← Back to Search
Upgrading The Definition Of Early Gastric Cancer: Better Staging Means More Appropriate Treatment
Published 2015 · Medicine
Save to my Library
Download PDFAnalyze on Scholarcy
Since Murakami defined early gastric cancer (EGC) as a “carcinoma limited to the gastric mucosa and/or submucosa regardless of the lymph node status”, several authors have focused on the most influential histopathological parameters for predicting the development of lymph node metastases by considering the lymph node status as an important prognostic factor. A few authors have also considered the depth of invasion as one of the keys to explaining the existence of subgroups of patients affected by EGC with poor prognoses. In any case, EGC is still considered an initial phase of tumor progression with good prognosis. The introduction of modern endoscopic devices has allowed a precise diagnosis of early lesions, which can lead to improved definitions of tumors that can be radically treated with endoscopic mucosal resection or endoscopic submucosal dissection (ESD). Given the widespread use of these techniques, the Japanese Gastric Cancer Association (JGCA) identified in 2011 the standard criteria that should exclude the presence of lymph node metastases. At that time, EGCs with nodal involvement should have been asserted as no longer fitting the definition of an early tumor. Some authors have also demonstrated that the morphological growth pattern of a tumor, according to Kodama’s classification, is one of the most important prognostic factors, thereby suggesting the need to report it in histopathological drafts. Notwithstanding the acquired knowledge regarding the clinical behavior of EGC, Murakami’s definition is still being used. This definition needs to be upgraded according to the modern staging of the disease so that the appropriate treatment would be selected.
This paper references
Application of minimally invasive treatment for early gastric cancer
W. Hyung (2004)
Cite this article as: Saragoni L. Upgrading the definition of early gastric cancer: better staging means more appropriate treatment
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
J. Ferlay (2010)
Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer
Y. Seto (2001)
Long-term results of operation for carcinoma of the 359 Cancer Biol Med Vol 12, No 4 December 2015 stomach in T1/T2 stages: critical evaluation of the concept of early carcinoma of the stomach
S Abe (1995)
Analysis of lymph node metastasis in early gastric cancer: Rationale of limited surgery
K. Kitamura (1997)
Pathology and genetics of tumours of the digestive system
S. Hamilton (2000)
Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis.
S. Tsujitani (1999)
Long-term results of operation for carcinoma of the stomach in T1/T2 stages: critical evaluation of the concept of early carcinoma of the stomach.
D. Roukos (1997)
Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer
Hyo-Joon Yang (2014)
Predictive Factors of Lymph Node Metastasis in Patients With Undifferentiated Early Gastric Cancers
J. Nasu (2006)
Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology and their impact on the surgical strategy: analysis of single institutional experience.
Z. Wang (2014)
Increasing incidence and excellent survival of patients with early gastric cancer: experience in a United States medical center.
P. Green (1988)
Polish Gastric Cancer Study Group. Long-term results of surgery for early gastric cancer
T Popiela (2002)
. Follow - up of 1475 patients and review of the Japanese literature
PH Green (1993)
Pathomorphological diagnosis, definition and gross classification of early gastric cancer
T. Murakami (1971)
Predictive Factors for Lymph Node Metastasis in Early Gastric Cancer With Submucosal Invasion: Analysis of a Single Institutional Experience
J. An (2007)
Problems in the definition and treatment of early gastric cancer
K. Inoue (1991)
Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection.
R. Takenaka (2008)
Characteristics of submucosal gastric carcinoma with lymph node metastatic disease
H. Son (2005)
Early Gastric Cancer: Lymph Node Metastasis Starts With Deep Mucosal Infiltration
A. Hoelscher (2009)
The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.
H. Inoue (2003)
Risk Factors for Lymph Node Metastasis in Undifferentiated Early Gastric Cancer
Chen Li (2007)
Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma.
D. Y. Kim (2004)
Predictive factors for lymph node metastasis and endoscopic treatment strategies for undifferentiated early gastric cancer
B. D. Ye (2008)
Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
R. Glynne-Jones (2014)
Clinicopathological variables associated with lymph node metastasis in submucosal invasive gastric cancer
S. Ohashi (2007)
Review article: the epidemiology and prevention of gastric cancer
K. Fock (2014)
[Early cancer of the stomach].
A. E. Cambessedes (1952)
Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC).
S. Folli (2001)
Risk of lymph node metastases from early gastric cancer in relation to depth of invasion: experience in a single institution.
Z. Wang (2014)
Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers
T. Gotoda (2000)
Prediction of lymph node metastasis in patients with submucosa-invading early gastric cancer.
A. Shida (2014)
Endoscopic mucosal resection for treatment of early gastric cancer
H. Ono (2001)
Predictable Factors for Lymph Node Metastasis in Early Gastric Cancer—Analysis of Single Institutional Experience
M. S. Lim (2011)
Recurrence of early gastric
T Sano (1995)
Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial
Y. Bang (2012)
Early gastric cancer: diagnosis, staging, and clinical impact. Evaluation of 530 patients. New elements for an updated definition and classification
L. Saragoni (2013)
The Vienna classification of gastrointestinal epithelial neoplasia
R. Schlemper (2000)
Detection of an increased incidence of early gastric cancer in patients with intestinal metaplasia type III who are closely followed up.
T. Rokkas (1991)
Japanese classification of gastric carcinoma: 3rd English edition
Japanese Gastric Cancer Association (2011)
Lymph node metastasis in early gastric cancer with submucosal invasion: feasibility of minimally invasive surgery.
Do-Joong Park (2004)
Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial.
J. Lee (2012)
Japanese classification of gastric carcinoma
Prevalence and Topography of Lymph Node Metastases in Early Esophageal and Gastric Cancer
R. Gertler (2014)
: relationship between histological type , depth of wall invasion , and lymph node metastasis
R Takenaka (2007)
Number of lymph node metastases and its prognostic significance in early gastric cancer: A multicenter italian study
F. Roviello (2006)
Radical lymphadenctomy in the management of early gastric cancer
T. Sano (1996)
Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine.
S. Sakuramoto (2007)
Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract.
R. Soetikno (2005)
Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer.
M. Sasako (2011)
Gastric cáncer: Overview
M. Piazuelo (2013)
The role of growth patterns, according to Kodama's classification, and lymph node status, as important prognostic factors in early gastric cancer: analysis of 412 cases
L. Saragoni (2000)
Lymph node metastasis and preoperative diagnosis of depth of invasion in early
Y Seto (2001)
Clinicopathological features associated with lymph node metastasis in early gastric cancer: analysis of a single-institution experience in China.
L. Shen (2009)
Growth patterns and prognosis in early gastric carcinoma. Superficially spreading and penetrating growth types.
Y. Kodama (1983)
Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach.
Y. Park (2008)
Long‐term results of surgery for early gastric cancer
T. Popiela (2002)
Lymph node metastases of gastric cancer. General pattern in 1931 patients.
K. Maruyama (1989)
Gastric ESD: current status and future directions of devices and training.
T. Gotoda (2014)
Endoscopic resection of early gastric cancer: the Japanese perspective
T. Gotoda (2006)
Clinicopathological study of lymph‐node metastasis in 1389 patients with early gastric cancer: Assessment of indications for endoscopic resection
H. Haruta (2008)
Early stomach 360 Luca Saragoni. Up-grading the definition of early gastric cancer carcinoma--pathologic-anatomic findings and prognosis
N Bösing (1998)
Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type, depth of wall invasion, and lymph node metastasis
S. Ishikawa (2006)
Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection.
S. R. Smalley (2012)
Involvement of three or more lymph nodes predicts poor prognosis in submucosal gastric carcinoma
S. Shimada (2001)
Lymph node metastasis from early gastric cancer: endoscopic resection of tumour
T. Sano (1992)
Upgrading the definition of early gastric cancer: better staging means more appropriate treatment
Lymph node metastasis and preoperative diagnosis of depth of invasion in early
S Shimoyama (2001)
Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer
T. Hirasawa (2009)
Lymphatic involvement in early gastric cancer: prevalence and prognosis in France.
F. Borie (2000)
Early gastric cancer: diagnosis, staging, and clinical impact. Evaluation of 530 patients. New elements for an updated definition and classification. Gastric Cancer 2013;16:549-554
L Saragoni (2013)
[Early stomach carcinoma--pathologic-anatomic findings and prognosis].
N. Bösing (1998)
Recurrence of early gastric cancer. Follow‐up of 1475 patients and review of the Japanese literature
T. Sano (1993)
The Current State of Diagnosis and Treatment for Early Gastric Cancer
T. Yada (2013)
[Characteristics of lymph node metastasis and prognostic analysis in 157 early gastric cancer patients].
Z. Wu (2009)
Pathological predictors of lymph node involvement in submucosal gastric carcinoma: a retrospective analysis of long-term outcome.
G. Nesi (2009)
Pathological factors related to lymph node metastasis of submucosally invasive gastric cancer: criteria for additional gastrectomy after endoscopic resection
M. Fujii (2012)
Risk factors for lymph node metastasis and evaluation of reasonable surgery for early gastric cancer.
Y. Xu (2007)
World Health Organization. Pathology and Genetics of Tumours of the Digestive System. 4th edition
Longterm outcomes after endoscopic mucosal resection for early gastric cancer
N. Uedo (2005)
Prediction of risk factors for lymph node metastasis in early gastric cancer.
G. Ren (2013)
Gastric cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
T. Waddell (2014)
Early gastric cancer: Prognostic factors in 223 patients
S. Folli (1995)
Early gastric cancer in the province of Forlì: follow-up of 337 patients in a high risk region for gastric cancer.
L. Saragoni (1998)
Surgical Treatment of Early Gastric Cancer
S. Nomura (2007)
Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.
J. Macdonald (2001)
Pathological predictors of lymph node involvement in submucosal 361 Cancer Biol Med Vol 12, No 4 December 2015 gastric carcinoma: a retrospective analysis of long-term outcome
G Nesi (2009)
Race/Ethnicity Is Predictive of Lymph Node Status in Patients with Early Gastric Cancer
S. Fukuhara (2014)
Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection.
Hyun Jeong Kang (2010)
Risk factors for lymph node metastasis in patients with early gastric cancer and signet ring cell histology
J. Lee (2010)
Clinicopathological features of early gastric cancer: results of 100 cases from a rural general hospital.
M. Tachibana (1999)
Growth patterns and prognosis in early gastric carcinoma: Superficially spreading and penetrating growth types
Y. Kodama (1983)
Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer.
C. Kunisaki (2009)
Predictive factors of lymph node metastasis in undifferentiated early gastric cancers and application of endoscopic mucosal resection.
Hua Li (2010)
Characteristics of intramucosal gastric carcinoma with lymph node metastatic disease
S. Song (2004)
Early gastric cancer and lymph node metastasis.
K. Koufuji (1997)
: analysis of 412 cases
K Inoue (2000)
Growth patterns and prognosis in early gastric carcinoma. Superficially spreading and penetrating growth
Y Kodama (1983)
Comparison of Survival Curves of Gastric Cancer Patients After Surgery According to the UICC Stage Classification and the General Rules for Gastric Cancer Study by the Japanese Research Society for Gastric Cancer
Y. Nio (1993)
Ethnicity is predictive of lymph node status in patients with early gastric cancer
S Fukuhara (2014)
Clinicopathological Features and Outcome of Surgical Treatment of 149 Patients with Early (pT1) Gastric Cancer
V. Skoropad (2005)
Indication for endoscopic mucosal resection in early signet ring cell gastric cancer
T. K. Ha (2007)
Gastric High-grade Dysplasia Can Be Associated With Submucosal Invasion: Evaluation of its Prevalence in a Series of 121 Endoscopically Resected Specimens
Urara Sakurai (2014)
A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer.
Jingjing Lian (2012)
The new Vienna classification of epithelial neoplasia of the gastrointestinal tract: advantages and disadvantages
M. Stolte (2002)
Risk factors for lymph node metastasis from intramucosal gastric carcinoma
T. Yamao (1996)
Survival of Early Gastric Cancer in a Specialized European Center. Which Lymphadenectomy Is Necessary?
M. Degiuli (2006)
This paper is referenced by
Antithrombotic drug use effect in the treatment of early gastric cancer by endoscopic submucosal dissection.
J. Tao (2017)
Acute Tumor Transition Angle on Computed Tomography Predicts Chromosomal Instability Status of Primary Gastric Cancer: Radiogenomics Analysis from TCGA and Independent Validation
Y. Lai (2019)
Can PEN A Type Early Gastric Cancer be Considered as Advanced Cancer ?
L. Saragoni (2017)
An aggressive early gastric cancer: Kodama's PenA type.
P. Morgagni (2018)
Epigenetic changes in gastric cancer induction by Helicobacter pylori
B. Yousefi (2019)
Management of Early Stage Gastric and Gastroesophageal Junction Malignancies.
F. Azari (2019)
Long term oncological outcome of patients with grossly early gastric cancer-mimicking advanced gastric cancer.
S. E. Oh (2020)
Expression of the cytoskeleton regulatory protein Mena in human gastric carcinoma and its prognostic significance
Lihua Xu (2017)
Case-Control Study of Risk Factors for Gastric Cancer
Xiaoxu Song (2020)
Biotherapy Effect of Shenfuweikang Herbs on Gastric Carcinoma
Xiao-Ping Wang (2016)
A minimally invasive treatment for early GI cancers
Lady Katherine Mejía-Pérez (2017)
Drug effect analysis of sorafenib combined with transcatheter arterial chemoembolization in the treatment of advanced hepatocellular carcinoma.
X. Xu (2018)
Laparoscopic gastrectomy for early gastric cancer and the risk factors of lymph node metastasis
J. Jiao (2019)
Overexpression of DGKI in Gastric Cancer Predicts Poor Prognosis
Chao Huang (2020)
Clinicopathologic parameters associated with the FDG-avidity in staging of early gastric cancer using 18F-FDG PET
Joon-Kee Yoon (2019)
Supervivencia en pacientes adultos con diagnóstico de adenocarcinoma gástrico atendidos en el hospital militar central
Fabián Leandro Rubiano Bello (2016)
Gastric Adenocarcinoma: A Multimodal Approach
H. Quadri (2017)
Early Gastric Cancer: identification of molecular markers able to distinguish submucosa-penetrating lesions with different prognosis
C. Molinari (2020)