Second Lesions Occurring within the same belt-like region along the short axis of the stomach as Primary Lesions “BELT: Born Equal Line Tumors”: A Retrospective Clinicopathological Study of Early Gastric Cancer and Adenomas

Aims Gastric adenoma and cancer are common neoplasms in Asian countries. Gastric adenoma is a precancerous lesion, and early detection prior to malignant transformation is crucial. Similarly, early identification of gastric cancer significantly impacts patient prognosis. The reported frequency of synchronous multiple early gastric cancers ranges from 6% to 14%. However, the clinical characteristics of these cases remain unclear. To aid in early detection of similar lesions, we retrospectively analyze the clinicopathological characteristics of synchronous multiple gastric neoplasms treated with endoscopic resection or surgery [1] [2] [3] [4] [5] [6] [7] [8] [9].

Methods Among 2,991 cases diagnosed with early gastric cancer or adenoma at our institution, we included 173 cases with 346 lesions diagnosed with synchronous multiple gastric neoplasms from January 2016 to March 2024. Multiple lesions were categorized into a “1st lesion” group and a “2nd lesion” group based on tumor diameter, with larger lesions defined as 1st lesions and smaller as 2nd lesions. Clinicopathological characteristics between these two groups were analyzed retrospectively.

Results A total of 173 patients (mean age 73.2 years, 72.8% male) with 346 lesions were analyzed. Lesions were primarily located in the lower and middle thirds of the stomach, and most were differentiated carcinomas (92.2%). Lesion morphology was predominantly depressed (52.9%), with a brownish appearance on narrow band imaging in 65.3%. The mean tumor diameter was 13.4mm. Comparison between the 1st lesion and 2nd lesion groups showed significant differences in size but no notable differences in others. The concordance rates and Cramer's V coefficient for various parameters were high. The concordance rates are 69.4% for location (U; Upper third, M; Middle third, L; Lower third), 62.4% for location (l; lesser curvature, a; anterior wall, g; greater curvature, p; posterior wall), 75.1% for histology, 67.1% for morphology, 78.0% for depth of invasion, 68.2% for BA and 65.3% for coloration. Cramér's V is 0.607 for location (UML), 0.481 for location (lagp), 0.220 for pathologic results, 0.438 for morphology, 0.404 for depth of invasion, 0.796 for BA, and 0.768 for coloration. In particular, Cramér's V exceeded 0.25 for 'location (U, M, L)', 'location (l, a, g, p)', 'morphology', 'depth of invasion', 'BA', and 'coloration', indicating a high correlation. During the observation period, the survival rate was 94.8%, with nine deaths, all due to unrelated causes.

Conclusions Synchronous multiple gastric neoplasms tend to have similar endoscopic and histopathologic features and often occur within the same belt-like region along the short axis of the stomach. The tumors that occur in multiple lesions in this area were named BELT: Born Equal Line Tumors. When one lesion is identified, it is essential to consider the possibility of “BELT”.

Publication History

Article published online:
27 March 2025

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