Clinicopathological characteristics of clinical early XXXX in the upper-third stomach.

@entity1 @entity5 @entity356 @entity3
AIM: To elucidate the clinicopathological characteristics of clinically early @entity356 in the upper-third stomach and to clarify treatment precautions. METHODS: A total of 683 @entity1 with clinical early @entity356 were enrolled in this retrospective study, 128 of whom had @entity356 in the upper-third stomach (U group). All @entity1 underwent a double contrast barium examination, endoscopy, and computed tomography (CT), and were diagnosed preoperatively based on the findings obtained. The clinicopathological features of these @entity1 were compared with those of @entity1 with @entity356 in the middle- and lower-third stomach (ML group). We also compared clinicopathological factors between accurate-diagnosis and under-diagnosis groups in order to identify factors affecting the accuracy of a preoperative diagnosis of @entity5 depth. RESULTS: @entity1 in the U group were older (P = 0.029), had a higher ratio of males to females (P = 0.015), and had more histologically differentiated @entity5 (P = 0.007) than @entity1 in the ML group. A clinical under-diagnosis occurred in 57 out of 683 @entity1 (8.3%), and was more frequent in the U group than in the ML group (16.4% vs 6.3%, P < 0.0001). Therefore, the rates of lymph node @entity3 and lymphatic invasion were slightly higher in the U group than in the ML group (P = 0.071 and 0.082, respectively). An under-diagnosis was more frequent in histologically undifferentiated @entity5 (P = 0.094) and in those larger than 4 cm (P = 0.024). The median follow-up period after surgery was 56 mo (range, 1-186 mo). Overall, survival and disease-specific survival rates were significantly lower in the U group than in the ML group (P = 0.016 and 0.020, respectively). However, limited operation-related @entity5 recurrence was not detected in the U group in the present study. CONCLUSION: Clinical early @entity356 in the upper-third stomach has distinguishable characteristics that increase the risk of a clinical under-diagnosis, especially in @entity1 with larger or undifferentiated @entity5 .
