Ulcer Size and Gastric Cancer Prognosis

ferent types of macroscopic appearances (polypoid, ulcerative, fungating) of gastric cancer. Accordingly, several studies have already shown the prognostic importance of tumor size [2, 3] . In their study, there is a significant relationship between ulcer size and tumor size (4 cm). In the U2 group (ulcer 1 3 cm), 94% of the patients had tumor diameters 1 4 cm. If the authors had chosen to compare tumor size of 5 cm instead of 4 cm, it might have been 100%. For that reason, I think that tumor size is a much better prognostic criterion than ulcer size in clinical practice when we consider all gastric cancer patients. Dear Sir, I read with great interest the article by Xu et al. [1] . The authors present the ulcer size as a novel prognostic criterion for gastric cancer. The authors also emphasize the preoperative predictive use of ulcer size. In fact, it is not surprising that the patients with larger tumors and wider ulcers have greater invasion into the gastric wall in terms of depth of invasion and more frequent lymph node metastasis than the patients with smaller ulcers. However, there is one item missing. Nearly half of gastric cancers are fungating or polypoid and we cannot ignore these patients. Moreover, there is considerable overlap between difPublished online: June 22, 2010