Long-term recreational physical activity and breast cancer in the National Health and Nutrition Examination Survey I epidemiologic follow-up study.

Our purpose was to study the association between long-term recreational physical activity and breast cancer in the Epidemiological Follow-up Study (NHEFS) of the first National Health and Nutrition Examination Survey (NHANES I, 1971-1975). The analytic cohort included 6160 women who were free of breast cancer at the first NHEFS follow-up in 1982-1984 and had interview data on recreational physical activity (low, moderate, and high) in 1982-1984 and 10 years earlier, in 1971-1975. We created categories of long-term (1982-1984 + 1971-1975) recreational physical activity: (a) consistently low; (b) moderate/inconsistent; and (c) consistently high. Data were analyzed using Cox proportional hazard regression models. A total of 138 women developed breast cancer between 1982-1984 and 1992. In women > or =50 years of age in 1982-1984, consistently high (versus consistently low) recreational physical activity was associated with a 67% reduction in breast cancer risk (n = 96 cases; relative risk, 0.33; 95% confidence interval, 0.14-0.82; P for trend = 0.03); in women <50 years of age (n = 42 cases), there was no association. Associations were not modified by body mass index or by weight gain as an adult. High recreational physical activity over the long-term may reduce breast cancer risk in women > or =50 years of age; in this sample, it did so regardless of weight history.     

Recent results of multimodal therapy of gastric lymphoma

The efficacy of multimodality treatment of gastric lymphoma was examined in a retrospective study of 46 patients treated at the Memorial Sloan-Kettering Cancer Center from 1971 to 1982. The principal treatment plan consisted of surgical resection of the gastric lymphoma (n = 36) where feasible, followed by radiation therapy of the whole abdomen (n = 23) with a boosting dose to the stomach-bed to 3700 cGy, and/or chemotherapy using mainly the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen as an adjuvant (n = 7), or CHOP plus other drugs for advanced disease. The median follow-up time of patients was 61 months (range, 30 months to 14 years). There was no operative mortality. No patient developed known relapse in the abdomen after resection and total abdominal irradiation, and none suffered relapses after adjuvant chemotherapy, for Stages I-E and II-E. At 5 years, the estimated survival rate after treatment was 95%, 78%, and 25%, respectively for Stages I-E (n = 20), II-E (n = 9) and IV (n = 17). The results for Stage I-E and II-E resectable tumors were significantly improved (P less than 0.05 and less than 0.1 respectively) over those of similar tumors treated in 1949 to 1970.     

The outcome of surgical treatment for gastric carcinoma in the elderly

Surgeons are increasingly being faced with the problem of treating elderly gastric carcinoma patients. The purpose of this study was to elucidate the feasibility of surgical treatment for these patients. Among 4740 gastric carcinoma patients treated from 1971 to 1990, 112 (2.4%) were aged 80 or over. The results of treatment in this elderly group were compared retrospectively with those in 2664 younger gastric carcinoma patients (aged 50-69, control group, 56.2%). The TNM stage distribution and the curative resection rates (75.9 vs 81.4%) were similar between the groups. Reduced nodal dissection was more common in the elderly group. The elderly had a higher incidence of preoperative risk factors (76.8 vs 53.1%) and 90-day mortality (10.7 vs 3.9%). However, the postoperative complication rates were similar between the groups. The 90-day mortality rates in the elderly group were higher in the subgroups undergoing total gastrectomy or D2 dissection. In the patients without pre-existing morbidity, the 30-day mortality, 90-day mortality and postoperative complications were similar between the groups. The 5-year survival rate after curative resection of the elderly group was significantly lower than that of the control group (44.4 vs 74.0%). This difference lost significance when non-cancer death was excluded (62.5 vs 79.9%). We believe that, although gastrectomy can be carried out safely in elderly patients, extended surgery should be limited to those without preoperative morbidity.      

Rational Operation for Primary Gastric Carcinoma with Liver Metastasis

OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations. METHODS The operations and prognosis of 102 primary gastric carcinoma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who underwent a resection operation, the 6-month, 1- and 2-year post-operative survival rates were 61%, 42% and 7%. There was a statistically significant difference in survival between resected and non-resected patients （P=0.000） in gastric carcinoma cases with H2 metastasis, resection operations resulted in 54%, 16% and 8% respective survival rates, with no significant difference compared to patients not receiving a resection （P=0.132）. Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%, 13% and 0% respective survivals with no significantly better prognosis compared to the non-resected cases （P=0.135）. There was no statistically significant difference in survival between the cases with or without peritoneal metastasis （P=0.152）. CONCLUSION A resection operation provides a better prognosis for gastric carcinoma patients with H1 metastasis independent of peritoneal metastasis, but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis. Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.     

影响胃神经内分泌癌预后因素的分析

目的 探讨影响胃神经内分泌癌患者预后的因素。方法 回顾性分析2006年5月至2011年7月38例经手术切除、病理学检查证实为胃神经内分泌癌患者的临床病理资料和随访情况。单因素生存分析用Kaplan-Meier法,预后多因素分析用Cox风险比例模型。结果 38例患者均获得随访,中位生存时间为25个月,1、3和5年生存率分别为71.1％、26.3％和15.8％。单因素和多因素分析均显示,病理分期、肿瘤最大直径和手术方式是影响胃神经内分泌癌预后的独立因素,而性别、年龄与预后无关。结论 病理分期、肿瘤直径和手术方式是胃神经内分泌癌的预后影响因素。早期诊断和根治性手术有助于提高患者的术后生存率。     

Radiation therapy of retroperitoneal soft tissue sarcomas

Between 1971 and 1982, 23 patients have been treated with radiation therapy at the Massachusetts General Hospital (MGH) for retroperitoneal soft tissue sarcomas. Seventeen patients were treated with curative intent and six with palliative intent. Of the patients treated with curative intent, the 5 year actuarial survival rate was 54% and the 5 year actuarial local control rate was also 54%. With a complete surgical resection local tumor control was obtained in 5 of 7 patients (71%), 4 of 7 (57%) with incomplete resection and 1/3 (33%) with no resection having local control. The radiation dose appeared to influence tumor control with 2 of 6 patients (33%) having local control with less than 5,000 cGy compared to 0 of 5 patients with doses of 5,000 to 6,000 cGy and 5 of 6 (83%) with doses greater than 6,000 cGy. An effect of tumor grade on either local control or on rate of metastasis formation could not be demonstrated in this series. Long-term local control and survival appears to be associated with maximal surgical resection and high dose radiation therapy.     

Hepatic resection for a hepatocellular carcinoma larger than 10 cm.

Twenty-one patients with hepatocellular carcinoma (HCC) larger than 10 cm diameter were treated during the 18 year period from 1971 to 1988. The mean tumor size was 13 cm (range 10-18 cm). Nineteen patients (90.5%) had subjective symptoms. Eight patients (38.1%) had alpha-fetoprotein (AFP) levels over 10,000 ng/ml, and in 18 patients (85.7%) the levels were over 20 ng/ml. Nevertheless, only three (14.3%) were detected by AFP. Scintigraphy before 1981 and ultrasonography after 1982 appears to be most helpful for detection of HCC. Nineteen lesions (90.5%) were localized in the right hepatic lobe. Large HCC showed a low incidence of histologically verified concomitant cirrhosis (33%; 7 of 21) and a relatively well preserved hepatocellular function (indocyanine green test; 13.9 +/- 6.6%). Curative resection could be done for all 21 patients. There were three (14.3%) operative deaths. The 1-, 3-, and 5-year survival rates were 72.2, 32.9, and 8.2%, respectively. One patient who underwent a left hepatic lobectomy has survived for over 5 years, with recurrence. There were 14 recurrences (66.7%) in 21 patients: 11 were hepatic and three were in the lungs. In patients with large HCC, surgical resection should be done, provided the clinical status and hepatocellular reserves are adequate.     

Trends in the management of breast cancer

Responses of general surgeons to a questionnaire on breast cancer were analyzed to determine the current trends in the management of this disease. A 21-item questionnaire was mailed to members of the New Jersey Chapter of the American College of Surgeons in 1982 and the responses, received on noncoded, anonymous answer sheets, were analyzed for frequency distribution. These responses were compared to previously recorded responses to the same questions for 1971 and 1977. Seventy-six percent of the respondents in 1982 performed needle aspirations often or always, compared to 36% in 1971 and 80% in 1977. The use of routine mammography has increased from 16% in 1971 and 20% in 1977 to 38% in 1982. Modified radical mastectomy is now the most common type of procedure employed in the management of stage I breast cancer, with 89% of respondents in favor of this approach compared to 15% in 1971 and 60% in 1977. Fifty-nine percent of the respondents are not opposed to breast reconstruction following mastectomy versus 14% in 1971 and 49% in 1977. For patients with axillary nodes, chemotherapy with multiple agents was recommended by 76% of general surgeons in 1982, compared to 58% in 1977. These results indicate a continuing trend towards increasing use of needle aspiration and routine mammography for diagnosis and for employment of chemotherapy with multiple agents in the adjuvant treatment of patients with positive axillary nodes. Furthermore, modified radical mastectomy is the operation of choice for stage I cancer of the breast for increasing numbers of surgeons.     

Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors

BACKGROUND: The indication for liver resection for gastric metastases remains controversial and few previous studies have reported the outcome of surgery in the treatment of liver metastases of gastric cancer. The aim of this study is to clarify the effectiveness of surgical resection for liver metastases arising from gastric cancer. METHODS: A retrospective analysis was performed on the outcome of 42 consecutive patients with synchronous (n = 20) or metachronous (n = 22) gastric liver metastases that were curatively resected. RESULTS: The overall 1, 3 and 5 year survival rates after hepatic resection were 76, 48 and 42%, respectively, and the median survival was 34 months. Univariate analysis revealed that survival significantly differed between cases of solitary and multiple metastases (P = 0.03). Multivariate analysis revealed that solitary liver metastasis and the absence of serosal invasion by primary gastric cancer were favorable independent prognostic factors (P = 0.005 and P = 0.02, respectively). All eight patients who survived for more than 5 years after initial hepatectomy had a solitary metastasis, and six of these had no serosal invasion by the primary gastric cancer. No patient with multiple metastatic diseases survived beyond 3 years. CONCLUSIONS: Patients with a solitary liver metastasis are good candidates for surgical resection, whereas those with multiple gastric liver metastases should be treated by multimodal approaches.     

Gastric Carcinoma in Young Adults

Among 4608 patients with gastric carcinoma treated during a20-year period from 1971 to 1990, 328 (7.1%) were less than40 years of age. The clinicopathologic features and treatmentresults in this young group were compared with those for oldergastric carcinoma patients (40–79 years of age, controlgroup). In the young group, the male/female ratio and the prevalenceof tumors in the lower third of the stomach were both lowerthan in the control group, and undifferentiated-type adenocarcinomaswith diffusely infiltrative growth predominated. The TNM stagedistribution and the proportion of curative resections weresimilar in the two groups. The overall cumulative 5-year survivalrates were also similar, although that of patients who underwentcurative resection was higher in the young group, due probablyto the low rate of death from other causes. There was no differencein the recurrence rates after curative resection between thetwo groups. Contrary to widely held belief, the prognosis ofyoung patients with gastric carcinoma is not poorer than thatof older patietns if the disease is diagnosed at a reasonablyearly stage.     

Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group

Controversy still exists on the optimal surgical resection for potentially curable gastric cancer. Much better long-term survival has been reported in retrospective/non-randomized studies with D2 resections that involve a radical extended regional lymphadenectomy than with the standard D1 resections. In this paper we report the long-term survival of patients entered into a randomized study, with follow-up to death or 3 years in 96% of patients and a median follow-up of 6.5 years. In this prospective trial D1 resection (removal of regional perigastric nodes) was compared with D2 resection (extended lymphadenectomy to include level 1 and 2 regional nodes). Central randomization followed a staging laparotomy. Out of 737 patients with histologically proven gastric adenocarcinoma registered, 337 patients were ineligible by staging laparotomy because of advanced disease and 400 were randomized. The 5-year survival rates were 35% for D1 resection and 33% for D2 resection (difference -2%, 95% CI = -12%-8%). There was no difference in the overall 5-year survival between the two arms (HR = 1.10, 95% CI 0.87-1.39, where HR > 1 implies a survival benefit to D1 surgery). Survival based on death from gastric cancer as the event was similar in the D1 and D2 groups (HR = 1.05, 95% CI 0.79-1.39) as was recurrence-free survival (HR = 1.03, 95% CI 0.82-1.29). In a multivariate analysis, clinical stages II and III, old age, male sex and removal of spleen and pancreas were independently associated with poor survival. These findings indicate that the classical Japanese D2 resection offers no survival advantage over D1 surgery. However, the possibility that D2 resection without pancreatico-splenectomy may be better than standard D1 resection cannot be dismissed by the results of this trial.     

Surgical management and outcome of metachronous Krukenberg tumors from gastric cancer

BACKGROUND AND OBJECTIVES: The question of whether resection should be performed in Krukenberg tumors from gastric cancer has yet to be adequately examined. Despite some reports on the surgical treatment of Krukenberg tumors, the outcomes after resection are not well characterized. PATIENTS AND METHODS: Using a gastric cancer database, a total of 34 patients who underwent a resection of metastatic ovarian tumors after curative surgery for gastric cancer were identified. A prospective database of these patients was reviewed for the presentation, clinical features, and outcomes after resection. RESULTS: The median age of 34 patients was 44 years (range, 24-66). The majority of patients was in the premenopausal state and had bilateral ovarian involvement. The most common presenting symptom was an abdominal mass (35.3%). Tumor size ranged from 3.5 to 20 cm with 61.8% measuring larger than 10 cm. In 17 patients who had metastatic disease confined to the pelvis, a complete gross resection (R0) was achieved. In the other 17 with the disease beyond the pelvis gross residual tumors remained after the resection (R1). The median survival of all patients was 11 months (95% confidence interval [CI] 8-14), and that of the patients rendered R0 was 18 months (95% CI, 14-22), in comparison with 9 months (95% CI, 3-15) for those with R1 resection (P = 0.0001; log-rank test). The median progression free survival was also significantly longer for the patients with R0 resection than those with R1 resection (8 months, 95% CI, 5-11 vs. 5 months, 95% CI, 4-6, P = 0.0103). Multivariate analysis identified R0 resection as the only significant factor predictive of survival. CONCLUSIONS: In the management of Krukenberg tumors after gastric cancer, a metastasectomy may significantly improve the overall and progression free survival if it could render a complete gross resection. To define the patient group that benefits most from resection, the extent of disease and resectability must be carefully evaluated before surgery.     

贲门癌切除术后生存10年以上病例分析

目的 探讨影响贲门癌切除术后长期生存的因素。方法 对５８４例贲门癌切除术后生存１０年病例进行回顾性分析。结果 本组１０年生存率为１７．１％。肿瘤的病理分期、分化程度、大体类型、瘤体大小对１０年生存率的影响均有显著性，有无淋巴结转移对１０年生存率的影响有非常显著性。伴有切端癌残留、癌栓形成、肿瘤浸润浆膜、手术切除性质、以及性别、年龄、病程等对１０年生存率影响无显著性，结论 贲门癌的早期发现、早期诊断     

Indication of hepatic resection for metastatic liver tumors from gastric cancer

To clarify the benefit and indication of resection for metastatic liver tumors from gastric cancer, we reviewed the therapeutic outcomes at the Niigata University Medical Hospital and at a referred institution. From January 1982 to April 2004, thirty-nine patients with synchronous and 40 with metachronous liver metastases from gastric cancer had been treated. In synchronous cases, forty percent of the patients had many metastatic tumors in bilateral hepatic lobes and the majority of them had advanced gastric cancer with serosal invasion and widely spread of lymphatic metastases. On the other hand, over 70% of metachronous patients had unilobar or scattered bilobar metastases and only 20% of them accompanied other types of metastases. A survival analysis showed that the prognoses of patients undergoing hepatic resection were statistically better than other treatments in both synchronous and metachronous cases. And there was no evidence for the benefit of palliative gastrectomy. So we conclude that surgical treatment for hepatic metastases from gastric cancer is a beneficial option if all the lesions including the primary and lymphatic ones can be eradicated in limited candidates of synchronous cases and in more candidates of metachronous cases, especially unilobar and a few scattered bilobar metastases.     

Evaluation of surgical submucosal resection for an early stage gastric cancer

In the present study, we demonstrated a surgical submucosal resection (SSR) with an early stage gastric cancer for 212 patients. We assessed the results of SSR in 212 patients based on the outcome of surgery, recurrent cases and prognoses. RESULT: The mean operation time was 93 +/- 36 minutes, bleeding volume was 34.6 +/- 12.0 mL, and postoperative hospitalization in days was 11 +/- 4 days. Pathological examination revealed a tumor invasion of the mucosal layer in 155 cases, submucosal layer in 55 cases, and proper muscle in 2 cases. There were 14 cases (6.6%) of incomplete resection. We performed a curative resection for 6 cases and a frequent follow-up for 7 cases of incomplete resection. There was one gastric cancer death case in incomplete resection. There were no recurrent cases in complete resection. However, we found 3 missing diagnosis cases of synchronous multiple gastric cancer and 10 metachronous multiple gastric cancer cases. CONCLUSION: SSR is a useful option of minimally invasive surgery for an early stage gastric cancer.     

Intestinal and diffuse types of gastric cancer: secular trends in Sweden since 1951.

In order to test the hypothesis that the general decline in gastric cancer observed in many countries is due to a selective decline in Laurén's intestinal type, we re-examined all 427 histologic sections obtained from gastric carcinomas diagnosed at the Department of Pathology, University Hospital, Uppsala, Sweden, in 1951, 1961, 1971-72 and 1981. The relative proportions of intestinal and diffuse type cancers were compared. The intestinal type was significantly (P less than 0.001) more common among elderly people than in the younger age groups. The relative proportions of intestinal type carcinoma in the four periods under study were 65%, 55%, 42% and 60%, respectively. The absence of any clearly discernible trend over time contradicts the hypothesis of diverse secular trends for intestinal and diffuse types of gastric carcinoma.     

Improvement in treatment results of gastric cancer with surgery and chemotherapy: experience of 9,700 cases in the Cancer Institute Hospital, Tokyo.

Treatment results of 9,741 cases of gastric cancer treated at the Cancer Institute Hospital, Tokyo during the past 42 years were retrospectively analyzed. Resectability was 89.6% (94.1% for 1960-1988) and operative mortality was 1.9% (1.5% for 1960-1988). Five-year survival rate was 48.5% (54.9% for 1960-1988) for all cases, 68.8% (73.1% for 1960-1988) for patients with curative surgery, and 4.7% (4.9% for 1960-1988) for those with noncurative surgery. Curative rate was improved twofold among patients with curative gastrectomy. Postoperative adjuvant chemotherapy had a marginal benefit for stage II and III disease. Improvement could be attributed mainly to the relative increase in early gastric cancer, and partly to the extended surgeries for stage III and IV cases, such as systemic lymphadenectomy and combined resection of involved adjacent organs. Multimodality therapy is expected to control the relapse of peritoneal dissemination (14.2%) and hematogenous metastasis (8.9%).     

不能切除和复发的局部进展期胃癌放疗疗效分析

目的 回顾分析不能切除和复发的局部进展期胃癌行腹部放疗的疗效及影响因素。方法 回顾分析2009—2015年我院收治的57例患者,其中不能切除36例(包括局部晚期19例、术后肉眼残留17例),术后复发21例。接受3DCRT 17例、IMRT 40例,照射中位剂量50 Gy (42~60 Gy)。81%患者放疗同期口服氟尿嘧啶类药物化疗。结果 全组患者放疗后中位随访时间为16个月(3.9~77.5个月),放疗后缓解率65%。局部晚期、术后肉眼残留(R₂术后) 、术后复发组放疗后中位生存时间分别为13.9、13.9、19.0个月。全组放疗后2年的预期OS、PFS、LRRFS分别为50%、37%、50%。多因素分析显示病变分组是预后影响因素,而第3站淋巴结受侵并不是不良预后因素。结论 对不能切除及术后复发的局部进展期胃癌进行中等剂量放疗并结合化疗能取得较好的LC并改善患者生存,而术后复发和第3站淋巴结受侵病例均应被视为挽救性放化疗的良好适应征。     

Surgical treatment of gastric metastases from cutaneous melanoma: experience of the National Cancer Institute of Milan.

AIM: To evaluate the role of a surgical approach in patients affected with gastric metastases from cutaneous melanoma. METHODS: A retrospective review of our local melanoma database of 2100 patients identified 31 cases with gastric metastatic deposits. Nine of them were considered candidates for surgical resection. RESULTS: Median overall survival of the 9 patients who underwent surgery was 14.2 months. Six (67%) underwent a local radical resection of disease, and 3 (33%) had a simple exploratory laparotomy. The median survival was 21.6 months (range, 4-32 months) for the subset receiving radical surgery and 3.6 months (range, 2-6 months) for the patients who had no resection. Median follow-up was 14.2 months. No specific correlation of serologic LDH levels and final outcome, as documented elsewhere, was observed. A marked decreased or substantial remission of symptoms with an improvement in quality of life was observed in all radically resected patients. CONCLUSIONS: Patients with gastric metastases from melanoma may benefit from surgery if all macroscopic disease can be removed. In addition, gastric resection in patients with symptomatic melanoma spread to the stomach provides important symptomatic palliation.     

Surgical management of carcinoma of the cervical esophagus

OBJECTIVES: The aim of the present study was to clarify the clinicopathological characteristics, reconstruction methods after resection, and prognosis of cervical esophageal squamous cell carcinoma. METHODS: Seventy-four with squamous cell carcinomas of the cervical esophagus not previously treated who underwent cervical esophagectomy or total esophagectomy with or without laryngectomy were retrospectively analyzed. RESULTS: The operative morbidity and in-hospital mortality rates were 34% (25 patients) and 4% (3 patients), respectively. Alimentary continuity was achieved with free jejunal transfer (50 patients), gastric pull-up (19 patients), and other procedures (5 patients). The frequencies of postoperative complications and death did not differ between free jejunal transfer and gastric pull-up. The overall 3- and 5-year survival rates were 42% and 33%, respectively. The significant clinicopathological factors affecting survival were patient gender, high T factor, lymph node involvement, palpable cervical lymph nodes, vocal cord paralysis, lymphatic invasion, and extracapsular invasion. The pattern of first failure was most often locoregional (82%, 36 patients). CONCLUSION: The choice of free jejunal transfer or gastric pull-up for reconstruction after surgical resection of cervical esophageal carcinoma depends on the degree of tumor extension. Adverse factors affecting survival should be considered when candidates for the surgery are selected.