Background: The macroscopic appearance of early gastric cancer (EGC) is known to reflect its growth patterns. The purpose of this study was to investigate the role of the endoscopic appearance as a predictor of clinical behavior in EGC. Methods: Between January 2005 and December 2008, 1,845 patients were diagnosed with EGC and underwent surgery. The clinicopathologic characteristics were retrospectively analyzed according to gross appearance. Endoscopic findings were classified by predominant type as elevated, flat, or depressed. Flat and depressed types were categorized together as nonelevated type. Results: The proportions of elevated, flat, and depressed types were 16.6, 28.6, and 54.8 %. The gross appearance of the elevated type predominantly showed well/moderate differentiation, whereas the flat and depressed types showed signet-ring cells and poor differentiation, respectively. When the elevated and nonelevated types were compared, submucosal invasion, lymphovascular invasion (LVI), and lymph-node metastasis (LNM) were higher in elevated than in nonelevated type. In differentiated EGC, submucosal invasion, LVI, LNM, and multiplicity were significantly higher in the elevated than the nonelevated type. These patterns were significantly common in the order elevated, depressed, and flat types. In undifferentiated EGC, submucosal invasion, LVI, and perineural invasion were significantly higher in elevated than in nonelevated type. These patterns were significantly common in the order elevated, depressed, and flat types. However, LNM was not significantly different based on gross appearance in undifferentiated EGC. Conclusions: Clinical behavior differs according to endoscopic appearance in EGC. The endoscopic appearance of EGC may facilitate prediction of clinical behavior, particularly in differentiated EGC.
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