Discordant findings between preoperative endoscopy and postoperative pathology as an independent prognostic factor in gastric cancer patients.
Endoscopically diagnosed early gastric cancers (EGCs) are sometimes revealed to be advanced gastric cancers (AGCs) on pathologic examination of the resected specimen, and also endoscopically diagnosed AGCs are often determined to be EGCs. This study was designed to determine the impact on prognosis of the discordant finding between preoperative endoscopy and postoperative pathology in gastric cancer patients.



Patients with gastric cancer stages pT1a-T4a who underwent curative gastrectomy between 2004 and 2010 were included in the study. The preoperative endoscopic findings and clinicopathologic features were analyzed. The prognostic impact on recurrence-free survival of discordance between endoscopic and pathologic examinations was analyzed using multivariate analysis.



Among 367 patients diagnosed with EGC on preoperative endoscopy, 40 (11 %) had AGC on final pathologic examination; this was more common in female patients, upper one-third location of the cancer, poorly differentiated tumor, combined gross type (elevated and depressed), lymphovascular invasion and lymph node metastasis. Among 350 patients diagnosed with AGC on preoperative endoscopy, 66 (19 %) had EGC pathologically; this was more frequent in patients with tumor in the lower and/or middle third of the stomach, differentiated tumor, Borrmann type 1 and absence of lymph node metastasis. The endoscopic appearance of AGC was identified as a poor prognostic factor related to recurrence-free survival in patients with EGC, whereas discordance did not influence recurrence-free survival in patients with AGC.



Discordant preoperative endoscopic appearance may be an indicator of biologic aggressiveness and a reliable prognostic factor in EGC, but not in AGC.
Department of Surgery, Hanyang University Hospital, Seoul, Republic of Korea.
Ju-Hee
JH
Lee
Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Kang Nyeong
KN
Lee
Department of Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea.
Hyun-Il
HI
Kim
Department of Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea.|Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Min Gyu
MG
Kim
Department of Surgery, Hanyang University Hospital, Seoul, Republic of Korea.|Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Tae Kyung
TK
Ha
Department of Surgery, Hanyang University Hospital, Seoul, Republic of Korea. sjkwon@hanyang.ac.kr.|Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea. sjkwon@hanyang.ac.kr.
Sung Joon
SJ
Kwon
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
Endoscopic appearance; Gastric cancer; Prognosis