title: [Clinical Risk Factors and Problems Associated with the Difference between Preoperative and Pathological Diagnosis of Tumor Depth in Patients with Upper Third Gastric Cancer].
abstract: OBJECTIVE
  The epidemiology of gastric cancer is changing with an increasing proportion of tumors in the upper stomach. This study was designed to identify risk factors and clinical problems related to the difference between clinical and pathological diagnosis of tumor depth in cases of upper third gastric cancer.
  
  
  METHODS
  A total of 119 consecutive patients with upper third gastric cancer, who underwent curative gastrectomy between 2008 and 2012, were retrospectively analyzed.
  
  
  RESULTS
  The patients were divided into 2 groups based on the pattern of the difference between the clinical (c) and pathological (p) diagnosis of the T factor. Thirty patients (25%) were included in the underestimated diagnosis group (UE group, cT<pT), and 89 patients (75%) were included in the overestimated or correct diagnosis group (OC group, cT>pT or cT=pT). The number of cases showing undifferentiated type (TMN) and lymphatic invasion was significantly higher in the UE group compared to the OC group. Multivariate analysis revealed that the undifferentiated type (TMN) was an independent risk factor for underestimation (p<0.05).
  
  
  CONCLUSIONS
  The presence of undifferentiated components in upper third gastric cancer was associated with a high incidence of underestimated diagnosis. Care should be taken in decision-making for surgical treatments based on the clinical diagnosis.
authors.affiliation: Division of Digestive Surgery, Dept. of Surgery, Kyoto Prefectural University of Medicine.
authors.forename: Wataru
authors.initials: W
authors.lastname: Okajima
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Arita
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimura
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D014680:Veins / Q000473:pathology