Brief Article
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World J Gastroenterol. Nov 7, 2013; 19(41): 7154-7159
Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7154
Characteristics and prognosis of synchronous multiple early gastric cancer
Taro Isobe, Kousuke Hashimoto, Junya Kizaki, Naotaka Murakami, Keishiro Aoyagi, Kikuo Koufuji, Yoshito Akagi, Kazuo Shirouzu
Taro Isobe, Kousuke Hashimoto, Junya Kizaki, Naotaka Murakami, Keishiro Aoyagi, Kikuo Koufuji, Yoshito Akagi, Kazuo Shirouzu, Department of Surgery, Kurume University School of Medicine, Fukuoka 830-0011, Japan
Author contributions: Isobe T performed the analysis, analyzed the data, and wrote the paper; Hashimoto K, Kizaki J and Murakami N participated in the analysis; Aoyagi K and Koufuji K analyzed the data; Akagi Y helped to conceive the study; Shirouzu K designed and supervised the study.
Correspondence to: Taro Isobe, MD, PhD, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan. taro_isobe@yahoo.co.jp
Telephone: +81-942-35-3311 Fax: +81-942-34-0709
Received: June 28, 2013
Revised: August 26, 2013
Accepted: September 15, 2013
Published online: November 7, 2013
Processing time: 141 Days and 3.1 Hours
Abstract

AIM: To assess the clinicopathologic characteristics, risk factors, and prognosis for synchronous multiple early gastric cancer (SMGC).

METHODS: A total of 146 patients with SMGC and 1194 patients with single gastric cancer who had undergone gastrectomy between 1989 and 2008 were retrospectively analyzed to determine their clinicopathologic characteristics and postoperative survival. Tumors were classified into groups on the basis of location and histology. Smoking habits were evaluated using the Brinkman index. Clinical and pathological factors were compared using either Fisher’s exact test or Pearson’s χ2 test. Logistic regression analysis was performed to identify independent risk factors. Survival rate was calculated using the Kaplan-Meier method.

RESULTS: SMGCs accounted for 10.9% of gastric cancer cases and occurred predominantly in elderly male patients with a family history of gastric cancer who were both smokers and drinkers. These tumors were typically macroscopically elevated and histologically differentiated. There were no significant differences between SMGC and single gastric cancer patients with respect to tumor location, tumor size, lymph node metastasis, the number of metastatic lymph nodes, venous invasion, or tumor stage (P = 0.052, P = 0.347, P = 0.595, P = 0.805, P = 0.559, and P = 0.408, respectively). Further, there was no significant difference in postoperative survival between the patient groups (P = 0.200). Of the 146 SMGC patients, a single patient had remnant cancer.

CONCLUSION: A careful preoperative endoscopy is necessary for patients who are at high risk of SMGC, and minimally invasive treatment may be indicated in some cases.

Keywords: Gastric cancer; Synchronous; Multiple; Endoscopy; Prognosis

Core tip: This study compares the clinicopathologic characteristics of synchronous multiple gastric cancer (SMGC) and single gastric cancer, Further, we identified risk factors for SMGC and assessed whether they can be treated with a minimally invasive approach. We found that SMGC occurred predominantly in elderly male patients who had a family history of gastric cancer, and who were both smokers and drinkers. The tumors were macroscopically elevated and histologically differentiated. Lymph node metastasis and vascular invasion were equally prevalent, and there was no significant difference in postoperative survival between these patient groups. We suggest minimally invasive approach may be applicable.