Dukes' A tumor: New criteria for early gastric cancer

Dukes' classification for colorectal cancer is easy to remember and accurate in estimating survival. The Japanese definition of early gastric cancer have some problems, since it includes node-positive cases showing a worse prognosis. The aim of this study was to clarify whether or not Dukes' A tumor can be used as new criteria for early gastric cancer. Using 217 patients who underwent radical gastrectomy and lymph node dissection for primary gastric adenocarcinoma, long-term results and cumulative survival rates after operation were examined. Patients consisted of three groups: Group 1, 20 patients with node-negative tumor invading down to the muscularis propria, Group 2, 175 patients with node-negative tumor limited to the mucosa or submucosa, and Group 3, 22 patients with node-positive tumor limited to the mucosa or submucosa. The 10-year survival rates for Group 1, Group 2, and Group 3 patients were 94.7%, 96.9%, and 85.1%, respectively. The survival rate of Group 3 patients was significantly lower than that of Group 1 and Group 2 patients (p<0.05). The prognosis of patients with Dukes' A tumor (Group 1 plus Group 2) was excellent, showing 10-year survival rate of 96.6%. Mucosal or submucosal cancer brought a poor prognosis when there was lymph node metastasis. Early gastric cancer would better be defined as a Dukes' A tumor which includes node-negative tumor not beyond the muscularis propria.