Early gastric cancer--a clinicopathological study.

From 1983 to 1991. 981 cases with gastric cancer underwent gastric resection in Chang Gung Memorial Hospital. Ninety-two cases (9.4%) had early gastric cancer with a mean age of 54.5 years. The most commonly present symptoms were epigastralgia and abdominal fullness (79.3%). Most lesions were located in the lower third of stomach (64.0%). Type IIc was the most common macroscopic type (31.5%). The tumor was confined to the mucosa layer in 40 (43.5%) cases; submucosa invasion was noted in the remaining 52 (56.5%) patients. Lymph node involvement was found in 5 (5.4%) cases. No statistical correlation between the depth of tumor invasion and the size of the tumor was noticed. Three patients died of tumor recurrence on the 11th, 13th and 36th months after operation. The Kaplan-Meier estimate for five year survival was 96.4% in these 92 cases. 96.6% in mucosa cancer and 95.6% in submucosa cancer. The risk factor for mortality was lymph node metastasis which had a positive correlation with the depth of tumor invasion. There were four (4.3%) cases of minute early gastric cancer. However, there was neither mortality nor lymph node metastasis in these four cases. Retrospectively, the review of original histological slides in 40 cases, the intestinal type of early gastric cancer had a higher association with intestinal metaplasia, had more frequency of submucosa invasion (70% vs 35%, p = 0.026), and were older in age (61 vs 50.4 years old) than the diffuse type. Although statistically insignificant, the intestinal type had the tendency to involve the lymph node.