Jize MYG, Wu W, Ding SG, Zhang J. Discrepancies between preoperative assessment and final pathological criteria in early gastric cancer. World J Gastrointest Oncol 2026; 18(1): 110102 [DOI: 10.4251/wjgo.v18.i1.110102]
Corresponding Author of This Article
Jing Zhang, MD, Associate Professor, Chief Physician, Department of Gastroenterology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing 100083, China. sihuizhang@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 15, 2026 (publication date) through Jan 12, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Oncology
ISSN
1948-5204
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Jize MYG, Wu W, Ding SG, Zhang J. Discrepancies between preoperative assessment and final pathological criteria in early gastric cancer. World J Gastrointest Oncol 2026; 18(1): 110102 [DOI: 10.4251/wjgo.v18.i1.110102]
World J Gastrointest Oncol. Jan 15, 2026; 18(1): 110102 Published online Jan 15, 2026. doi: 10.4251/wjgo.v18.i1.110102
Discrepancies between preoperative assessment and final pathological criteria in early gastric cancer
Mo-Yi-Ge Jize, Wei Wu, Shi-Gang Ding, Jing Zhang
Mo-Yi-Ge Jize, Wei Wu, Shi-Gang Ding, Jing Zhang, Department of Gastroenterology, Peking University Third Hospital, Beijing 100083, China
Mo-Yi-Ge Jize, Wei Wu, Shi-Gang Ding, Jing Zhang, Department of Gastroenterology, Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases (BZ0371), Beijing 100083, China
Author contributions: Jize MYG, Ding SG, and Zhang J designed the study; Jize MYG and Wu W were responsible for developing the methodology and participated in formal analysis and investigation; Jize MYG wrote the original draft; Ding SG and Zhang J participated in manuscript review and editing.
Supported by China Health & Medical Development Foundation, No. M2021551.
Institutional review board statement: This study was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee (Approval No. 2021-509-02).
Informed consent statement: The need for informed consent was waived by the Peking University Third Hospital Medical Science Research Ethics Committee (Approval No. 2021-509-02).
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Zhang, MD, Associate Professor, Chief Physician, Department of Gastroenterology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing 100083, China. sihuizhang@sina.com
Received: May 30, 2025 Revised: July 5, 2025 Accepted: November 13, 2025 Published online: January 15, 2026 Processing time: 227 Days and 19.1 Hours
Abstract
BACKGROUND
Inappropriate selection of patients with early gastric cancer (EGC) for endoscopic submucosal dissection (ESD) may lead to non-curative resection, necessitating additional gastrectomy. Conversely, inappropriate selection for gastrectomy may result in overtreatment, adversely affecting patients’ quality of life. Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC. To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’, we specifically assess the suitability of Japanese guidelines in non-Japanese populations. This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.
AIM
To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.
METHODS
A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022. Cases were categorized into three groups: Same-estimated (preoperative therapeutic indication with postoperative pathological criteria matched), underestimated (preoperative ESD indication but postoperative surgical criteria), and overestimated (preoperative surgical indication but postoperative ESD criteria). The rate of discrepancy and associated risk factors were assessed.
RESULTS
The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0% (321/430) and 76.0% (278/366), respectively. The overall discrepancy rate was 25.6% (204/796). Multivariate analysis identified tumor location in the upper-third stomach (odds ratio = 2.158, 95% confidence interval: 1.373-3.390, P = 0.001) was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy (odds ratio = 2.005, 95% confidence interval: 1.036-3.879, P = 0.039) was more likely to be overestimated. Significant differences were observed in tumor diameter (P < 0.001), depth of infiltration (P < 0.001), ulcerative findings (P < 0.001), and histologic type (P < 0.001) between preoperative and postoperative evaluations.
CONCLUSION
The accuracy of preoperative EGC indications is 74.4%. Upper-third stomach and undifferentiated histology are primary discrepancy predictors. Upper-third tumors are prone to underestimation, while undifferentiated tumors are prone to overestimation.
Core Tip: Current Japanese guideline-based therapeutic indications for early gastric cancer show 74.4% concordance with postoperative pathological criteria in this cohort of 796 patiensts (2010-2022). Key discordance risk factors are tumors in the upper third stomach (prone to pathological underestimation) and undifferentiated histology (prone to overestimation). These findings necessitate heightened preoperative vigilance: endoscopic reevaluation with mapping biopsies for proximal lesions to address technical challenges and avoid non-curative and secondary resections.
