Early Gastric Cancers in Central Norway 2001 to 2016—A Population-Based Study

TL;DR

Early gastric cancers are rare and hard to cure, with few diagnosed in Central Norway from 2001 to 2016, and survival rates were moderate.

Contribution

The study provides a population-based characterization of early gastric cancers and evaluates the eCura score's predictive value in a Western setting.

Findings

Only 7.3% of gastric cancers were early, with no significant change in proportion over 15 years.

eCura score alone was insufficient to predict patients without lymph node metastases.

The 5-year survival rate for early gastric cancer patients was 75%.

Abstract

Stomach cancer is rarely diagnosed at early stages, while it is still easy to cure. We gathered information from national registries and evaluated all patients with early stomach cancer in a defined healthcare region and re-examined tissue samples to characterize this group. We found that only 88 of 1205 stomach cancers from 2001 to 2016 were early cancers, with no major change in how common early cancers were during the 15-year study period. Specific features of the early gastric cancer (EGC), such as size, growth depth, growth into veins, and ulceration, were associated with spreading to regional lymph nodes. The patients were followed up for a minimum of five years after the operation, and most died of causes unrelated to stomach cancer. However, 12.7% of the deaths were cancer-related, with similar proportions being due to complications after surgery and recurrence of EGC, which could manifest itself more than five years after diagnosis.

Early gastric cancers (EGCs) are confined to the gastric mucosa and submucosa irrespective of lymph node metastases and constitute only a minor proportion of gastric cancer in Western countries. We aimed to characterize EGCs and assess the survival of EGC in Central Norway during 2001–2016. A retrospective population-based study on 1205 patients with gastric cancer was performed. At the time, surgical resection was the standard treatment, and 88 (7.3%) EGCs were identified. Histopathological specimens were re-examined, and the eCura score and survival were evaluated. The number of gastric cancers declined (p = 0.010), but the relative proportion of EGC was unchanged during the study period. EGCs were more often of the Lauren intestinal type (p < 0.001) compared with controls. A significant proportion (9.4%, n = 5) of the patients with a low-risk eCura had lymph node metastases, whereas further exclusion of tumors with histological ulceration or SM2 invasion identified an N0 cohort. The median survival for EGC patients was 117.1 months (95% CI 99.8–134.3) and the 5-year overall survival was 75%. Twelve deaths were cancer-related, either due to postoperative complications (5.7%, n = 5) or cancer recurrence (8%, n = 7). In conclusion, EGCs constituted a minor but constant proportion of gastric cancers. eCura alone was insufficient in predicting patients with pN0 disease.

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