Objective To investigate the clinical meanings of lymphangiogenesis, lymph vessel invasion (LVI) and lymph node (LN) micrometastasis in gastric cancer. Methods The expression of D2-40 in 68 patients with gastric cancer of primary lesion and the expressions of CK20 and (or) CKpan in 791 lymph nodes from 51 cases which were detected by immunohistochemical staining were analyzed, as well as their clinicopathologic profiles. The relationship of lymph vessel density (LVD), LVI and LN micrometastasis with LN metastasis and other clinicopathologic parameters was analyzed respectively. Results Positive rate of LVI with HE (LVI-HE) and D2-40 (LVI-IM) staining was respectively 66.2%(45/68) and 76.5%(52/68), P=0.118. The positive rate of LVI-IM was related to deeper tumor invasion (P=0.044), later stage of TNM (P=0.003) and LN metastasis (P=0.000). Average LVD of 68 cases was (18.19±7.44)/HP. The increment of LVD was significantly associated with LVI-HE positive status （P=0.040）, LVI-IM positive status （P=0.001）, venous invasion （P=0.037）, later stage of TNM （P=0.020） and LN metastasis （P=0.001）. The survival rate of the group sharing ≥15/HP of LVD was significantly lower than that in the group sharing ≤14/HP of LVD in early period of follow-up （P=0.032）. The incidence of nodal involvement in 51 patients was increased from 74.5%(38/51) by HE staining to 88.2%(45/51) by CK (CK20 or CKpan) immunostaining. The detection rate of metastasized LN was increased from 32.0%（253/791） by HE staining to 41.5%（328/791） by CK immunostaining (Plt;0.001). The significant difference of LN micrometastasis detection rate between CK20 (8.7%) and CKpan (12.3%) was also identified (P=0.003). The increased number of LN micrometastasis was related to larger diameter of tumor (P=0.001), higher LVI-HE positive rate (P=0.040), deeper invasion of tumor (P=0.018) and later stage of TNM (P=0.012). Both LN stage and TNM stage were changed according to the detection of LN micrometastasis: Seven patients of N0 should be recognized as N1 (N0→N1)， 6 as N1→N2, 1 as N2→N3. Four patients of stage Ⅰb should be recognized as stage Ⅱ (Ⅰb→Ⅱ)， 4 as Ⅱ→Ⅲa， 3 as Ⅲa→Ⅲb， 1 as Ⅲb→Ⅳ. Conclusion Detection of D2-40 and CK in diagnosis of LVI and LN micrometastasis is better than HE staining. The combined detection of CK20 and CKpan may be much easier to find out the LN with micrometastasis. Later stage of TNM the tumor is, more frequently the LN micrometastasis happens. The relationships of LVI-IM, LVD and LN micrometastasis with LN metastasis in gastric cancer has been demonstrated. Patients with higher LVD share a lower survival rate in early period of follow-up.
Stomach cancer is a malignancy arising from the stomach mucous epithelium. It accounts for 95% of all stomach malignancy cancer. The prevalence of stomach cancer is high in China and the treatment is debated, especially regarding choice of chemotherapy and treatment duration. In order to identify the best treatment and follow-up for patient with stage T2N0M0 stomach sinus cancer, we searched MEDLINE, SUMsearch, The Cochrane Library (Issue 4, 2004), Clinical Evidence (Issue 4, 2003) and CBMdisc (1981 to 2004). A total of 3 systematic reviews, 28 randomized controlled trails, 3 cohort studies and 3 observational studies were identified. We evaluated the quality of included studies.All studies were divided into 5 grades by the levels and grades of recommendation. We drew a conclusion by synthesizing the results of included studies: The primary treatment for the patient was surgery treatment including gastric deuto-total resection and D1 lymph node dissection. There was no evidence supporting chemotherapy use in either systematic or abdominal cavity after surgery. The survival rate was high in 5 years and 10 years, so the follow-up time should not be long and the follow-up infermission should not less than 1 year. Follow-up included the dynamic and delayed MR sequence with Gd-DTPA, the level of serum CA199, endoscope, and stool occult blood test.
Objective To summarize the current value of neoadjuvant chemotherapy (NAC) for potentially resectable gastric cancer. Methods The recent 5-year literatures searched through the PubMed with the key words: stomach neoplasm, gastric cancer/carcinoma, neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed. The present status of NAC for advanced gastric cancer was summarized, the necessity and feasibility were evaluated, and the patients features for selecting, the predictors for response, the mainly existing problems and development trend of NAC were analyzed. Results At present, there were 7 randomized control trails (RCT) published, and among them 3 were phase Ⅲ. It was safe, effective and feasible to most of trails in NAC for gastric cancer. However, it was still little to obtain survival benefit for NAC RCT, and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy. It remained lots of problems such as how to select the appropriate patients, the effective induced regimes and the predicted factors, the evaluated indices for response. Conclusion NAC is a safe, feasible and efficient method to potentially resectable gastric cancer, but strict phase Ⅲ randomized trials are needed. In the future, substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.
Objective To clarify the most important factors affecting the survival of patient with gastric carcinoma. Methods 428 cases of resected gastric carcinoma were studied by using univariate analyses and multivariate regression analyses. Results The most significant factors influencing survival of these patients were peritoneal dissemination, Borrmann classification, type of operation, hepatic metastasis, size of tumor, location, lymph node metastasis and age. Conclusion The factors influencing survival in patient with gastric carcinoma after resection can be correctly analyzed by cox’s proportional hazard model.
Objective To investigate the effect of mRNA expression of gelatinase A on the invasion and metastasis of human gastric carcinoma (HGC). MethodsThirtysix cases of HGC were examined by in situ hybridization technique. ResultsPositive expression rates of gelatinase A in the normal gastric tissue, peritumor tissue and HGC were 8.3%,35.7% and 83.3% respectively （P＜0.01）. The positive rates of gelatinase A in the group with serosal invasion and lymph node metastasis were 93.1% and 90.6%, much higher than those in the group with negative ones (42.9% and 25.0%).By in situ hybridization, gelatinase A mRNA was showed to be expressed in the extracellular matrix of tumor tissues,which surrounded the invasive margin of cancer tissues. The positive cells at these sites were mainly tumorinfiltrating macrophages. Conclusion There is good correlation between gelatinase A mRNA expression and the invasion, metastasis of HGC. So it can be used as a useful marker for invasion and metastasis of HGC.
Objective To investigate the expression of suppressor gene Runt-related transcription factor 3 (Runx3) in gastric carcinoma and its relationship with clinicopathologic parameters. Methods RT-PCR and Western blot were used to determine the mRNA expression and protein expression of Runx3 gene in primary tumor and corresponding normal tissues respectively in 52 patients with gastric carcinoma. The relationship between Runx3 expression and clinicopathologic parameters was analyzed. Results RT-PCR and Western blot analysis in 52 patients with gastric carcinoma showed down-regulation of Runx3 mRNA and Runx3 protein in 59.6% (31/52) and 48.1% （25/52） of the primary tumors tested, and in none of the normal tissues (P＜0.05) respectively. There was a significant negative correlation between the expression level of Runx3 gene and the clinicopathologic parameters such as tumor size, differentiation, infiltrative depth, lymph node metastasis and TNM stage (P＜0.05， P＜0.01). Runx3 gene transcription was coincident with its protein expression (r=0.840, P＜0.01）. Conclusion The expression of Runx3 gene is down-regulated in gastric carcinoma, which suggests that Runx3 gene plays an important role in carcinogenesis and the progression of gastric carcinoma. It may be a new target of diagnosis and treatment of gastric carcinoma.
ObjectiveTo detect the content of stromal cell derived factor-1α(SDF-1α) in peripheral blood of patients with gastric adenocarcinoma (GC) and investigate its clinical significances. MethodsThe contents of SDF-1αin the peripheral blood of 90 patients with GC were detected by enzyme-linked immunosorbent assay. The correlation of SDF-1αcontent with the clinicopathologic parameters and prognosis after operation were analyzed. Results①The content of SDF-1αin the patients with GC[(6950.8±1131.3) ng/L] was significantly higher than that in the normal healthy volunteers[(5023.7±1103.8) ng/l, P=0.036].②The content of SDF-1αin the GC patients with distant metastasis[(8251.6±1042.5) ng/L] was significantly higher than that without distant metastasis[(6785.3±1025.0) ng/L, P < 0.001]. The contents of SDF-1αin the peripheral blood of patients with distant metastasis either in the liver (P=0.002) or in the lung (P=0.030) were significantly higher than those without distant metastasis (liver or lung).③The TNM stage was later (P < 0.001), lymph node metastasis was broader (P=0.018), invasion of tumor was deeper (P < 0.001), vascular invasion (P < 0.001) and lymphatic vessel invasion were present (P < 0.001), the contents of SDF-1αwere higer. Logistic regression analysis revealed that the depth of tumor invasion (OR=14.999, 95% CI 3.568-74.456, P=0.027) and distant metastasis (OR=0.186, 95% CI 0.610-2.014, P=0.026) were correlated with the high SDF-1αcontent.④The survival time of the patients with higher content of SDF-1αwas significantly shorter than that of the lower content of SDF-1α(P < 0.001). Cox proportial hazard regression model analysis demonstrated that TNM stage (RR=2.497, 95% CI 1.987-10.238, P=0.009), vascular invasion (RR=7.501, 95% CI 2.086-16.942, P=0.002), and high content of SDF-1α(RR=18.302, 95% CI 6.895-30.538, P=0.001) in the peripheral blood were the independent risk factors for survival of the patients with GC. ConclusionHigh content of SDF-1αin peripheral blood might suggest the occurrence of lymph node metastasis, hepatic metastasis or lung metastasis and indicate the poorer prognosis of GC.
Objective To evaluate the status of lymph node metastasis and reasonable procedure in gastric cancer. Methods The incidence of metastases from gastric cancer to various regional lymph node stations was studied in 1 505 patients with gastric cancer. The patients underwent surgical resection from January 1995 to December 2004.Results Lymph node metastasis were observed in 928 of 1 505 cases (61.7%). Lymph node metastasis frequency was found in groups No.1 （32.9%），No.3 （28.7%）， No.2 （20.4%）， and No.7 （18.6%） at upper third stomach cancer；in groups No.3 （32.5%）， No.4 （24.7%）， No.7 （20.6%）， and No.1 （17.3%） at middle third stomach cancer； in groups No.6 （33.7%）， No.3 （31.3%）， No.4 （25.6%）， and No.7 （21.5%） at lower third stomach cancer. Conclusions Distribution of metastatic lymph node is clearly related to the location of the tumor. Anatomical extent of lymph node metastases in gastric cancer provid surgical guidance for surgeons.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
Objective To investigate the effect and surgical skill of ultracision harmonic scalpel in curative gastrectomy for patients with gastric carcinoma. Methods From January 2007 to May 2008, the data of 152 patients who were treated by curative gastrectomy with ultracision harmonic scalpel were analyzed retrospectively. Results The mean operative time was (189.5±24.2) min. Compared with the conventional operation, the number of harvested lymph nodes (mean: 30.4±11.6) in patients treated with ultracision harmonic scalpel was increased. The application of ultracision harmonic scalpel could shorten the operation time, decrease the intraoperative blood loss and make the operation field clear. There were no postoperative complications, such as anastomotic leakage, lymphatic leakage and massive hemorrhage. And there was no death in this series. Conclusion The usage of ultracision harmonic scalpel which could improve the curative degree of lymphadenectomy is safe in curative gastrectomy for patients with gastric carcinoma.