Clinicopathological features of type 1 gastric carcinoma: the need to be cautious of superficial lesion surrounding type 1 gastric carcinoma.

BACKGROUND/AIMS: Gastric carcinoma (GC) is one of the most common malignant tumors of the digestive tract and the incidence of adenocarcinoma of the upper one-third of the stomach has increased recently worldwide. The objective of this study was to analyze the clinicopathological variables in patients with GC and examine preoperative diagnosis and the medical treatment strategy of Type 1 GC.

METHODOLOGY: Nine hundred and eighty-one patients with GC who underwent surgical resection between 1981 and 2002 at Kochi Medical School were studied. Thirty-five patients with Type 1 GC were compared with non-Type 1 GC patients on postoperative surgicopathological parameters, and changing trends were evaluated.

RESULTS

The characteristics of patients with Type 1 GC were different from those of patients with non-Type 1 GC: Their tumors were more often in the upper one-third of the stomach (37% vs. 15%), lesions were histologically differentiated in 80% (vs. 56%), and there were more superficial lesions surrounding Type 1 GC (80% vs. 8%). The absolute value and the rate of Type 1 GC increased significantly from the first half to the second half of the study.

CONCLUSIONS

Our findings showed that when Type 1 GC is discovered, physicians should investigate the mucosa around the main neoplasm carefully. The current series suggested that Type 1 GC are associated frequently with superficial lesions, making local resections more difficult, and that Type 1 GC was similar clinicopathologically to carcinoma of the gastric cardia and had different etiologies contributed to its tumorgenesis, compared with non-Type 1 GC, and Type 1 GC may become the key which solves the problem of carcinoma at the gastric cardia.