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Liu YF, Guo S, Zhao R, Chen YG, Wang XQ, Xu KS. Correlation of vascular endothelial growth factor expression with tumor recurrence and poor prognosis in patients with pN0 gastric cancer. World J Surg 2012; 36:109-17. [PMID: 21773953 DOI: 10.1007/s00268-011-1192-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)-9 play important roles in tumor angiogenesis, development, and progression. This study investigates the expression of VEGF combined with MMP-9, their correlation with clinical characteristics, and their effect on the prognosis for patients with pN0 gastric cancer after curative surgery. METHODS A total of 55 patients were enrolled in the study. They were analyzed by immunohistochemistry, and their correlation with clinical characteristics was then investigated. Their relations and the survival time of patients were retrospectively analyzed. RESULTS VEGF and MMP-9 were positively expressed in 24 (43.6%) and 16 (29.1%) patients, respectively, and had a positive correlation (r = 0.324, p = 0.016) in the Spearman rank correlation analysis. Univariate analysis showed that VEGF, MMP-9 expression, vascular invasion, T stage, and tumor size were associated with tumor recurrence as well as the disease-specific (DSS) and overall (OS) survival rates. Patients with positive VEGF expression showed significantly higher recurrence and poorer DSS and OS rates compared with those with negative VEGF expression. Multivariate analysis showed that VEGF expression, vascular invasion, T stage (serosal invasion), and tumor size were significant independent prognostic factors for tumor recurrence, DSS, and OS in patients with pN0 gastric cancer with the exception that T stage was not for DSS. CONCLUSIONS VEGF expression, vascular invasion, T stage (serosal invasion), and tumor size can be used as valuable prognosticators in predicting tumor recurrence and prognosis for patients with pN0 gastric cancer after curative surgery. VEGF may have a synergistic effect with MMP-9 during tumor angiogenesis, development, and progression.
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Affiliation(s)
- Yan-Feng Liu
- Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, 107#, Wenhua Xi Road, Jinan 250012, China
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Kim HG, Kang H, Kim DY, Joo JK, Ryu SY, Lee JH. Clinicopathologic characteristics of serosa-positive gastric carcinoma in elderly patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:19-24. [PMID: 22066096 PMCID: PMC3204556 DOI: 10.4174/jkss.2011.81.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/18/2011] [Indexed: 11/30/2022]
Abstract
Purpose The relationship between the prognosis and the age of patients with gastric carcinoma is controversial. This study examined the clinicopathologic features of elderly gastric carcinoma patients with serosal invasion. Methods We reviewed the hospital records of 136 elderly gastric carcinoma patients with serosal invasion retrospectively to compare the clinicopathologic findings in the elderly (aged > 70 years) and young (aged < 36 years). Results The 5-year survival rates of elderly and young patients with curative resection did not differ statistically (33.9% vs. 43.3%; P = 0.318). Multivariate analysis showed that two factors were independent, statistically significant parameters associated with survival: histologic type (risk ratio, 1.805; 95% confidence interval [CI], 1.041 to 3.132; P < 0.05) and operative curability (risk ratio, 2.506; 95% CI, 1.371 to 4.581; P < 0.01). Conclusion This study demonstrated that elderly gastric carcinoma patients with serosal invasion do not have a worse prognosis than young patients. The important prognostic factor was whether the patients underwent curative resection.
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Affiliation(s)
- Ho Gun Kim
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Raftopoulos SC, Segarajasingam DS, Burke V, Ee HC, Yusoff IF. A cohort study of missed and new cancers after esophagogastroduodenoscopy. Am J Gastroenterol 2010; 105:1292-7. [PMID: 20068557 DOI: 10.1038/ajg.2009.736] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Little is known about missed rates of upper gastrointestinal cancer (UGC) in Western populations, with most data originating from Japanese centers quoting high missed rates of 23.5-25.8%. The objective of this study was to better define missed rates of esophagogastroduodenoscopy (EGD) and the natural history of UGC in a Western population that underwent an initial EGD without cancer, but were subsequently diagnosed with a UGC. Our hypothesis was that a normal EGD rarely misses the detection of UGC. METHODS This is a retrospective cohort study. A prospectively maintained electronic database was used to identify all patients who underwent EGD between 1990 and 2004 at the study institution. Patients in this cohort who were diagnosed with UGC before 2006 were identified through the Western Australian Cancer Registry. We defined missed cancers as those diagnosed within 1 year of EGD, possible missed cancers as those diagnosed 1-3 years after EGD, and new cancers as those diagnosed more than 3 years after EGD. This study had no interventions and was conducted at a tertiary referral center. The main outcome measurement included UGC. RESULTS Of the 28,064 EGDs performed, UGC was diagnosed subsequent to the procedure in 116 cases (0.41%). There were 29 missed cancers, 26 possible missed cancers, and 75 new cancers. Of the missed cancers, 11 were esophageal, 15 were gastric, and 3 were duodenal. In 69% (n=20) of the missed cancers, an abnormality was described at the site of malignancy. In 59% (n=17) of the missed cancers, the indication for EGD was an alarm symptom of dysphagia or suspected blood loss. In an univariate analysis, the presence of an alarm symptom was related to missed cancers, whereas operator experience, trainee participation, and usage of newer equipment were not. One of the main limitations of this study is that it was a retrospective review. CONCLUSIONS UGC is rare after normal EGD, confirming the high accuracy of EGD. Institutional approval was granted for the conduct of this study.
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Affiliation(s)
- Spiro C Raftopoulos
- Department of Gastroenterology/Hepatology, Sir Charles Gairdner Hospital, and School of Medicine and Pharmacology, University of Western Australia, Nedlands, Perth, Western Australia, Australia.
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Prognosis of gastric cancer patients with node-negative metastasis following curative resection: outcomes of the survival and recurrence. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 22:835-9. [PMID: 18925308 DOI: 10.1155/2008/761821] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The purpose of the present study was to provide valuable prognostic information on lymph node-negative gastric cancer patients following curative resection. METHODS Data from 112 lymph node-negative gastric cancer patients who underwent curative resection were reviewed to identify the independent factors of overall survival and recurrence. RESULTS The five-year survival rate of lymph node-negative gastric cancer patients was 85.7%, and recurrence was identified in 25 patients after curative surgery. The five-year survival rate of lymph node-negative gastric cancer patients was higher than that of lymph node-positive gastric cancer patients (P<0.001). Recurrence in lymph node-negative gastric cancer patients was less than that of lymph node-positive gastric cancer patients (P=0.001). The median survival after recurrence of lymph node-negative gastric cancer patients was longer than that of lymph node-positive gastric cancer patients (P=0.021). Using multivariate analyses, the following results were determined for lymph node-negative gastric cancer patients: sex, operative type and the presence of serosal involvement were independent factors of overall survival; and lymphadenectomy, number of dissected nodes and the presence of serosal involvement were independent factors of recurrence. CONCLUSIONS The prognosis of lymph node-negative gastric cancer patients was better than that of lymph node-positive gastric cancer patients. Male sex, subtotal gastrectomy and nonserosal involvement should be considered to be the favourable predictors of postoperative long-term survival of lymph node-negative gastric cancer patients. Conversely, limited lymphadenectomy, few dissected nodes and serosal involvement should be considered to be risk factors of postoperative recurrence of lymph node-negative gastric cancer patients.
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Kim DY, Joo JK, Park YK, Ryu SY, Kim YJ, Kim SK. Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection. Langenbecks Arch Surg 2006; 392:131-4. [PMID: 17089174 DOI: 10.1007/s00423-006-0114-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Accepted: 09/20/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS We analyzed the clinicopathologic features of node-positive gastric carcinoma patients who were long-term survivors (5 years or longer) and evaluated the predictive factors associated with long-term survival. PATIENTS AND METHODS Of 554 node-positive gastric carcinoma patients with curative resection, 161 (29.1%) were long-term survivors, and 393 died of the disease before 5 years. RESULTS The long-term survivor group had a recurrence rate of 16.1%, while the recurrence rate was 95.4% in the short-term survivor group (P < 0.05). The mean tumor size in the long-term survivors (4.5 cm) was significantly smaller than that in the short-term survivors (5.3 cm; P < 0.001). A depth of invasion greater than T3 was found more frequently in the short-term survivor group (88.1%) than in the long-term survivor group (70.1%; P < 0.001). Using Cox's proportional hazard regression model, the only factor found to be an independent, statistically significant prognostic parameter was tumor size (risk ratio, 0.301; 95% confidence interval, 0.10-0.88; P < 0.05). CONCLUSION The tumor size emerged as the only independent, significant factor for the prediction of long-term survival in node-positive gastric carcinoma patients with curative resection.
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Affiliation(s)
- Dong Yi Kim
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, 8, Hakdong, Dongku, Gwangju, 501-757, South Korea.
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Kim DY, Seo KW, Joo JK, Park YK, Ryu SY, Kim HR, Kim YJ, Kim SK. Prognostic factors in patients with node-negative gastric carcinoma: A comparison with node-positive gastric carcinoma. World J Gastroenterol 2006; 12:1182-6. [PMID: 16534868 PMCID: PMC4124426 DOI: 10.3748/wjg.v12.i8.1182] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the clinicopathological characteristics of lymph node-negative gastric carcinoma, and also to evaluate outcome indicators in the lymph node-negative patients.
METHODS: Of 2848 gastric carcinoma patients, 1524 (53.5%) were lymph node-negative. A statistical analysis was performed using the Cox model to estimate outcome indicators.
RESULTS: There was a significant difference in the recurrence rate between lymph node-negative and lymph node-positive patients (14.4% vs 41.0%, P < 0.001). The 5-year survival rate was significantly lower in lymph node-positive than in lymph node-negative patients (31.1% vs 77.4%, P < 0.001). Univariate analysis revealed that the following factors influenced the 5-year survival rate: patient age, tumor size, depth of invasion, tumor location, operative type, and tumor stage at initial diagnosis. The Cox proportional hazard regression model revealed that tumor size, serosal invasion, and curability were independent, statistically significant, prognostic indicators of lymph node-negative gastric carcinoma.
CONCLUSION: Lymph node-negative patients have a favorable outcome attributable to high curability, but the patients with relatively large tumors and serosal invasion have a poor prognosis. Curability is one of the most reliable predictors of long-term survival for lymph node-negative gastric carcinoma patients.
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Affiliation(s)
- Dong Yi Kim
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
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Zulfikaroglu B, Koc M, Ozmen MM, Kucuk NO, Ozalp N, Aras G. Intraoperative lymphatic mapping and sentinel lymph node biopsy using radioactive tracer in gastric cancer. Surgery 2006; 138:899-904. [PMID: 16291391 DOI: 10.1016/j.surg.2005.04.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Revised: 04/21/2005] [Accepted: 04/23/2005] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastric cancer continues to be a significant health problem around the world. Surgical resection with a lymph node dissection remains the only potentially curative treatment with gastric cancer. Determination of the extent of lymph node dissection required on the basis of actual node involvement in patients with gastric cancer is important as less extensive dissection may reduce postoperative morbidity and mortality rates. The current study examines the feasibility and reliability of sentinel lymph node biopsy in gastric cancer. METHODS A total of 32 patients who underwent gastrectomy with extended lymphadenectomy were enrolled in this study. A total volume of 148 MBq (2 mL) technetium-99m-radiolabeled, filtered sulphur colloid solution was injected into the primary lesion under gastroscopy 2 hours before the operation. Lymph nodes were examined as soon as possible by a hand-held gamma probe during the operation, without significant manipulation of the stomach or greater omentum. A sentinel lymph node (SLN) was defined by a level of radioactivity 10 times higher than the background. RESULTS Thirty-one of 32 patients had successful SLN biopsy, with a success rate of 97%. The sensitivity, specificity, positive predictive value, and negative predictive value of SLN biopsy were 100%, 95%, 90%, and 100%, respectively. CONCLUSIONS SLN biopsy using gamma probe in gastric cancer is a feasible procedure with high sensitivity and accuracy. This technique may be of a great benefit to surgeons in planning the extend of lymph node dissection in gastric cancer.
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Affiliation(s)
- Baris Zulfikaroglu
- Department of Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
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Song X, Wang L, Chen W, Pan T, Zhu H, Xu J, Jin M, Finley RK, Wu J. Lymphatic mapping and sentinel node biopsy in gastric cancer. Am J Surg 2004; 187:270-3. [PMID: 14769318 DOI: 10.1016/j.amjsurg.2003.11.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2002] [Revised: 11/16/2003] [Indexed: 12/19/2022]
Abstract
BACKGROUND To determine the feasibility and significance of lymphatic mapping and sentinel lymph node biopsy (SLNB) in patients with gastric cancer. METHODS From August 1999 to January 2002, 27 gastric cancer patients underwent lymphatic mapping and sentinel lymph node biopsy using isosulfan blue dye. RESULTS The success rate of SLNB was 96.3% (26 of 27). Accuracy, sensitivity, and specificity were 100%. There were no false negatives. In 26 successful cases, 8 patients had positive sentinel lymph nodes and 18 had negative sentinel nodes. Of 8 patients with positive sentinel nodes, 6 had positive sentinel nodes only at N1 lymph node station, 1 only at N2 station, and 1 had positive sentinel nodes at both N1 and N2 stations. Of 18 patients with negative sentinel lymph nodes, 9 patients had sentinel nodes only at N1, 3 only at N2, 5 at both N1 and N2, and 1 at both N1 and N3. There were no cases in which sentinel lymph nodes were the only sites of metastases. CONCLUSIONS Sentinel lymph node biopsy using isosulfan blue dye in gastric cancer is a feasible procedure with high sensitivity and accuracy. Sentinel lymph nodes demonstrate the varied lymphatic drainage. If the sentinel nodes at N2 are positive, it will guide surgeons to do a more extended lymph node dissection in early stage gastric cancer.
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Affiliation(s)
- Xiangyang Song
- Oncology Center, Sir Run Run Shaw Hospital and Sir Run Run Shaw Clinical Medical Institute, Medical College of Zhejiang University, Hangzhou, Zhejiang Province, 310016, China
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Athlin L, Lundskog B, Stenling R, Eriksson S. Local recurrence and long-term survival in patients with gastric cancer--analysis of possible impact of clinicopathological parameters. Eur J Surg Oncol 1995; 21:162-7. [PMID: 7720891 DOI: 10.1016/s0748-7983(95)90336-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In a retrospective study comprising 88 patients operated upon with curative intent a number of histopathological parameters of possible prognostic value regarding local recurrence and long-time survival were analysed. Local recurrence within 5 years was found in 28 patients (32%) of which 17 (61%) were diagnosed within the first 2 years. Crude survival rates at 5 and 10 years were 25% and 15%. According to Laurén's classification the results indicated better, but not significant, 5- and 10-year survival for the diffuse type (36% vs 25%). The probability of 10-year survival suggested a better (P = 0.06) prognosis for tumours in the middle third of the stomach, and for patients operated with total gastrectomy (P = 0.025). The probability of recurrence in relation to lymph node involvement suggested a more favourable prognosis (P = 0.06) for patients without lymph node metastases, and in relation to tumour fibrosis a less favourable prognosis for pronounced fibrosis (P = 0.001).
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Affiliation(s)
- L Athlin
- Department of Surgery, University Hospital, Umeå, Sweden
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Mori M, Adachi Y, Kamakura T, Ikeda Y, Maehara Y, Sugimachi K. Neural invasion in gastric carcinoma. J Clin Pathol 1995; 48:137-42. [PMID: 7745113 PMCID: PMC502382 DOI: 10.1136/jcp.48.2.137] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS To determine whether neural invasion in advanced gastric cancer is of clinicopathological significance. METHODS The study population comprised 121 cases of primary advanced gastric carcinoma. Two paraffin wax embedded blocks taken from the central tissue slice in each primary tumour were used. For definitive recognition of neural invasion, immunostaining for S-100 protein was applied to one slide; the other slide was stained with haematoxylin and eosin. RESULTS Neural invasion was recognised in 34 of 121 (28%) primary gastric carcinomas. There were significant differences in tumour size, depth of tumour invasion, stage, and curability between patients with and without neural invasion. The five year survival rates of patients with and without neural invasion were 10 and 50%, respectively. Multivariate analysis, however, demonstrated that neural invasion was not an independent prognostic factor. CONCLUSIONS Neural invasion could be an additional useful factor for providing information about the malignant potential of gastric carcinoma. This may be analogous to vessel permeation which is thought to be important, but is not an independent prognostic factor.
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Affiliation(s)
- M Mori
- Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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de Almeida JC, Bettencourt A, Costa CS, de Almeida JM. Curative surgery for gastric cancer: study of 166 consecutive patients. World J Surg 1994; 18:889-94; discussion 894-5. [PMID: 7846914 DOI: 10.1007/bf00299097] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
From January 1980 to December 1991 we operated on 295 patients with a gastric carcinoma. In 166 cases (56.3%) surgery was performed with curative intent. In 93 patients (56%) a subtotal gastrectomy was performed, and in 73 cases (44%) a total gastrectomy. In all the cases a D-2 type lymphadenectomy was used. The global morbidity rate was 23%, and in-hospital mortality was 3.6%. The morbidity and mortality rates of these two operations were statistically different. Global 5-year survival estimate for the whole series is 61.3%. Univariate and multivariate analysis according to T and N (TNM classification), the number of positive nodes resected, and the relation of positive per resected nodes, revealed statistically different outcomes. This kind of quantitative classification allowed identification of high risk groups irrespective of site of nodal involvement. Tumors classified as intestinal or diffuse type by the Lauren classification had similar survival curves and 5-year survival estimates (p = 0.834). By univariate and multivariate analysis this classification did not reveal a prognostic value in this group of patients. In our opinion, tumor penetration and lymph node involvement are at present the most reliable prognostic factors available.
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Affiliation(s)
- J C de Almeida
- Department of Surgery, Instituto Português de Oncologia de Francisco Gentil, Centro de Lisboa, Clínica Oncológica III, Lisbon, Portugal
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