This study aimed to clarify the clinicopathologic features and explore treatment strategies for patients with pathologically confirmed advanced gastric cancer (AGC) diagnosed as clinically early gastric cancer (cEGC) before surgery. We included 955 patients who were treated by curative gastrectomy between 2008 and 2013; 42 patients had cEGC. The clinicopathologic features of the patients with cEGC were compared with those of patients with early gastric cancer (EGC); AGC; cancer of the muscularis propria (MP cancer, gastric cancer invading the muscularis propria of the stomach); or SM3 cancer (gastric cancer invading all 3 parts of the submucosal layer). Patients with cEGC had more tumor lymph node metastasis; more lymphatic invasion; and more perineural invasion (all P < 0.001) compared with those with EGC. Patients with cEGC had more tumor lymph node metastasis (P = 0.017) than did patients with SM3. Compared with patients with AGC or MP cancer, patients with cEGC were more likely to be operated on using a laparoscopic procedure and less likely to receive lymph node dissection. Multivariate analysis showed that gross type III [odds ratio (OR), 12.92; P < 0.001] and tumor location (middle body, OR, 2.691; P = 0.009) were significant predictors of cEGC before surgery. Although patients with cEGC had clinicopathologic features similar to those of patients with MP cancer, they were treated like patients with SM3 cancer (e.g., limited use of lymphadenectomy). These findings suggest that patients with cEGC should be given a more aggressive treatment strategy.
Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer
