To elucidate the clinicopathological characteristics of clinically early gastric cancer in the upper-third stomach and to clarify treatment precautions.

METHODS: A total of 683 patients with clinical early gastric cancer were enrolled in this retrospective study, 128 of whom had gastric cancer in the upper-third stomach (U group). All patients underwent a double contrast barium examination, endoscopy, and computed tomography (CT), and were diagnosed preoperatively based on the findings obtained. The clinicopathological features of these patients were compared with those of patients with gastric cancer in the middle- and lower-third stomach (ML group). We also compared clinicopathological factors between accurate-diagnosis and under-diagnosis groups in order to identify factors affecting the accuracy of a preoperative diagnosis of tumor depth.

RESULTS: Patients in the U group were older (P = 0.029), had a higher ratio of males to females (P = 0.015), and had more histologically differentiated tumors (P = 0.007) than patients in the ML group. A clinical under-diagnosis occurred in 57 out of 683 patients (8.3%), and was more frequent in the U group than in the ML group (16.4% vs 6.3%, P < 0.0001). Therefore, the rates of lymph node metastasis and lymphatic invasion were slightly higher in the U group than in the ML group (P = 0.071 and 0.082, respectively). An under-diagnosis was more frequent in histologically undifferentiated tumors (P = 0.094) and in those larger than 4 cm (P = 0.024). The median follow-up period after surgery was 56 mo (range, 1-186 mo). Overall, survival and disease-specific survival rates were significantly lower in the U group than in the ML group (P = 0.016 and 0.020, respectively). However, limited operation-related cancer recurrence was not detected in the U group in the present study.

CONCLUSION: Clinical early gastric cancer in the upper-third stomach has distinguishable characteristics that increase the risk of a clinical under-diagnosis, especially in patients with larger or undifferentiated tumors.

Keywords: Upper-third stomach, Diagnosis, Gastric cancer

Core tip: The clinicopathological features of patients with gastric cancer in the upper-third stomach (U group) were compared with those of patients with gastric cancer in the middle- and lower-third stomach (ML group). The rate of clinical under-diagnoses was significantly higher in the U group than in the ML group and more frequent in histologically undifferentiated tumors and in those larger than 4 cm.