Histotype-based prognostic classification of gastric cancer

AIM: To test the efficiency of a recently proposed histotype-based grading system in a consecutive series of gastric cancers.METHODS: Two hundred advanced gastric cancers operated upon in 1980-1987 and followed for a median 159 mo were investigated on hematoxylin-eosin-stained sections to identify low-grade [muconodular, well differentiated tubular, diffuse desmoplastic and high lymphoid response (HLR)], high-grade (anaplastic and mucinous invasive) and intermediate-grade (ordinary cohesive, diffuse and mucinous) cancers, in parallel with a previously investigated series of 292 cases. In addition, immunohistochemical analyses for CD8, CD11 and HLA-DR antigens, pancytokeratin and podoplanin, as well as immunohistochemical and molecular tests for microsatellite DNA instability and in situ hybridization for the Epstein-Barr virus (EBV) EBER1 gene were performed. Patient survival was assessed with death rates per 100 person-years and with Kaplan-Meier or Cox model estimates.RESULTS: Collectively, the four low-grade histotypes accounted for 22% and the two high-grade histotypes for 7% of the consecutive cancers investigated, while the remaining 71% of cases were intermediate-grade cancers, with highly significant, stage-independent, survival differences among the three tumor grades (P = 0.004 for grade 1 vs 2 and P = 0.0019 for grade 2 vs grade 3), thus confirming the results in the original series. A combined analysis of 492 cases showed an improved prognostic value of histotype-based grading compared with the Lauren classification. In addition, it allowed better characterization of rare histotypes, particularly the three subsets of prognostically different mucinous neoplasms, of which 10 ordinary mucinous cancers showed stage-inclusive survival worse than that of 20 muconodular (P = 0.037) and better than that of 21 high-grade (P < 0.001) cases. Tumors with high-level microsatellite DNA instability (MSI-H) or EBV infection, together with a third subset negative for both conditions, formed the T8 cell-rich HLR group, the largest group among low-grade histotypes. Coexisting HLR proved to be a factor in improved prognosis in tumors with microsatellite instability (P = 0.0015 vs HLR-/MSI-H tumors) or DR type human leukocyte antigen expression (P = 0.033 vs HLR^-/HLA-DR⁺ tumors).CONCLUSION: Identification of low- and high-grade histotypes can improve the prognostic assessment of a substantial proportion of gastric cancers in routine diagnostic practice.     

Krüppel-like factor 8 overexpression is correlated with angiogenesis and poor prognosis in gastric cancer

AIM:To investigate Krüppel-like factor 8 (KLF8) expression in gastric cancer and its relationship with angiogenesis and prognosis of gastric cancer. METHODS:One hundred and fifty-four patients with gastric cancer who underwent successful curative resection were retrospectively enrolled in the study. Fifty tumor-adjacent healthy gastric tissues (≥ 5 cm from the tumor margin) obtained during the original resection were randomly selected for comparative analysis. In situ expression of KLF8 and CD34 proteins were examined by immunohistochemistry. The intratumoral microvessel density (MVD) was determined by manually counting the immunostained CD34-positive endothelial cells in three consecutive high-magnification fields (× 200). The relationship between differential KLF8 expression and MVD was assessed using Spearman’s correlation coefficient test. χ2 test was performed to evaluate the effects of differential KLF8 expression on clinicopathologic factors. Kaplan-Meier and multivariate Cox survival analyses were used to assess the prognostic value of differential KLF8 expression in gastric cancer. RESULTS:Significantly higher levels of KLF8 protein were detected in gastric cancer tissues than in the adjacent non-cancerous tissues (54.5% vs 34.0%, P < 0.05). KLF8 expression was associated with tumor size (P < 0.001), local invasion (P = 0.005), regional lymph node metastasis (P = 0.029), distant metastasis (P = 0.023), and tumor node metastasis (TNM) stage (P = 0.002), as well as the MVD (r = 0.392, P < 0.001). Patients with KLF8 positive expression had poorer overall survival (P < 0.001) and cancer-specific survival (P < 0.001) than those with negative expression. Multivariate analysis demonstrated that KLF8 expression independently affected both overall and cancer-specific survival of gastric cancer patients (P = 0.035 and 0.042, respectively). CONCLUSION:KLF8 is closely associated with gastric tumor progression, angiogenesis and poor prognosis, suggesting it may represent a novel prognostic biom     

Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer

BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification. These two subtypes show distinct differences in metastasis frequency, treatment application, and prognosis. Therefore, accurately assessing the Lauren classification before treatment is crucial. However, studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse-and intestinal-type gastric cancers in Helicobacter pylori(H. pylori)-infected patients.METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled. The Kyoto classification included atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness. The effects of age, sex, and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed. We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification. Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.RESULTS A total of 499 H. pylori-infected patients(49.6% males; average age: 54.9 years) were enrolled; 132 patients with gastric cancer(39 diffuse-and 93 intestinal-type cancers) and 367 cancer-free controls were eligible. Gastric cancer was independently associated with age ≥ 65 years, high atrophy score, high intestinal metaplasia score, and low nodularity score when compared to the control. Factors independently associated with intestinal-type cancer were age ≥ 65 years(coefficient: 1.98), male sex(coefficient: 1.02), high intestinal metaplasia score(coefficient: 0.68), and low enlarged folds score(coefficient:-1.31) when compared to diffuse-type cancer. The Lauren predictive background score was defined as the sum of +2(age ≥ 65 years), +1(male sex), +1(endoscopic intestinal metaplasia), and-1(endoscopic enlarged folds) points. Area under the receiver operative characteristic curve of the Lauren predictive background score was 0.828 for predicting intestinal-type cancer. With a cut-off value of +2, the sensitivity, specificity, and accuracy of the Lauren predictive background score were 81.7%, 71.8%, and 78.8%, respectively.CONCLUSION Patient backgrounds, such as age, sex, endoscopic intestinal metaplasia, and endoscopic enlarged folds are useful for predicting the Lauren type of gastric cancer.     

Perspectives on new biomarkers in gastric cancer: Diagnostic and prognostic applications

Gastric cancer is considered one of the most deadly tumors worldwide. Even with the decline in its incidence, the mortality rate of this disease has remained high, mainly due to its late diagnosis and to the lack of precise prognostic markers. The main purpose of this review is to present genetic, epigenetic and proteomic molecular markers that may be used in a diagnostic and prognostic manner and to discuss the pros and cons of each type of marker for improving clinical practice. In this sense, we observed that the use of genetic markers, especially mutations and polymorphisms, should be carefully considered, as they are strongly affected by ethnicity. Proteomic-based markers show promise, but the higher costs of the associated techniques continue to make this approach expensive for routine use. Alternatively, epigenetic markers appear to be very promising, as they can be detected in bodily fluids as well as tissues. However, such markers must be used carefully because epigenetic changes may occur due to environmental factors and aging. Despite the advances in technology and its access, to date, there are few defined biomarkers of prognostic and diagnostic use for gastric tumors. Therefore, the use of a panel of several approaches (genetic, epigenetic and proteomic) should be considered the best alternative for clinical practice.     

新的肿瘤标志物GP87在老年胃癌及胃癌前病变组织中表达的研究

目的探讨新的肿瘤标志物ＧＰ８７在老年胃癌及胃癌前病变中表达的情况,从而确定其在上述病变中的应用价值。方法采用ｓＡＢＣ免疫组化染色法对２８３例标本进行染色分析。结果正常胃体、胃窦均为阴性,浅表性胃炎组阳性率为７．１％,明显低于癌症组及癌前病变组（Ｐ＜０．０１）。胃癌组阳性率为６２．０％,明显低于癌前病变各组阳性率（Ｐ＜０．０５）,癌旁粘膜组阳性率亦较高,在８０．０％左右。结论新的肿瘤标志物ＧＰ８７在胃癌及胃癌前病变中均有较高表达,特别是在胃癌前病变中的表达更高,故认为ＧＰ８７是检测胃癌前病变较好的肿瘤标志物,可用于胃癌高危人群的普查,筛选出具有明确癌前病变的病人,定期随访、长期追踪,无疑有助于发现早期胃癌。     

Liver metastasis is the only independent prognostic factor in AFP-producing gastric cancer

AIM:To investigate differences between common gastric cancer andα-fetoprotein(AFP)-producing gastric cancer according to the presence or absence of liver metastasis.METHODS:Between 1997 and 2011,1299 patients underwent gastrectomy for gastric cancer(GC)at our institute and their hospital records were reviewed retrospectively.Patients were immunohistochemically divided into two groups:23 patients(1.8%)with AFPproducing GC and 1276 patients(98.2%)without it.RESULTS:AFP-producing GC patients had a significantly higher incidence of deeper tumors,venous invasion,lymphatic invasion,lymph node metastasis,and liver metastasis and a poorer prognosis(P<0.005)than those without AFP-producing GC.However,multi-variate analysis revealed that AFP-positivity was not an independent prognostic factor.The prognosis of AFPproducing GC was similar to that of AFP-non producing GC according to the presence or absence of liver metastasis.Concerning recurrence,47.8%of patients(11/23)with AFP-producing GC and 20.0%of patients(256/1276)without AFP-producing GC exhibited recurrence.Liver metastasis[90.9%(10/11)]was the most prevalent in AFP-producing GC patients.Multivariate analysis revealed that liver metastasis was the only independent prognostic factor in AFP-producing GC(HR=17.6,95%CI:2.1-147.1;P=0.0081).CONCLUSION:AFP-producing GC is similar to common GC without liver metastasis,which should be specifically targeted in an effort to improve the prognosis of AFP-producing GC patients.     

New therapeutic options opened by the molecular classification of gastric cancer

Gastric cancer(GC) is one of the most lethal and aggressive cancers, being the third cause of cancer related death worldwide. Even with radical gastrectomy and the latest generation of molecular chemotherapeutics, the numbers of recurrence and mortality remains high. This is due to its biological heterogeneity based on the interaction between multiple factors, from genomic to environmental factors, diet or infections with various pathogens. Therefore, understanding the molecular characteristics at a genomic level is critical to develop new treatment strategies. Recent advances in GC molecular classification provide the unique opportunity to improve GC therapy by exploiting the biomarkers and developing novel targeted therapy specific to each subtype. This article highlights the molecular characteristics of each subtype of gastric cancer that could be considered in shaping a therapeutic decision, and also presents the completed and ongoing clinical trials addressed to those targets. The implementation of the novel molecular classification system will allow a preliminary patient selection for clinical trials, a mandatory issue if it is desired to test the efficacy of a certain inhibitor to the given target. This will represent a substantial advance as well as a powerful tool for targeted therapy. Nevertheless, translating the scientific results into new personalized treatment opportunities is needed in order to improve clinical care, the survival and quality of life of patients with GC.     

The applicability of the WHO classification in paediatric AML. A NOPHO‐AML study

The World Health Organization (WHO) classification of myeloid leukaemia was revised in 2008. It incorporates newly recognized entities and emphasizes the pivotal role of cytogenetic abnormalities. The aim of this study was to evaluate the usability of the WHO classification when applied to a large population‐based paediatric acute myeloid leukaemia (AML) cohort. We included children diagnosed with de novo AML, 0–18 years of age from the Nordic countries and Hong Kong from 1993 to 2012. Data were retrieved from the Nordic Society for Paediatric Haematology and Oncology AML database and patients classified according to the WHO 2008 classification. A successful karyotype was available in 97% of the cases. AML with recurrent genetic abnormalities were present in 262 (41%) and 94 (15%) were classified as AML with myelodysplasia‐related changes (AML‐MDS). WHO classifies patients with monosomy 7 and del(7q) into one group. We found that ?7 (n = 14) had significantly poorer outcome than del(7q) (n = 11); 5‐year event‐free survival 26% vs. 67%, (P = 0·02), and 5‐year overall survival 51% vs. 90%, (P = 0·04). The largest group was the highly heterogeneous AML not otherwise specified (NOS) (n = 280) (44%). In conclusion, the WHO classification allocated 15% to AML‐MDS, 44% to NOS and grouped together entities with clearly different outcome, therefore limiting the applicability of the current WHO classification in children with AML.     

胃液CEA、CA19-9联检在胃癌预后判断与复发筛查中的价值

目的探讨胃液中癌胚抗原(CEA)、糖链多肽抗原19-9(CA19-9)在胃癌预后判断和复发筛查中的价值. 方法应用免疫放射法检测了62例胃癌患者(术后复发组32例,未复发组30例)手术前后胃液中CEA、CA19-9变化,并进行随访观察.结果复发组CEA为(65.81±43.62)ng/ml,CA19-9为(172.53±159.38)U/ml.两组比较,有非常显著差异(P＜0.01).CEA、CA19-9联检可将敏感性提高至81.25%,并可在胃癌术后亚临床期检出复发.结论胃液CEA、CA19-9联检对胃癌疗效观察、预后判断和复发筛查具有重要意义.     

Long-term outcomes for unselected patients with acute myeloid leukemia categorized according to the World Health Organization classification: a single-center experience

The actual utility of a new classification system of acute myeloid leukemia (AML) recently introduced by the World Health Organization (WHO) has not been thoroughly investigated yet. In this study, we evaluated long-term outcomes of unselected AML patients categorized according to the new WHO classification. Between 1990 and 2002, 109 adult AML cases were referred to our hospital. For the entire population, the median survival duration was 1.2 yr with a 5-yr survival rate of 31%. AML with recurrent genetic abnormalities accounted for 26%, AML with multilineage dysplasia for 29%, therapy-related AML for 13%, and AML not otherwise categorized for 32% of classifiable cases. Among the four groups, a significant difference was observed in terms of overall survival (P < 0.0001). Univariate analysis showed that six variables affected survival: cytogenetic risk, age, multilineage dysplasia, prior chemo/radiotherapy, type of treatment (intensive or palliative), and transplantation. However, in multivariate analysis no adverse prognostic impact of multilineage dysplasia and prior chemo/radiotherapy was detected (P = 0.4979 and 0.8702), whereas cytogenetic risk and patient age maintained their prognostic value (P = 0.0005 and 0.0100). These results indicate that outcomes for AML patients appear to be distinguished on the basis of the WHO classification, but the prognostic significance of multilineage dysplasia and prior therapy is lost after adjusting for cytogenetic risk and age. Our findings suggest that the WHO classification may be strengthened by greater emphasis on genetic/cytogenetic information.     

MicroRNAs as a potential prognostic factor in gastric cancer

AIM:To compare the microRNA (miR) profiles in the primary tumor of patients with recurrent and non-recurrent gastric cancer.METHODS:The study group included 45 patients who underwent curative gastrectomies from 1995 to 2005 without adjuvant or neoadjuvant therapy and for whom adequate tumor content was available.Total RNA was extracted from formalin-fixed paraffin-embedded tumor samples,preserving the small RNA fraction.Initial profiling using miR microarrays was performed to identify potential biomarkers o...     

Diagnostic role of serum interleukin-18 in gastric cancer patients

AIM: To determine the current status in various aspects of gastric cancer patients and to find out the clinical correlation with prognostic role of serum interleukins in Thai patients. METHODS: Sixty-eight patients were enrolled in this study at King Chulalongkorn Memorial Hospital during April 2003 to May 2005. Gastric cancer was histologically proven in 51 patients and gastric ulcer in 17 patients. Serum IL-6, IL-10, IL-12, and IL-18 levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: There were 26 males (55.32%) and 21 females (44.68%) with their age ranging from 33 to 85 years (mean age 64.49±13.83 years). The common presentations were weight loss (41.2%), dyspepsia (39.2%), and upper gastrointestinal bleeding (15.7%). A total of 35.3% gastric cancer patients and 6.3% of gastric ulcer patients were smokers (P = 0.029). Moreover, 32.4% of gastric cancer patients and 6.3% of gastric ulcer patients were alcoholic drinkers (P = 0.044). Lesion location was pyloric-antrum in 39.4%, gastric body in 39.4%, upper stomach in 12.2% and entire stomach in 6.1% of the patients. H pylori infection was detected in 44.4%. The poorly-differentiated adenocarcinoma was the most common pathologic finding (60.7%). Surgical treatment was performed in 44.1% patients (total gastrectomy in 5.9%, subtotal gastrectomy in 32.4% and palliative bypass surgery in 5.9%). Systemic chemotherapy was given as an adjuvant therapy in 8.8% patients. Carcinomatosis peritoneii were found in 18.8% patients. The mean survival time was 13.03±9.75 mo. The IL-18 level in gastric cancer patient group (58.54±43.96 pg/mL) was significantly higher than that in gastric ulcer patient group (30.84±11.18 pg/mL) (P = 0.0001) (95% CI was 42.20, 13.19). The cut point of IL-18 for diagnosis of gastric cancer was 40 pg/mL, the positive predictive value was 92.31%. The IL-6 level in gastric cancer patients with distant metastasis (20.21±9.37 pg/mL) was significantly higher than that in those with no metastasis (10.13±7.83 pg/mL) (P = 0.037) (95% CI was 19.51, 0.65). The role of IL-10 and IL-12 levels in gastric cancer patients was to provide data with no significant difference. CONCLUSION: These findings demonstrate that serum IL-6 and IL-18, but not IL-10 and IL-12 levels may be the useful biological markers of clinical correlation and prognostic factor in patients with gastric cancer. Moreover, IL-18 could serve as a diagnostic marker for gastric cancer with a high positive predictive value.     

粘着斑激酶在胃癌中的表达及临床意义

目的观察粘着斑激酶(FAK)在胃癌及癌旁组织表达的差异,探讨FAK与胃癌临床病理参数的关系。方法应用免疫组化SP法检测61例胃癌组织及其癌旁组织FAK的表达。结果FAK在胃癌及其癌旁组织阳性表达率分别为86.8%(53/61)和75.4%(46/61),差异无显著性(P>0.05);但FAK较强阳性/强阳性(即++/+++)的表达率分别为59%、26.2%,差异有显著性(P<0.05),且其表达水平与胃癌分化程度、浸润深度、淋巴结转移、临床分期呈正相关。结论在胃癌组织中FAK(++/+++)的表达水平较正常组织明显增高,提示FAK参与胃癌的发病,并与胃癌的浸润、转移关系密切。     

DNA methyltransferase3a expression is an independent poor prognostic indicator in gastric cancer

AIM: To explore the alteration of DNA methyltransferase expression in gastric cancer and to assess its prognostic value.METHODS: From April 2000 to December 2010, 227 men and 73 women with gastric cancer were enrolled in the study. The expression of DNA methyltransferases (DNMTs), including DNMT1, DNMT3a and DNMT3b, in the 300 cases of gastric carcinoma, of which 85 had paired adjacent normal gastric mucus samples, was evaluated by immunohistochemistry using a tissue microarray. Serum anti-Helicobacter pylori (H. pylori) IgG was detected by enzyme-linked immunosorbent assay (ELISA). The relationships between the above results and the clinicopathological characteristics were analyzed. Their prognostic value was evaluated using the Cox proportional hazards model.RESULTS: In gastric cancer, expression of DNMTs was mainly seen in the nucleus. Weak staining was also observed in the cytoplasm. Expression of DNMT1, DNMT3a and DNMT3b in gastric cancer was significantly higher compared to that in the paired control samples (60.0% vs 37.6%, 61.2% vs 4.7%, and 94.1% vs 71.8%, P < 0.01). The overall survival rate was significantly higher in the DNMT3a negative group than in the DNMT3a positive group in gastric cancer patients (Log-rank test, P = 0.032). No significant correlation was observed between DNMT1 and DNMT3b expression and the overall survival time (Log-rank test, P = 0.289, P = 0.347). Multivariate regression analysis indicated that DNMT3a expression (P = 0.025) and TNM stage (P < 0.001), but not DNMT1 (P = 0.54) or DNMT3b (P = 0.62), were independent prognostic factors in gastric cancer. H. pylori infection did not induce protein expression of DNMTs.CONCLUSION: The results suggest that expression of DNMT3a is an independent poor prognostic indicator in gastric cancer. DNMT3a might play an important role in gastric carcinogenesis.     

Helicobacter pylori and gastric cancer: Indian enigma

Helicobacter pylori(H. pylori) is a gram negative microaerophilic bacterium which resides in the mucous linings of the stomach. It has been implicated in the causation of various gastric disorders including gastric cancer. The geographical distribution and etiology of gastric cancer differ widely in different geographical regions and H. pylori, despite being labeled as a grade Ⅰ carcinogen, has not been found to be associated with gastric cancer in many areas. Studies in Asian countries such as Thailand, India, Bangladesh, Pakistan, Iran, Saudi Arabian countries, Israel and Malaysia, have reported a high frequency of H. pylori infection co-existing with a low incidence of gastric cancer. In India, a difference in the prevalence of H. pylori infection and gastric cancer has been noted even in different regions of the country leading to a puzzle when attempting to find the causes of these variations. This puzzle of H. pylori distribution and gastric cancer epidemiology is known as the Indian enigma. In this review we have attempted to explain the Indian enigma using evidence from various Indian studies and from around the globe. This review covers aspects of epidemiology, the various biological strains present in different parts of the country and within individuals, the status of different H. pylori-related diseases and the molecular pathogenesis of the bacterium.     

Prognostic value of Muc5AC in gastric cancer: A meta-analysis

AIM: To assess the correlation between decreased Muc5 AC expression and patients' survival and clinicopathological characteristics by conducting a metaanalysis.METHODS: Literature searches were performed in Pub Med and EMBASE,and 11 studies met our criteria. Summary hazard ratios or odds ratios(ORs) with 95% confidence intervals(CIs) were calculated to estimate the effect. For the pooled analysis of the correlation between decreased Muc5 AC expression and clinicopathological characteristics(tumour invasion depth,lymph node metastasis,tumour-node-metastasis stage,tumour size,venous invasion and lymphatic invasion),ORs and their variance were combined to estimate the effect. RESULTS: Eleven retrospective cohort studies comprising 2135 patients were included to assess the association between Muc5 AC expression and overall survival and/or clinicopathological characteristics. Decreased Muc5 AC expression was significantly correlated with poor overall survival of gastric cancer patients(pooled HR = 1.35,95%CI: 1.08-1.7). Moreover,decreased Muc5 AC expression was also significantly associated with tumour invasion depth(pooled OR =2.12,95%CI: 1.56-2.87) and lymph node metastasis(pooled OR = 1.56,95%CI: 1.00-2.44) in gastric cancer.CONCLUSION: Decreased Muc5 AC expression might be a poor prognostic predictor for gastric cancer.     

Diagnostic utility of small-caliber and conventional endoscopes for gastric cancer and analysis of endoscopic false-negative gastric cancers

AIM: To analyze the diagnostic utility of a small-caliber endoscope(SC-E) and clinicopathological features of false-negative gastric cancers(FN-GCs). METHODS: A total of 21638 esophagogastroduodenoscopy(EGD) gastric cancer(GC) screening examinations were analyzed. Secondary endoscopic examinations(n = 3352) were excluded because most secondary examinations tended to be included in the conventional endoscopy(C-E) group. Detection rates of GCs and FN-GCs were compared between SC-E and C-E groups. FN-GC was defined as GC performed with EGD within the past 3 years without GC detection. Macroscopic types, histopathological characteristics and locations of FN-GCs were compared with firstly foundgastric cancers(FF-GCs) in detail. RESULTS: SC-E cases(n = 6657) and C-E cases(n = 11644), a total of 18301 cases, were analyzed. GCs were detected in 16(0.24%) SC-E cases and 40 C-E(0.34%) cases(P = 0.23) and there were 4 FN-GCs(0.06%) in SC-E and 13(0.11%) in C-E(P = 0.27), with no significant difference. FN-GCs/GCs ratio between SC-E and C-E groups was not significantly different(P = 0.75). The comparison of endoscopic macroscopic types of FN-GCs tended to be a less advanced type(P = 0.02). Histopathologically, 70.6% of FN-GCs were differentiated and 29.4% undifferentiated type. On the other hand, 43.0% of FF-GCs were differentiated and 53.8% undifferentiated type, so FN-GCs tended to be more differentiated type(P = 0.048). CONCLUSION: The diagnostic utility of SC-E for the detection of GCs and FN-GCs was not inferior to that of C-E. Careful observation for superficially depressed type lesions in the upper lesser curvature region is needed to decrease FN-GCs.     

Treatment of early gastric cancer in the Western World

The incidence rate of gastric cancer is much higher in Asia than in the Western industrial nations.According to the different screening programs in Japan and Korea about fifty percent of treated patients had an early tumor stage.In contrast,European and American patients with gastric cancer had an advanced tumor stage.Therefore,the experience for the various therapeutic options for gastric cancer may be different between these regions.In this review we tried to point out the treatment modalities in Western industrial countries for early gastric cancer.