Clinical And Pathological Characteristic Of Early Gastric Cancer

Purpose:To retrospectively analyze the clinical and pathological characteristics of early gastric cancer, endoscopic morphology, depth of invasion, presence of lymph node metastasis, histological classification, etc., discuss the endoscopic performance of early gastric cancer and the relationship with pathologic classification, in order to increase the understanding of early gastric cancer in digestive internal medicine and endoscopic physicians, improve early gastric cancer endoscopic detection rate.Methods:The clinical and pathological data of early gastric cancer patients who were treated by surgery or endoscopic mucosal resection in the second hospital of Shandong university from January 2012 to January 2012 was retrospectively analyzed, including the relationship of age, sex, site, helicobacter pylori infection, endoscopic morphology and depth of invasion, and presence of lymph node metastasis, histological classification.Results:The basic information of early gastric cancer:Between January 2012 and January 2015, there were 89 samples founded by endoscopic biopsy which is early gastric cancer or high-grade intraepithelial neoplasia, then confirmed by the pathological of surgery or endoscopic submucosal resection.56 patients accepted surgery therapy while 33 people accepted endoscopic treatment. There were 39 male patients and 60 female patients. The ratio of male and female is 2.9:1. Patients over 50 accounted for 88.8%. There were 2 cases of multiple carcinoma with 4 lesions.91 lesions were checked out. The high risk position of early gastric cancer is antrum with 44 lesions, followed by 28 lesions in gastric body,11 lesions in gastric angle and 8 lesions in the fundus and cardia. Endoscopic morphology:There were 6 type Ⅰ (protruding) lesions, 81 type Ⅱ (flat) lesions(18 type Ⅱ a,2 type Ⅱ b and 23 type Ⅱ c lesions,31 type Ⅱ a+Ⅱ c lesions,7 type Ⅱc+Ⅱ a lesions),4 typeⅢ(excavated) lesions. Pathologic classification: 70of 91 lesions in differentiated type, accounted for 80.2%, of which 8 high level intraepithelial neoplasia,49 well-differentiated tubular adenocarcinoma and 13 moderately differentiated adenocarcinoma. There were 21 undifferentiated type, of which 10 poorly differentiated adenocarcinoma,7 signet ring cell carcinoma,4 mucous adenocarcinoma. Lymph node metastasis rate was 12.1%,11 lesions with lymph node metastasis, including 2 differentiation type,9 undifferentiated type. There were 80 lymph node metastasis-negative lesions, of which 68 differentiated type,12 undifferentiated type, P<0.05. There were 26 nonexcavated lesions, without the lymph node metastasis. Excavated lesions is 65, associated with lymph node metastasis is 11, p<0.05. The depth of invasion:the lesions limited to the mucosa layer is 51, accounted for 56.0%, and lesions in submucosal layer is 40, accounted for 44.0%. The metastasis rate of submucosal lesions is much higher than it in mucosal lesions (22.5%> 3.9%, P<0.05). Lesion diameter size:There were 53 lesions which diameter less than 2.0 cm, lymph node metastasis rate was 5.7%. There were 17 lesions diameter between 2.0 and 3.0 cm, lymph node metastasis rate was 5.9%. There were 13 lesions had diameter more than 3.0 cm, lymph node metastasis rate was 44%(P<0.05).In this study early gastric cancer patients with helicobacter pylori infection was 40.7%, helicobacter pylori infection and lymph node metastasis has no statistical significance (P>0.05).Conclusion:Early gastric cancer peek age is more than 50 years old, male to female ratio is about 2.9:1. The main risk position of early gastric cancer is antrum, gastric body, gastric angle, fundus and cardia. Depressed lesions is the most common type of endoscopic morphology, including type Ⅱ c and type Ⅱ a+Ⅱ c. Type I and typeⅢlesions were rare. Differentiated type was more than undifferentiated type. The main histologic type is high differentiated tubular adenocarcinoma, differentiation type lesions in lymph node metastasis rate is lower than that in undifferentiated type. The lesions limited in mucosal layer was more than in submucosal layer. Lymph node metastasis rate in mucosal significantly lower than that in the submucosal layer. Excavated lesions in lymph node metastasis rate was significantly higher than nonexcavated lesions. The diameter of early gastric cancer is usually less than 3cm. With the increase of diameter, the lymph node metastasis is increase. Helicobacter pylori infection and lymph node metastasis has no statistical significance.