title: Clinicopathological characteristics of clinical early gastric cancer in the upper-third stomach.
abstract: OBJECTIVE
  To elucidate the clinicopathological characteristics of clinically early gastric cancer in the upper-third stomach and to clarify treatment precautions.
  
  
  METHODS
  A total of 683 patients with clinical early gastric cancer were enrolled in this retrospective study, 128 of whom had gastric cancer in the upper-third stomach (U group). All patients underwent a double contrast barium examination, endoscopy, and computed tomography (CT), and were diagnosed preoperatively based on the findings obtained. The clinicopathological features of these patients were compared with those of patients with gastric cancer in the middle- and lower-third stomach (ML group). We also compared clinicopathological factors between accurate-diagnosis and under-diagnosis groups in order to identify factors affecting the accuracy of a preoperative diagnosis of tumor depth.
  
  
  RESULTS
  Patients in the U group were older (P = 0.029), had a higher ratio of males to females (P = 0.015), and had more histologically differentiated tumors (P = 0.007) than patients in the ML group. A clinical under-diagnosis occurred in 57 out of 683 patients (8.3%), and was more frequent in the U group than in the ML group (16.4% vs 6.3%, P < 0.0001). Therefore, the rates of lymph node metastasis and lymphatic invasion were slightly higher in the U group than in the ML group (P = 0.071 and 0.082, respectively). An under-diagnosis was more frequent in histologically undifferentiated tumors (P = 0.094) and in those larger than 4 cm (P = 0.024). The median follow-up period after surgery was 56 mo (range, 1-186 mo). Overall, survival and disease-specific survival rates were significantly lower in the U group than in the ML group (P = 0.016 and 0.020, respectively). However, limited operation-related cancer recurrence was not detected in the U group in the present study.
  
  
  CONCLUSIONS
  Clinical early gastric cancer in the upper-third stomach has distinguishable characteristics that increase the risk of a clinical under-diagnosis, especially in patients with larger or undifferentiated tumors.
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Hirotaka Konishi, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Diagnosis; Gastric cancer; Upper-third stomach