Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
【Abstract】Objective To study the correlation between focal adhesion kinase (FAK) expression and biological behavior of invasion and metastasis in gastric carcinoma. MethodsThe immunoreactivity of FAK was revealed by immunohistochemical method in gastric carcinoma tissues,canceradjacent tissues, normal gastric mucosa,and 200 regional lymph nodes in 50 collected specimens when radical resection of gastric carcinoma were carried out. ResultsThe percentage of FAK bly positive immunoreactivity were 10.0%（5/50）， 20.0%（10/50） and 78.0%（39/50） in normal gastric mucosa， cancer-adjacent tissues and gastric carcinoma tissues respectively. The b immunoreactivity was obviously higher in gastric carcinoma tissues than that in normal gastric mucosa or canceradjacent tissues (P＜0.01). There were no difference between normal gastric mucosa and canceradjacent tissues (Pgt;0.05). The percentage of bly positive immunoreactivity of FAK were 68.8%（22/32） and 33.3%（6/18） in cases with metastasis and without metastasis of lymph node respectively. The immunoreactivity of FAK in cases with metastasis of lymph node was significantly higher than that without metastasis of lymph node (P＜0.05).The b immunoreactivity of FAK were 87.2%（136/156） and 40.9%(18/44) in withmetastatic lymph node and withoutmetastatic lymph node. The immunoreactivity of FAK in withmetastatic lymph node was significantly higher than that withoutmetastatic lymph node （P＜0.01）. The percentage of FAK bly positive immunoreactivity showed correlation with the cellular differentiation and depth of infiltration of gastric carcinoma. The deeper infiltration and lower differentiation, the ber expression rate was obtained (P＜0.05), which showed no correlation with Borrmann type, location and size of tumor (Pgt;0.05). ConclusionIncreased immunoreactivity of FAK is an important role of invasion and metastasis for gastric carcinoma cells. Detection of FAK expression in cancer tissues can be helpful to understand the carcinogenic biological behavior of gastric carcinoma as well as to make judgment and treatment of prognosis of patients.
ObjectiveTo evaluate the effect of neoadjuvant chemotherapy and find the mechanism of multidrug resistance. MethodsTwenty patients with gastric cancer and 31 patients with colorectal cancer underwent neoadjuvant chemotherapy and then operations. The preoperative specimens were stained by immunohistochemical techniques for testing p53,multidrug resistanceassociated protein (MRP), glutathione S transferase（GST）, telomerase. Resection specimens were evaluated for chemotherapy effect by routine histology; at the same time, the postoperative morbidity and mortality were observed. ResultsIn 51 patients, the response rate of neoadjuvant chemotherapy was 27.45%(14/51),so multidrug resistance was a kind of common phenomena in gastrointestinal carcinomas. The postoperative morbidity was 15.69%(8/15), the main operation complication was infection,the mortality was 1.96%(1/51),only one person died from severe infection.The expression rate of p53, MRP, GST, telomerase was 58.0%,51.0%,66.7%,74.0%respectively, the location of p53 was at cell nucleus,location of MRP,GST was at cell memberane and cytoplasm,location of telomerase was at cytoplasm.The response rate had nothing to do with age, sex and metastasis. But it was related with p53 and telomerase expression. ConclusionNeoadjuvant chemotherapy is an effective, safe therapy. But the rate of drug resistance is high in gastrointestinal carcinomas, and the response rate is related to p53, telomerase expression.
【Abstract】Objective To investigate the correlation between the expression of fibronectin (FN) in extracellular matrix (ECM) and angiogenesis of gastric carcinoma.Methods The expressions of FN and vascular endothelial growth factor (VEGF) in 20 specimens of normal gastric tissue (normal group) and 80 specimens of gastric carcinoma tissue(gastric carcinoma group) were detected by EnVisonTM immunohistochemical technique. Tumor microvessel densit y (MVD) was evaluated by using antiCD34 antibody as an endothelial marker by the same technique as well. Results The immune complex of FN stained in brown were distributed around glands and in connective tissue of gastric specimens. In normal group, the staining of FN formed intact linear structure at basement membrane and presented regular striae form in connective tissue. In gastric carcinoma group, the integrity of linear structure of FN staining at basement membrane were destroyed to different extent and the staining of FN in connective tissue were changed deeper and distributed irregularly. The expression of VEGF and the value of MVD in the gastric carcinoma group was higher than those in normal group’s(P＜0.01, P＜0.01, respectively).This study indicated, that in gastric carcinoma group, the degree of FN expression in connective tissue had statistically positive correlations with the degree of VEGF expression and MVD value(P＜0.01, P＜0.05, respectively). Whereas the destruction extent of linear structure of FN staining at basement membrane showed no correlation with VEGF expression and MVD value(Pgt;0.05, Pgt;0.05, respectively).Conclusion The higher expression of FN in connective tissue of gastric carcinoma may well play a critical role in its process of angiogenesis and vasculogenesis. There may be an cooperative interactions between FN and VEGF in the process of angiogenesis and vasculogenesis of gastric carcinoma.
Objective To investigate the expression of syndecan-1 protein in gastric carcinoma and normal gastric mucosa tissues, and find out the correlation between the expression of syndecan-1 protein and the clinicopathologic characteristics of gastric carcinoma. Methods The expression of syndecan-1 protein was detected by immunohistochemistry (ABC) in 60 cases of gastric carcinoma, including gastric carcinoma tissues and normal gastric mucosa tissues. Results Syndecan-1 protein expressed in all of the 60 normal gastric mucosa tissues, however, only 10 of 60 gastric carcinoma tissues (16.67%) showed positive expression. The positive rate of syndecan-1 expression in normal gastric mucosa tissues was higher than that in gastric carcinoma tissues, and this difference was statistically significant (χ2=65.88, P＜0.05). The expression level of syndecan-1 protein in gastric carcinoma tissues with lymph node metastasis was lower than that without lymph node metastasis, and this difference was also statistically significant (χ2 =18.62, P＜0.05). In addition, syndecan-1 expression was not correlated with patients’ age and position of tumor (Pgt;0.05), but correlated with the diameter， invasion depth and TNM stage of tumor (Plt;0.05). Conclusion The positive expression of syndecan-1 protein is low in gastric carcinoma tissue and has b correlation with tumor stage and lymph node metastasis.
Objective To study the relationship between angiopoietin and the angiogenesis of gastric carcinoma, and to investigate the inter-regulation effect between different vascular growth factors which exist in microenvironment of gastric carcinoma. Methods Literatures about angiopoietin and angiogenesis of gastric carcinoma were collected and reviewed. Results There is a relationship between the expression of angiopoietin in microcirculation and the angiogenesis of gastric carcinoma. Yet, it is still a disputable issue on the inter-regulation effect of different vascular growth factors. Conclusion Angiopoietin may play an important role in the processes of sprouting, development and apoptosis of the microvessel of gastric carcinoma.
The effects of all-trans retinoic acid (ATRA) on primary gastric carcinoma models made by subcutaneous implanting gastric cancer to mice were observed. Thirty-two cancer bearing nude mice were randomly divided into 4 groups: control group (group Ⅰ)， ATRA low dose feeding group (100μg/day， group Ⅱ), moderate dose feeding group (300μg/day， group Ⅲ), and high dose feeding group (1 000 μg/day, group Ⅳ). The alteration of tumor growth, morphology, cytobiology, and immuno-histochemical assay were perfermed. The results showed significant inhibition of tumor growth and inducing differentiation in the group Ⅲ and group Ⅳ as compared with group Ⅰ (Ｐ＜0.01),and inhibited expression of p53, p21 protein in implanted tumor. The authors consider that ATRA has some effects of growth inhibition and differentiation on gastric cancer cells in vivo, and these is related to the inhibition of expression p53 and p21 onco-gene of cancer cells and accelerate apoptosis of carcinoma cells.
Objectives To evaluate the expression and clinical significance of COX-2 in gastric carcinoma. Methods Such databases as PubMed, CNKI, WanFang Data and VIP were searched for the studies on the association between COX-2 and gastric carcinoma from inception to January 2017. Two researchers independently screened literature, extracted data and evaluate the risk of bias of included studies. RevMan 5.3 software were used to analyze the data. Results Eleven case-control studies involving 1 366 patients were included. The results of meta-analysis showed that, there were significant differences of COX-2 expression in the following comparisons: gastric carcinoma vs. normal esophageal tissues (RR=1.69, 95%CI 1.39 to 2.06, P<0.000 01), with serosa invasivevs. without serosa invasive (RR=1.37, 95%CI 1.14 to 1.66, P=0.001), clinical stages Ⅰ-Ⅱ vs. clinical stages Ⅲ-Ⅳ (RR=0.78, 95%CI 0.69 to 0.90, P=0.000 3), as well as lymph node metastasis vs. non-lymph node metastasis (RR=1.48, 95%CI 1.34 to 1.63, P<0.000 01). While no significant difference was found between well/general differentiation group and poorly differentiation group (RR=0.84, 95%CI 0.51 to 1.38,P=0.48). Conclusion COX-2 expression is associated with depth of invasion, clinical stage and lymph node metastasis, which prompts that COX-2 may play an important role in the occurrence and development of gastric carcinoma. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo investigate the clinicopathological significance of integrin α5β1 expression and microvessel density(MVD) in gastric cancer(GC) and the correlation of MVD with integrin α5β1. MethodsThe expression of integrin α5β1 was detected by means of immunohistochemical staining (SP method) on paraffinembeded tissue specimens from 35 primary gastric carcinoma(PGC), 10 metastasic lymph node of gastric cancer and 8 chronic superficial gastritis (CSG). Vascular endothelial cells were stained immunohistochemically using antiCD34 monoclonal antibody to recognize microvessel(MV) in 35 cases of PGC and 8 CSG, MV was counted in 4 hot spot per slide under lightmicroscope (×400) and the average was defined as MVD. The results combined with clinicopathological parameters were analyzed statistically to characterize the role of integrin α5β1 and MVD in the progression of gastric cancer. ResultsIntegrin α5β1 expression and MVD in PGC were significantly higher than those in CSG respectively （t=3.32, P lt;0.01; t=2.30, Plt;0.05）; the expression of integrin α5β1 in PGC showed only a correlation with the invasion depth of tumor (t=2.29, Plt;0.05） while MVD showed all correlations with invasion depth,lymph node status and TNM stage （t=3.07, Plt;0.01; t=2.48, Plt;0.05; t=2.94,Plt;0.01）. Neither integrin α5β1expression nor MVD showed a relation with differential of PGC （t=0.15, Pgt;0.05; t=0.41, Pgt;0.05）. Integrin α5β1 was significantly overexpressed in lymph node metastatic cancer compared with that in corresponding PGC （t=2.45, Plt;0.05）; the difference of MVD showed no statistical significance among levels of integrin α5β1 expression in PGC （F =1.43,P＞0.05） and it showed no correlation with integrin α5β1 expression（r= 0.156, P=0.37）.Conclusion Overexpression of integrin α5β1 is present in GC and associates with the progression of tumor, implying that it may be viewed as the indicator of invasion and metastasis and the candidate target of gene therapy of gastric cancer. However, integrin α5β1 may not play an important role in the vascularization of GC.
【Abstract】 Objective To introduce the recent studies about the lymph node-targeted chemotherapy for gastric carcinoma. Methods The literatures on the lymph node-targeted chemotherapy for gastric carcinoma in recent years were collected and reviewed. Results The lymph node-targeted chemotherapy for gastric carcinoma was effective because it couled improve the drug concentrations in regional lymph node. Conclusion As a part of multiple treatments for gastric carcinoma, lymph node-targeted chemotherapy will be further developed.