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A clinicopathologic study of mucinous gastric carcinoma including multivariate analysis

1999; Wiley; Volume: 85; Issue: 8 Linguagem: Inglês

10.1002/(sici)1097-0142(19990415)85

1097-0142

Yosuke Adachi, Seigo Kitano, Masaki Mori,

Metastasis and carcinoma case studies

We read with great interest the recent article by Dr. Wu et al.1 The authors referred to our study2 and stated in the “Discussion” section that: “…Adachi et al. chose only advanced gastric carcinoma cases for the NGC [nonmucinous gastric carcinoma] control group to compare with all [italics authors'] MGC [mucinous gastric carcinoma] cases, including early gastric carcinoma.” However, Wu et al. misinterpreted our study, and this statement is not accurate. They compared the data of 22 patients with MGC with the data of 46 patients with NGC who were selected as controls from 905 NGC patients. The 5-year survival rate for the MGC cases was lower than that for the NGC cases, but the frequency of Stage I and II disease was significantly less frequent in MGC cases (0% and 18%, respectively) compared with NGC cases (11% and 33%, respectively) (P < 0.05). If MGC was considered to be more aggressive it would be because MGC was detected most often in an advanced stage and rarely in an early stage. Therefore, to clarify the biologic behavior of MGC clinicopathologic characteristics and treatment results must be compared among the same stages. In our previous study,2 we investigated 42 patients with MGC and, after excluding 1 patient with early stage MGC, we compared the surgical outcome of 41 patients with advanced MGC with that of 73 patients with advanced NGC. The results indicated that the MGC cases and NGC cases were not different with regard to the frequencies of serosal invasion (76% vs. 77%), lymph node metastases (85% vs. 79%), Stage III and IV disease (78% vs. 86%), overall 5-year survival rate (39% vs. 30%), and 5-year survival rate after curative resection (58% vs. 56%). Thus, we concluded that when comparing advanced tumors, the biologic behavior of MGC did not differ from that of NGC. To confirm the results of our previous study in Kyushu University Hospital, pathologic and follow-up data from Oita Medical University Hospital were analyzed. A total of 630 patients underwent gastrectomy for gastric adenocarcinoma and 17 patients (2.7%) had MGC; all were cases of advanced MGC and there was no case of early MGC. The 10-year survival rate for the 17 MGC patients (45%) was lower than that for the 613 NGC patients (72%) (P < 0.05), whereas the 10-year survival rate for the 17 patients with advanced MGC (45%) was not different from that for the 326 patients with advanced NGC (49%). Therefore, if MGC was considered clinically more malignant, it would be because advanced MGC predominates over early MGC. Again we would like to emphasize that the biologic behavior of advanced MGC is similar to that of advanced NGC, and that histologic subtype (well differentiated and poorly differentiated types) is useful for predicting metastases and the recurrence pattern of MGC.2 We hope this letter will contribute to the further understanding of MGC. Yosuke Adachi M.D.*, Seigo Kitano M.D.*, Masaki Mori M.D. , * First Department of Surgery, Oita Medical University, Oita, Japan, Medical Institute of Bioregulation, Kyushu University, Kyushu, Japan