The aim of this paper was to propose an early gastric cancer (EGC) adapted staging system, based on an international consensus established between pathologists from Eastern Europe and Japan.
From 338 consecutive cases of gastric cancer (GC) diagnosed in four countries (Romania, Hungary, Poland, Japan), 29 cases were EGCs and were selected for further examinations. Based on their particular features, data from literature, and daily experience of the five Professors of Pathology, we suggest criteria for a specific staging system for EGC.
Because EGC can present aggressive behavior depending on the depth of invasion in the mucosa (upper-, middle-, and lower mucosa) and submucosa, the stages T1a and T1b should be subdivided. The pN parameter (lymph node metastases from EGC) should be reported based on the number of metastatic lymph nodes but the type of metastasis should also be mentioned (isolated cells, micrometastasis, metastasis). Angiolymphatic invasion and carcinomatosis of the lymph vessels should be included as distinct parameters of EGC, with prognostic and predictive role. The pM parameter (distant metastases from EGC) should be sub-divided in metastasis in distant lymph nodes (including skip metastasis), metastasis in one organ (liver, lung, brain, solitary bone metastasis, etc.), and metastasis in more than one organ (that includes multicentric bone metastasis).
Increasing number of GCs diagnosed in early stages and number of medical centers where endoscopic dissection of EGC is a routine technique, indicate the necessity of adapting AJCC/UICC staging system for EGC, correlating the Western and Eastern opinion. The research was founded by project UMFTGM-PO-CC-02-F01-19/2014.
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All authors have declared no conflicts of interest.