• Gastric cancer
• Guidelines
• Lymph node dissection
• Worldwide

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/mortality
• Lymph Node Excision/methods
• Prognosis
• Gastrectomy/methods
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymphatic Metastasis

• Long term survival
• Lymph station 16
• Pancreatic cancer

• Gastrectomy
• Gastric cancer
• Lymphadenectomy
• Management
• Palliative surgery
• Review

• Humans
• Stomach Neoplasms/pathology
• Gastrectomy
• Prognosis
• Endoscopy
• Pancreatectomy
• Lymph Node Excision

• ascites
• intraoperative period
• morphology
• ovarian cancer
• peritoneal carcinoma
• peritoneal carcinomatosis index (PCI)
• survival outcome

Though the survival benefit of primary tumor operation for patients with signet ring cell carcinoma of the stomach is known, the specific characteristics of those patients who would profit from the operation are yet to be determined. To this end, a predictive model was developed to identify the conjecture that the survival profit from primary tumor operation would only be obtained by patients.

The clinical data of the patients with signet ring cell carcinoma of the stomach were obtained from the Surveillance, Epidemiology, and End Results database, and then divided into operation and no-operation groups based on whether the patients underwent the primary tumor operation. To remove the confounding factors, propensity score matching was employed, and it was hypothesized that the patients who had been operated on and lived a longer life than the median cancer-specific survival time of those who hadn’t must have profited from the surgery. To discuss the independent factors of cancer-specific survival time in the beneficial group and the non-beneficial group, the Cox model was used, and based on the various vital predictive factors, a nomogram was drawn using logistic regression.

The number of eligible patients was 12,484, with 43.9% (5483) of them having received surgery. After employing propensity score matching, the cancer-specific survival time of the operation group was found to be apparently longer (median: 21 vs. 5 months; p < 0.001) than the no-operation group. In the operation group, 4757 (86.7%) of the patients lived longer than five months (beneficial group). The six indexes (beneficial and non-beneficial group) included gender, age, Tumor Node Metastasis stage, histologic type, differentiation grade, and tumor position, and were used as predictors to draw the nomogram. The nomogram was used to divide the patients who had taken operations into two groups: the beneficial operation group and the non-beneficial operation group. The beneficial operation group, it was found, survived longer than the non-beneficial operation group (median cancer-specific survival time: 28 vs. 3 months, p < 0.001). Moreover, there was we could tell little difference in survival between the two groups (median cancer-specific survival time: 3 vs. 5 months).

The predictive model created to select suitable candidates for surgical treatment from patients with signet ring carcinoma of the stomach could be adopted to identify certain patients benefiting from the primary tumor operation.

• Nomogram
• Predictive model
• SEER database
• Signet ring carcinoma of the stomach
• Surgery

• gastric cancer
• gastrointestinal cancer

• Adult
• Aged
• Aged, 80 and over
• Antigens, Tumor-Associated, Carbohydrate/analysis
• Decision Support Techniques
• Female
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Grading
• Nomograms
• Predictive Value of Tests
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stomach Neoplasms/immunology
• Stomach Neoplasms/pathology
• Tumor Burden
• Young Adult

• grant No.82001672 National Natural Science Foundation of China
• Y-2019Roche-157 Chinese Society of Clinical Oncology Roche foundation grants

The lung is one of the most common sites of metastasis in gastric cancer. Our study developed two nomograms to achieve individualized prediction of overall survival (OS) and cancer-specific survival (CSS) in patients with gastric cancer and lung metastasis (GCLM) to better guide follow-up and planning of subsequent treatment.

We reviewed data of patients diagnosed with GCLM in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. The endpoints of the study were the OS and CSS. We used the “caret” package to randomly divide patients into training and validation cohorts in a 7 : 3 ratio. Multivariate Cox regression analysis was performed using univariate Cox regression analysis to confirm the independent prognostic factors. Afterward, we built the OS and CSS nomograms with the “rms” package. Subsequently, we evaluated the two nomograms through calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Finally, two web-based nomograms were built on the basis of effective nomograms.

The OS analysis included 640 patients, and the results of the multivariate Cox regression analysis showed that grade, chemotherapy, and liver metastasis were independent prognostic factors for patients with GCLM. The CSS analysis included 524 patients, and the results of the multivariate Cox regression analysis showed that the independent prognostic factors for patients with GCLM were chemotherapy, liver metastasis, marital status, and tumor site. The ROC curves, calibration curves, and DCA revealed favorable predictive power in the OS and CSS nomograms. We created web-based nomograms for OS (https://zhenghh.shinyapps.io/aclmos/) and CSS (https://zhenghh.shinyapps.io/aslmcss/).

We created two web-based nomograms to predict OS and CSS in patients with GCLM. Both web-based nomograms had satisfactory accuracy and clinical usefulness and may help clinicians make individualized treatment decisions for patients.

• Advanced gastric cancer
• D2 lymphadenectomy
• D2 lymphadenectomy plus para-aortic lymph node dissection
• morbidity
• mortality
• prognosis

• Laparoscopy
• Neoplasm staging
• Stomach neoplasms

Background: There is controversy about the characteristics and prognostic implications of signet ring cell gastric cancers and non-signet ring cell gastric cancers.

Objective: This study aims to evaluate clinicopathological characteristics and prognoses of signet ring cell carcinoma (SRCC) and non-signet ring cell carcinoma (NSRCC) of stomach.

Methods: Studies compared between SRCC and NSRCC of the stomach after gastrectomy and published before September 1st, 2020, in the PubMed, Cochrane, and Embase databases, were identified systematically.

Results: A total of 2,865 studies were screened, and 36 studies were included, with 19,174 patients in the SRCC group and 55,942 patients in the NSRCC group. SRCC patients were younger in age (P < 0.001), less likely to be male patients (P < 0.001), more afflicted with upper third lesions (P < 0.001), and presenting with more Borrmann type IV tumors (P = 0.005) than NSRCC patients. Lymph nodes metastasis was similar between SRCC and NSRCC patients with advanced tumor stage (OR: 0.86, 95% CI: 0.671.10, P = 0.23), but lower in the SRCC than NSRCC patients with early tumor stage (OR: 0.73; 95% CI: 0.560.98, P = 0.02). SRCC patients had comparable survival outcomes with NSRCC patients for early gastric cancers (HR: 1.05, 95% CI: 0.651.68, P < 0.001) but had significantly poor prognosis for patients with advanced tumor stage (HR: 1.50, 95% CI: 1.281.76, P < 0.001).

Conclusions: Signet ring cell carcinomas of the stomach are an increasingly common histopathological subtype of gastric cancers. These kinds of patients tend to be younger in age and more often female. Although, signet ring cell gastric cancer is a negative prognostic factor for patients with advanced stage. The difference is that for early stage of signet ring cell gastric cancers, it has low lymph nodes metastasis rate and comparable prognosis with non-signet ring cell cancers.

• gastric cancer
• prognosis
• sex
• signet ring cell
• stage

• extended surgery
• gastric cancer
• laparoscopic gastrectomy
• postoperative complications
• robotic gastrectomy

Objective

In this study, we aimed to investigate the prognostic value of postoperative lymph node ratio (LNR)in locally advanced gastric cancer (GC) patients receiving neoadjuvant chemotherapy (NACT).

Methods

LNR was calculated as the ratio of positive LNs to the total LNs removed. The receiver operating characteristic (ROC) curve was plotted to estimate the cut-off value of LNR for recurrence. The area under the curve of LNR was 0.714 (95% CI: 0.604-0.825, p<0.001) with 60% sensitivity and >0.255 with 76% specificity. Patients were grouped as group I (≤0.255) and group II (>0.255).

Results

In this study, 157 GC patients were included (39.5% female and 60.5% male). Of the patients, 97 (61.8%) were in group I and 60 (38.2%) were in group II. Disease‑free survival (DFS) was not reached in group I, and it was 16 months in group II (p<0.001). Overall survival (OS) was 58 months in group I and 28 months in group II (p>0.001). In multivariate analysis, lymphovascular invasion, neoadjuvant response, adjuvant treatment, and LNR were found to be the factors associated with DFS and OS (p<0.05).

Conclusion

In our study, it was observed that LNR can predict survival rates better than LN staging.

• gastric cancer
• lymph node ratio
• neoadjuvdnt
• prognostic
• staging

• 18F-FDG PET/CT
• Advanced gastric cancer
• Heterogeneity
• Primary gastric lymphoma
• SUVmax

• Early gastric cancer
• Endoscopic resection
• Lymph node metastasis
• Stomach neoplasms

• Direct access endoscopy
• diagnosis
• endoscopy
• gastritis
• public healthcare

The results of D1-plus lymphadenectomy following gastric resection are seldom investigated. The aim of this study was to compare results of D1-plus vs D2 resections and to provide a literature review.

Patients who underwent upfront R0 gastrectomy for adenocarcinoma from 2000 to 2016 in three Institutions were selected using propensity scores and categorized according to lymphadenectomy. Statistical analyses were performed for the nodal harvest (LNH) and survival. Published literature comparing D1-plus and D2 was reviewed and analyzed according to PICO and PRISMA guidelines.

Two matched groups of 93 D1-plus and 93 D2 resections were selected. LNH was significantly greater in D2 vs D1-plus dissections (mean 31.2 vs 27.2, p 0.04), however LNH distribution was similar. The cumulative incidence curves for overall survival, disease free and disease specific events did not report significant differences, however Cox regression analysis disclosed that total gastrectomies (HR 1.8; 95% 1.0–2.9), advanced stages (HR 5.9; 95% 3.4–10.3) and D1-plus nodal dissection (HR 2.1; 95% 1.26–3.50) independently correlated with disease free survival. Literature review including 297 D1-plus and 556 D2 lymphadenectomies documented LNH in favor of D2 sub-group (SMD -0.772; 95%CI -1.222- -0.322).

D2 provided greater LNH than D1-plus dissections; prospective studies should aim to investigate long-term survival of D1-plus lymphadenectomy.

• D1-plus
• D2
• Gastric cancer
• Lymphadenectomy
• Nodal dissection
• PSM

Gastric cancer (GC) is a common malignant tumor with a high mortality rate.

To determine the accuracy of preoperative imaging information obtained from the combined use of general gastroscopy (GS), endoscopic ultrasonography (EUS), and multi-detector computed tomography (MDCT) regarding absolute indication of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC).

The relationship between clinical features of 794 EGC patients and lymph node metastasis (LNM) was analyzed. Multivariate logistic regression analysis was used to investigate the risk factors for LNM. Additionally, the accuracy of diagnosis of imaging techniques for ESD indications was determined by receiver operating characteristic (ROC) analysis.

Data showed that tumor size > 2 cm (p = 0.0071), T1b stage (p < 0.0001), undifferentiated histology (p < 0.0001), and vascular invasion (p = 0.0007) were independent risk factors for LNM in patients with EGC. Indications for ESD have a specificity of 100% for the diagnosis of patients with LNM. Additionally, the diagnostic efficacy of the use of GS, EUS, and MDCT in identifying node positive status, T1a disease, tumor size ≤ 2 cm, and ulceration was found to be moderate with area under the curve (AUC) of receiver operating characteristic curve (ROC) of 0.71, 0.64, 0.72, and 0.68, respectively. Furthermore, the use of imaging techniques for overall indication criteria for ESD had a moderate utility value with an AUC of 0.71.

Our data suggested that, based on the combined use of GS, EUS, and MDCT, a high specificity of patient selection for ESD treatment can be achieved.

• absolute indication
• early gastric cancer
• endoscopic submucosal dissection

• Early gastric cancer
• Lymph node metastasis
• Risk factors

• Adult
• Aged
• Aged, 80 and over
• China/epidemiology
• Female
• Gastrectomy
• Gastric Mucosa/pathology
• Humans
• Lymph Node Excision
• Lymphatic Metastasis
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Young Adult

• Lymph node dissection
• Prognosis
• Spleen preservation
• Splenectomy
• Stomach neoplasms

• Investigator Sponsored Research Program

Background: The number of retrieved lymph nodes (RLNs) affects the likelihood of detecting metastatic lymph nodes (MLNs) for gastric cancer (GC), but the retrieval of LNs is not satisfactory worldwide. There is no standard for LN examination.

Methods: We retrospectively analyzed 2,163 patients diagnosed with GC who underwent surgery at Nanfang Hospital between October 2004 and September 2016. According to the methods of LN examination, patients were classified into two groups: LN detection by pathologists (pathologist group) and LN examination by surgicopathologic team (surgicopathologist group). The relationship between RLNs and LN staging accuracy as well as the factors influencing the detection of MLNs were evaluated.

Results: There were 472 males in pathologist group and 467 males in surgicopathologist group. The number of RLNs and MLNs in surgicopathologist group was significantly higher than that in pathologist group (RLNs: 53.8 ± 20.9 vs. 18.8 ± 11.5, p < 0.001; MLNs: 5.6 ± 9.8 vs. 3.9 ± 5.7, p < 0.001). Notably, the detection of N3b node status was significantly improved in surgicopathologist group [83 (11.9%) vs. 34 (4.8%), p < 0.001]. Additionally, the detection rate of N3b status gradually increased from 0 in patients with 1-16 RLNs to 16.6% in patients with more than 49 RLNs. The MLNs detected increased gradually from 2.3 ± 3.0 in patients with 1-16 RLNs to 7.3 ± 11.7 in patients with more than 49 RLNs. Univariate and multivariate analyses indicated that LN examination by surgicopathologic team, more advanced pT, tumor size ≥5 cm and combined organ(s) resection were related to detecting more MLNs.

Conclusions: The retrieval of nodes immediately postoperatively by the surgicopathologic team could significantly improve the number of RLNs, detect more MLNs, and screen more patients with N3b node status.

• N3b
• examination
• gastric cancer
• lymph node
• node staging

• Cytoreductive surgery
• gastric cancer
• intraperitoneal chemotherapy
• peritoneal metastases

• Chemotherapy
• Gastrectomy
• Gastric cancer
• Laparotomy
• Metastases

• Oesophago-gastric junction
• Siewert classification
• Superior polar oesogastrectomy
• Total gastrectomy
• True cardia adenocarcinoma

Chromosomal instability (CIN) of gastric cancer is correlated with distinct outcomes. This study aimed to investigate the role of computed tomography (CT) imaging traits in predicting the CIN status of gastric cancer. We screened 443 patients in the Cancer Genome Atlas gastric cancer cohort to filter 40 patients with complete CT imaging and genomic data as the training cohort. CT imaging traits were subjected to logistic regression to select independent predictors for the CIN status. For the validation cohort, we prospectively enrolled 18 gastric cancer patients for CT and tumor genomic analysis. The imaging predictors were tested in the validation cohort using receiver operating characteristic curve (ROC) analysis. Thirty patients (75%) in the training cohort and 9 patients (50%) in the validation cohort had CIN subtype gastric cancers. Smaller tumor diameter (p = 0.017) and acute tumor transition angle (p = 0.045) independently predict CIN status in the training cohort. In the validation cohort, acute tumor transition angle demonstrated the highest accuracy, sensitivity, and specificity of 88.9%, 88.9%, and 88.9%, respectively, and areas under ROC curve of 0.89. In conclusion, this pilot study showed acute tumor transition angle on CT images may predict the CIN status of gastric cancer.

• chromosomal instability
• computed tomography
• gastric cancer
• morphology
• radiogenomics

Background: Specific guidelines recommend at least 15 or 16 lymph nodes (LNs) be examined to adequately assess nodal category of gastric cancer (GC), but the requirement for minimum number of regional LNs retrieval is not mentioned. This study aims to investigate survival significance from various numbers of perigastric (N1) LNs retrieval and to determine an optimal number harvested in such region.

Study design: From April 1994 to March 2012, 1003 resectable GC patients with at least 15 LNs examined were included. Patients with at least 15 N1 nodes retrieval were assigned into study group, with the rest into control group. The 5-year overall survival (OS) rate was compared between two groups, and an optimal number of examined N1 nodes was detected by a survival joinpoint analysis.

Results: 635 (63.3%) patients in study group had median 22 (range, 15-75) N1 nodes and 3 (range, 0-74) positive N1 nodes retrieval, with median 10 (range, 0-14) N1 nodes and 1 (range, 0-29) metastatic N1 nodes examined in control group. The number of N1 nodes retrieval was associated with tumor location (P=0.007), tumor stage (P<0.001) and total number of harvested LNs (r=0.691, P<0.001). Median survival time (79.0 vs. 72.0 months, P=0.462) and actual 5-year OS rate (41.0% vs. 39.2%, P=0.463) were slightly improved in study group compared with control group, with significance obtained via stage-by-stage analysis. The joinpoint analysis indicated that at least seven N1 nodes retrieval achieved survival significance (81.0 vs. 35.0 months, P=0.036), with survival superiority remained until reaching up to 15 N1 nodes.

Conclusion: Adequate retrieval of perigastric LNs is essential for radical gastrectomy. A harvest of at least 7-15 perigastric LNs could achieve long-term survival benefit for GC patients.

• gastric cancer
• lymphadenectomy
• regional lymph nodes
• survival
• tumor staging

Lymph node metastasis (LNM) is one of the important prognostic factors of early gastric cancer (EGC). Moreover, LNM is also important when choosing therapeutic intervention for EGC patients. The purpose of this study is to explore the risk factors of LNM in EGC and to discuss the corresponding treatment.

We retrospectively reviewed the medical records of 253 patients with EGC who underwent surgical therapy in our department between 2012 and 2015. Univariate analysis and Multivariate Cox regression were used to evaluate the independent risk factors of LNM.

LNM was present in 38 cases among 253 patients (15%). Univariate analysis showed an obvious correlation between LNM and tumour location, tumour size, depth of invasion, morphological classification, gross type of the lesion and venous invasion. Multivariate analysis indicated that poorly differentiated carcinoma, submucosal cancer, tumour size ≥2 cm and venous invasion were the independent risk factors for LNM.

Tumour size, depth of invasion, morphological classification and blood vessel invasion were predictive risk factors for LNM in EGC. We propose that EGC patients with those risk factors should be accepted gastrectomy with LN dissection.

• Early gastric cancer
• laparoscopic surgery
• lymph node metastasis

• Gastric cancer
• stage
• surgery
• survival

• Gastric cancer
• Outcomes
• RAG
• Robotic-assisted gastrectomy

Metastatic spread of gastric carcinoma to the breast is rare. In previous decades, reports on this subject were minimal and primarily limited to case reports. At present, little is known on the clinicopathological features and prognosis of this condition, and breast metastasis remains a challenging clinical problem. A total of 54 cases of breast metastasis from gastric cancer were collected from databases between January 1960 and December 2016. The present study included 3 cases of gastric cancer with breast metastasis from Renji hospital and 51 additional cases from previous studies. The clinicopathological features of patients, including epidemiology, symptoms, macroscopic presentation, pathological diagnosis, imaging, treatment and overall survival time, were analyzed. The median survival time was 8.6 months. All but one of the patients were female, and the median age at diagnosis of breast metastasis was 43 years old (age range, 22–72 years). A majority of patients presented with Borrmann class III disease, signet ring cell carcinoma, T4 tumor types, lymph node involvement, initial stage IV gastric cancer, primary lesions in the gastric antrum, left breast metastasis and palpable breast nodules. The median interval between the primary gastric carcinoma diagnosis and presentation of breast metastasis was 1.25 months (range, 0–72 months). The expression of the estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 and gross cystic disease fluid protein-15 was negative in the patients with breast metastases. In univariate analysis, age, gastric tumor size, gastric lymph node involvement and breast metastasis histology were significantly associated with overall survival (OS) time (P=0.001, 0.039, 0.034 and <0.001, respectively). Therapeutically, gastric surgery and chemotherapy were not associated with OS (P=0.959 and 0.290, respectively). In further multivariate analysis, the time between occurrence (P=0.017), age (P=0.009), histology (P=0.045) and breast metastasis localization (P=0.043) were independent indicators of OS time. Although breast metastasis from gastric cancer is rare, physicians should be vigilant when patients with a history of gastric cancer present with newly developed mammary symptoms and signs.

• breast metastasis
• gastric cancer
• metastatic tumor
• outcome
• overall survival

• Early gastric cancer
• Endoscopic submucosal dissection
• Lymph node metastasis
• Risk-scoring model

• Helicobacter pylori
• Mongolia
• environmental risk factors
• gastric cancer

• D1 lymph node dissection
• D2 lymph node dissection
• R0 resection
• total gastrectomy

Imaging of gastric cancer thickness is closely associated with the depth of tumor invasion, which provides guidance for clinical staging and assists the evaluation of the effects of adjuvant therapy. However, it is unclear whether the measurement of thickness is affected by the degree of gastric filling, and its accuracy and reliability are under-reported. The present study aimed to investigate the influence of the degree of gastric filling on the measurement of gastric cancer thickness. A total of 38 patients with advanced gastric cancer who underwent enhanced abdominal computed tomography (CT) scanning at the Department of CT and MR in The Fourth Hospital of Hebei Medical University (Shijiazhuang, China) between July and September 2016 were recruited, consisting of 21 newly diagnosed cases and 17 follow-up cases following non-surgical treatments. Plain scanning (prior to filling) and enhanced scanning in venous phase (following filling) were performed. Axial CT images prior to and following filling of the normal part of gastric wall and the lesions were compared. The same procedure was repeated on these participants 1 month later by the same radiologist, and the results were compared with those obtained previously. Normal gastric wall thickness prior to and following gastric filling was significantly different (all P<0.001) with the most substantial changes observed at the greater curvature. Lesion thickness prior to and following filling was similar in newly diagnosed patients, but significantly different in patients for re-examination (P<0.05). The two thickness measurements in the same patients were consistent. The measured thickness of gastric cancer in newly diagnosed patients was relatively stable, and could be used as an indicator in baseline CT examination. Maintaining a similar degree of gastric filling during re-examination could aid the accurate evaluation of treatment efficacy.

• X-ray computed tomography
• gastric wall
• stomach neoplasms
• tumor thickness

Background: The multi–slice computerized tomography (MSCT) is a medical imaging modality that has been used to determine the size and location of the stomach cancer. Additionally, MSCT is considered the best modality for the staging of gastric cancer. One way to assess the type 2 cancer of stomach is by detecting the pathological structure with an image segmentation approach. The tumor segmentation of MSCT gastric cancer images enables the diagnosis of the disease condition, for a given patient, without using an invasive method as surgical intervention.

Methods: This approach consists of three stages. The initial stage, an image enhancement, consists of a method for correcting non homogeneities present in the background of MSCT images. Then, a segmentation stage using a clustering method allows to obtain the adenocarcinoma morphology. In the third stage, the pathology region is reconstructed and then visualized with a three–dimensional (3–D) computer graphics procedure based on marching cubes algorithm. In order to validate the segmentations, the Dice score is used as a metric function useful for comparing the segmentations obtained using the proposed method with respect to ground truth volumes traced by a clinician.

Results: A total of 8 datasets available for patients diagnosed, from the cancer data collection of the project, Cancer Genome Atlas Stomach Adenocarcinoma (TCGASTAD) is considered in this research. The volume of the type 2 stomach tumor is estimated from the 3–D shape computationally segmented from the each dataset. These 3–D shapes are computationally reconstructed and then used to assess the morphopathology macroscopic features of this cancer.

Conclusions: The segmentations obtained are useful for assessing qualitatively and quantitatively the stomach type 2 cancer. In addition, this type of segmentation allows the development of computational models that allow the planning of virtual surgical processes related to type 2 cancer.

• Stomach tumor
• image enhancement
• marching cubes
• medical imaging
• multi–slice computerized tomography
• region growing method
• three-dimensional reconstruction
• type 2 cancer

• Stomach tumor
• image enhancement
• marching cubes
• medical imaging
• multi–slice computerized tomography
• region growing method
• three-dimensional reconstruction
• type 2 cancer

• Adenocarcinoma/classification
• Adenocarcinoma/diagnostic imaging
• Adult
• Algorithms
• Female
• Humans
• Male
• Middle Aged
• Stomach Neoplasms/classification
• Stomach Neoplasms/diagnostic imaging
• Tomography, X-Ray Computed
• Tumor Burden

• EBV infection
• gastric cancer
• gene expression profile
• gene mutation
• miRNA
• microsatellite
• molecular gastric cancer subtype
• preclinical models

• Animals
• Epigenesis, Genetic
• Gene Expression Regulation, Neoplastic
• Humans
• MicroRNAs/genetics
• MicroRNAs/metabolism
• Microsatellite Instability
• Mutation
• Signal Transduction
• Stomach Neoplasms/classification
• Stomach Neoplasms/genetics
• Stomach Neoplasms/metabolism
• Stomach Neoplasms/pathology
• Transcriptome

• Gastric cancer
• Lymphadenectomy
• Para-aortic lymphadenectomy

• Aorta
• Combined Modality Therapy
• Humans
• Lymph Node Excision/methods
• Lymphatic Metastasis
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Stomach Neoplasms/therapy

• Adenocarcinoma/epidemiology
• Adenocarcinoma/pathology
• Aged
• Female
• Humans
• Incidence
• Italy/epidemiology
• Male
• Middle Aged
• Retrospective Studies
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/pathology

• Adult
• Aged
• Antineoplastic Agents/adverse effects
• Antineoplastic Agents/therapeutic use
• Biomarkers, Tumor/blood
• Carcinoma/drug therapy
• Carcinoma/immunology
• Carcinoma/surgery
• Chemotherapy, Cancer, Regional Perfusion/methods
• Cisplatin/administration & dosage
• Disease-Free Survival
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Hyperthermia, Induced
• Middle Aged
• Mitomycin/administration & dosage
• Neoplasm Recurrence, Local/drug therapy
• Neoplasm Recurrence, Local/surgery
• Ovarian Neoplasms/drug therapy
• Ovarian Neoplasms/immunology
• Ovarian Neoplasms/surgery
• Peritoneum
• Survival Analysis
• Treatment Outcome

• Colonic Neoplasms/mortality
• Humans
• Liver/physiopathology
• Liver Neoplasms/classification
• Liver Neoplasms/pathology
• Liver Neoplasms/secondary
• Prognosis
• Rectal Neoplasms/mortality

Endoscopic submucosal dissection (ESD) has been widely accepted as a method of treatment of early gastric tumor. This study aimed to identify the incidence and characteristics of multiple gastric tumors after ESD.

Patients with early gastric tumors who were treated by ESD from January 2004 to June 2012 and followed up with endoscopic examination periodically for at least 1 year were enrolled. All multiple gastric lesions were subsequently treated with ESD and the medical records of the patients were retrospectively reviewed.

In total, 643 patients were included. The mean duration of endoscopic follow-up was 45.27±27.59 (range, 12–148) months. Overall, 144 patients (22.4%) showed multiple gastric tumors during the follow-up period (44 synchronous [6.8%] and 100 metachronous [15.5%]). The cumulative incidence rate steadily increased during the follow-up period. More than 50% of the tumors that developed at the same longitudinal location of the stomach were of the same macroscopic and histological type as the primary lesions.

Because synchronous and/or metachronous gastric tumors are common, considerable attention should be paid to detect multiple gastric lesions after ESD of early gastric neoplasm.

• Endoscopic submucosal dissection
• Neoplasms, second primary
• Stomach neoplasms

• Pseudomyxoma peritonei
• cytoreductive surgery
• hyperthermic intraperitoneal chemotherapy
• major tumour debulk
• survival

Gastric cancer is the second most common cause of cancer-related deaths in the world, the epidemiology of which has changed within last decades. A trend of steady decline in gastric cancer incidence rates is the effect of the increased standards of hygiene, conscious nutrition, and Helicobacter pylori eradication, which together constitute primary prevention. Avoidance of gastric cancer remains a priority. However, patients with higher risk should be screened for early detection and chemoprevention. Surgical resection enhanced by standardized lymphadenectomy remains the gold standard in gastric cancer therapy. This review briefly summarizes the most important aspects of gastric cancers, which include epidemiology, risk factors, classification, diagnosis, prevention, and treatment. The paper is mostly addressed to physicians who are interested in updating the state of art concerning gastric carcinoma from easily accessible and credible source.

• classification
• epidemiology
• gastric cancer
• risk factors
• treatment

• Crohn's-like lymphoid reaction
• Early gastric cancers
• FOXA1
• lymph node metastasis
• tumour stromal percentage
• tumour-infiltrating lymphocytes