Early gastric cancer: is it a distinct clinical entity?

Of 199 patients with gastric cancer seen at The Montreal General Hospital between 1970 and 1981, 104 were considered to have had a curative resection, and 26 of these were early gastric cancers (EGC). The authors compared early gastric cancers with advanced, but resectable, gastric cancers to determine whether EGC is a distinct entity or a stage in the progressive evolution of gastric cancer. They found that depth of invasion was the primary determinant of outcome, but that there was no discrete cut-off point between the depth of invasion associated with early and with advanced gastric cancers. The pathological features normally associated with a favourable prognosis in gastric cancer, such as absence of lymph-node metastases, an expanding growth pattern, intestinal metaplasia, and well-differentiated histologic features correlated highly with depth of invasion but did not appear to change abruptly between EGC and advanced resectable lesions. The authors conclude that EGC is not a distinct pathological or clinical entity but a stage in the progressive growth of gastric cancer.