Early gastric cancer in the province of Forlì: follow-up of 337 patients in a high risk region for gastric cancer.

Abstract Introduction Guidelines recommend endoscopy with biopsies to stratify patients with gastric premalignant lesions (GPL) to high and low progression risk. High-risk patients are recommended to undergo surveillance. We aimed to assess the accuracy of guideline recommendations to identify low-risk patients, who can safely be discharged from surveillance. Methods This study includes patients with GPL. Patients underwent at least two endoscopies with an interval of 1–6 years. Patients were defined ‘low risk’ if they fulfilled requirements for discharge, and ‘high risk’ if they fulfilled requirements for surveillance, according to European guidelines (MAPS-2012, updated MAPS-2019, BSG). Patients defined ‘low risk’ with progression of disease during follow-up (FU) were considered ‘misclassified’ as low risk. Results 334 patients (median age 60 years IQR11; 48.7% male) were included and followed for a median of 48 months. At baseline, 181/334 (54%) patients were defined low risk. Of these, 32.6% were ‘misclassified’, showing progression of disease during FU. If MAPS-2019 were followed, 169/334 (51%) patients were defined low risk, of which 32.5% were ‘misclassified’. If BSG were followed, 174/334 (51%) patients were defined low risk, of which 32.2% were ‘misclassified’. Seven patients developed gastric cancer (GC) or dysplasia, four patients were ‘misclassified’ based on MAPS-2012 and three on MAPS-2019 and BSG. By performing one additional endoscopy 72.9% (95% CI 62.4–83.3) of high-risk patients and all patients who developed GC or dysplasia were identified. Conclusion One-third of patients that would have been discharged from GC surveillance, appeared to be ‘misclassified’ as low risk. One additional endoscopy will reduce this risk by 70%.

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A Case of Early Gastric Cancer Detected during Long-Term Follow up of Gastric Ulcer Scar

Progress of Digestive Endoscopy(1972) ◽

10.11641/pdensks.48.0_180 ◽

1996 ◽

Vol 48 (0) ◽

pp. 180-181

Author(s):

Yoko Oishi ◽

Masao Tani ◽

Seitaku Hayashi ◽

Fumio Kando ◽

Naoya Saito ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Ulcer ◽

Early Gastric Cancer ◽

Ulcer Scar ◽

Long Term Follow Up

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Postoperative Follow-up of Early Gastric Cancer

Journal of Korean Medical Association ◽

10.5124/jkma.2010.53.4.324 ◽

2010 ◽

Vol 53 (4) ◽

pp. 324 ◽

Cited By ~ 1

Author(s):

Seong-Ho Kong ◽

Han-Kwang Yang

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer

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Early Gastric Cancer: Diagnosis, Surgical Treatment and Follow-Up of 45 Cases

Tumori Journal ◽

10.1177/030089169808400507 ◽

1998 ◽

Vol 84 (5) ◽

pp. 547-551 ◽

Cited By ~ 4

Author(s):

Roberto Sigon ◽

Vincenzo Canzonieri ◽

Renato Cannizzaro ◽

Bruno Pasquotti ◽

Alessandro Cattelan ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Early Gastric Cancer ◽

Total Gastrectomy ◽

Gastric Resection ◽

Critical Evaluation ◽

Pathological Examination ◽

Lymph Node Status ◽

Histopathological Diagnosis

Aims and background The 5-year survival rate of early gastric cancer (EGC) is 85%-100% after “curative” resection, as compared to 20%-30% in advanced gastric cancer (AGC). Because of this relatively high cure rate, the interest in the diagnosis and therapy of EGC has been steadily increasing. The present study, based on 45 EGCs, is aimed at a critical evaluation of the diagnostic procedures and surgical options. Methods and results Forty-five patients with early gastric cancer (27 men and 18 women; median age, 62 years; range, 28-84) were diagnosed and operated on. They represented 22.5% of all patients with gastric cancer (200) treated in the period July 1987 to January 1998. Forty-one patients were from the northeastern part of Italy. The most frequent symptom was epigastric pain (84%). Barium upper gastrointestinal radiography findings were strongly suggestive of malignancy in 41 cases (91%). Preoperative histopathological diagnosis of adenocarcinoma was performed in 43 cases (95.5%). In two cases (4.5%) severe epithelial dysplasia (associated with ulcer) was the first diagnosis, but the final diagnosis on the basis of the resected specimens was a well differentiated adenocarcinoma. The primary surgical procedure included i) subtotal distal resection (37 cases) with Billroth II (33) and Billroth I (4) reconstructions; ii) total gastrectomy (3) for proximal neoplastic extension; iii) proximal gastric resection (2) for cardial cancer; iv) degastro-total gastrectomy (3) for cancer of the stump. Two patients, previously treated with conservative surgery, underwent degastro-total gastrectomy for neoplastic microfocal extension to the margin of resection and for early anastomotic recurrence, respectively. Mural infiltration was limited to the mucosa and submucosa in 27 and 18 cases, respectively. Lymph node metastases were found in three mucosal and five submucosal tumor cases, involving either the first or the second echelon. No operative deaths or postsurgical complications occurred in this series. In the follow-up period (median, 36 months; range, 3-120) four patients died due to other causes; one developed liver metastases, another developed oropharyngeal cancer and two died of biopsy-proven lung cancer without evidence of gastric cancer recurrence. Conclusions The clinical presentation of EGC is aspecific. Preoperative endoscopy with biopsy remains the most sensitive diagnostic procedure. For treatment, subtotal distal gastric resection with lymphadenectomy is the “gold standard” but in some instances total gastrectomy may be indicated. Accurate pathological examination establishes the depth of infiltration, as well as the superficial extension of tumors and the lymph node status. Although the prognosis of EGC is favorable, a medium-term follow-up should be planned.

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Histology as a Prognostic Factor in Early Gastric Cancer

Tumori Journal ◽

10.1177/030089169207800307 ◽

1992 ◽

Vol 78 (3) ◽

pp. 181-184

Author(s):

Massimo Ferrari ◽

Enrico Ghislandi ◽

Giuseppe Landonio ◽

Margherita Majno ◽

Tiziano Porretta ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Early Gastric Cancer ◽

Lymph Node Involvement ◽

Depth Of Invasion ◽

Undifferentiated Histology ◽

Node Involvement

Of 431 patients with gastric cancer observed in our Istitution, 23 (5.3 %) had early gastric cancer (EGC). Macroscopic presentation, histology, depth of invasion, and lymph node involvement were evaluated in all the cases. All patients underwent surgery and an intensive follow-up was performed. Five of the 23 patients progressed, and the risk factors were examined. Histology seemed to be the main prognostic factor in our study, since intestinal type of EGC was associated to a significantly better prognosis. Total gastrectomy is indicated in the proximal localization of EGC, and should perhaps be performed also in cases presenting undifferentiated histology.

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Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score

Gut ◽

10.1136/gutjnl-2019-319926 ◽

2020 ◽

pp. gutjnl-2019-319926 ◽

Cited By ~ 1

Author(s):

Waku Hatta ◽

Yosuke Tsuji ◽

Toshiyuki Yoshio ◽

Naomi Kakushima ◽

Shu Hoteya ◽

...

Keyword(s):

Gastric Cancer ◽

High Risk ◽

Early Gastric Cancer ◽

Prediction Model ◽

Endoscopic Submucosal Dissection ◽

Clinical Decision Making ◽

Validation Cohort ◽

External Validation ◽

Derivation Cohort ◽

Submucosal Dissection

ObjectiveBleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is a frequent adverse event after ESD. We aimed to develop and externally validate a clinically useful prediction model (BEST-J score: Bleeding after ESD Trend from Japan) for bleeding after ESD for EGC.DesignThis retrospective study enrolled patients who underwent ESD for EGC. Patients in the derivation cohort (n=8291) were recruited from 25 institutions, and patients in the external validation cohort (n=2029) were recruited from eight institutions in other areas. In the derivation cohort, weighted points were assigned to predictors of bleeding determined in the multivariate logistic regression analysis and a prediction model was established. External validation of the model was conducted to analyse discrimination and calibration.ResultsA prediction model comprised 10 variables (warfarin, direct oral anticoagulant, chronic kidney disease with haemodialysis, P2Y12 receptor antagonist, aspirin, cilostazol, tumour size >30 mm, lower-third in tumour location, presence of multiple tumours and interruption of each kind of antithrombotic agents). The rates of bleeding after ESD at low-risk (0 to 1 points), intermediate-risk (2 points), high-risk (3 to 4 points) and very high-risk (≥5 points) were 2.8%, 6.1%, 11.4% and 29.7%, respectively. In the external validation cohort, the model showed moderately good discrimination, with a c-statistic of 0.70 (95% CI, 0.64 to 0.76), and good calibration (calibration-in-the-large, 0.05; calibration slope, 1.01).ConclusionsIn this nationwide multicentre study, we derived and externally validated a prediction model for bleeding after ESD. This model may be a good clinical decision-making support tool for ESD in patients with EGC.

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