-Original-

A Proposed New Clinical Classification of Metastatic Gastric Cancer: Pyloric and Antral Gastric Cancer

Tetsuro Kawagoe, Go Ikeda, Yu Oshiro, Keiko Kaneko and Katsuhiko Iwakiri

Department of Gastroenterological Medicine, Nippon Medical School, Tokyo, Japan

Background: We aimed to classify metastatic pyloric/antral gastric cancer in terms of macroscopic morphology and metastatic form.
Methods: Thirty-eight patients with pyloric/antral gastric cancer were included in the study. Patients were classified according to a combination of Borrmann classification type and metastatic type, and the clinicopathological characteristics of each group were compared.
Result: Of the 38 patients, 33 (type II: 9 and type III: 24) (87%) had ulcerative gastric cancer. Ulcerative gastric cancer was classified into four groups: lymphatic only group (L+H−P−), lymphatic + hematogenous group (L+H+P−), disseminated ± lymphatic group (L±H−P+), and lymphatic + hematogenous + disseminated group (L+H+P+). In the L+H−P− group, all patients had bulky lymph nodes and serum levels of both carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were high; the condition of patients was good, and the therapeutic response was good. In the L+H+P− group, metastases other than liver metastases were rare, and serum CEA levels were high. In the L±H−P+ group, the predominant histological type was signet ring cell carcinoma; both serum CEA and CA19-9 levels were low. Patients in the L+H+P+ group had higher serum CA19-9 levels and were more prone to hematogenous metastasis to various organs; these patients had worse patient status and lower treatment response. Gastric cancer other than ulcerative type was only detected in five patients (type V: 3, type IV: 1, type I: 1).
Conclusion: Classification by a combination of macroscopic and metastatic form in pyloric/antral metastatic gastric cancer might be useful for diagnosis and treatment.

J Nippon Med Sch 2022; 89: 176-183

Keywords
clinical classification, metastatic gastric cancer, pyloric and antral gastric cancer

Correspondence to
Tetsuro Kawagoe, Department of Gastroenterological Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
tetsuro@nms.ac.jp

Received, March 12, 2021
Accepted, June 8, 2021