Clinicopathological features of long-term survivors of scirrhous gastric cancer

BACKGROUND/AIMS: Prognosis of scirrhous gastric cancer remains low. To determine the clinicopathological features that are correlated with prognosis, we studied long-term survivors of scirrhous gastric cancer (survival duration more than 5 years) in comparison with patients with short survival. METHODOLOGY: Among 2719 gastric cancer patients who underwent surgery at Matsuyama Red Cross Hospital, 211 cases were diagnosed as scirrhous type gastric cancer. Seventeen patients survived more than 5 years, and the rest had short survival (less than 5 years). Comparison of clinicopathological factors was done by chi 2 analysis. Multivariate analysis was done in order to focus on the prognostic factors. RESULTS: The 5-year survival of the total 211 patients was 12%. The 5-year survival of patients who underwent curative surgery (67 cases) was 30%, which was significantly higher than that of the non-curative surgery group (144 cases, 6%). Significant differences were noted in the following variables: peritoneal dissemination, hepatic metastasis, lymph node dissection, pattern of infiltrating growth, depth of invasion, histological lymph node metastasis, histological stage, and histological curability. Patients with either hepatic metastasis or peritoneal dissemination did not survive 5 years. Multivariate analysis revealed that the most significant independent prognostic factor was histological curability, followed by peritoneal dissemination. CONCLUSIONS: There is a possibility of long-term survival for patients with scirrhous gastric cancers without hepatic metastasis, peritoneal dissemination, or extensive lymph node metastasis. Curative surgery is important, suggesting that the extended operation is rational if possible.     

Multivariate prognostic study on node-positive gastric cancer: is tumor size a prognostic indicator?

Background/Aims: We analyzed the clinicopathological factors of patients with node-positive gastric cancer, evaluated the prognostic factors associated with long-term survival and clarified the effect of tumor size on long-term survival. Methodology: The study included 591 patients who underwent curative resection for node-positive gastric cancer. Clinicopathological prognostic variables were evaluated as predictors of long-term survival by univariate and multivariate analyses. Results: The 5-year survival rate was influenced by tumor size, tumor location, depth on invasion, level of lymph node metastasis, Borrmann classification, histological type, liver metastasis, peritoneal dissemination and disease stage. Of these, independent prognostic factors were depth on invasion and lymph node metastasis. Tumor size is an influence but not independent factor for the prediction of long-term survival in patients with node-positive gastric cancer. Conclusions: In patients with node-positive gastric cancer, two independent prognostic factors were depth on invasion and the status of lymph node metastasis.     

Regional lymph node metastasis as a predictor of peritoneal carcinomatosis in patients with Borrmann type IV gastric carcinoma

OBJECTIVE: Postoperative survival of patients with Borrmann type IV gastric carcinoma is significantly worse than that in patients with other Borrmann types of gastric carcinomas. The most common pattern of recurrence in patients with Borrmann type IV gastric carcinoma is peritoneal metastasis. We examined the predictors of developing peritoneal metastasis. METHODS: We retrospectively analyzed the relationship between peritoneal metastasis and Borrmann type IV gastric carcinoma. We also examined the dependence of the peritoneal metastasis on clinicopathological findings. RESULTS: Borrmann type IV was an independent prognostic factor of survival by multivariate analysis, and regional lymph node metastasis was an independent predictor of peritoneal metastasis in patients with Borrmann type IV gastric carcinoma. CONCLUSION: Because type of lymph node dissection was not associated with developing peritoneal metastasis, early detection of cancer without lymph node metastasis may be the only means of improving survival in patients with Borrmann type IV gastric cancer.     

Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis

BACKGROUND: In Japan, the standard treatment policy for all potentially curable patients with gastric cancer is radical resection including extensive lymphadenectomy. This treatment strategy has been used for both early and advanced gastric cancers, and substantial increases in survival time have been reported. In advanced gastric cancer, lymphatic spread is reported to be one of the most relevant prognostic factors for gastric cancer resected for cure. The purpose of this study was to determine the factors affecting lymph node involvement and to establish guidelines for the extent of lymph node dissection most appropriate for the treatment of gastric cancer. METHODS: The clinicopathological features of 926 patients with gastric cancer were reviewed. Information on the clinicopathological features was obtained from the database of gastric cancer at the Department of Gastroenterological Surgery, Sendai National Hospital. Univariate and multivariate analyses of data for patients with gastric cancer tumors were performed to evaluate the prognostic significance of clinicopathological features. The independent risk factors influencing lymph node metastasis were determined by multiple logistic regression analysis. RESULTS: The following clinicopathologic factors were found to be correlated with prognosis of gastric cancer: (1) macroscopic type, (2) depth of invasion, (3) cancer-stromal relationship, (4) histological growth pattern, (5) lymph node involvement, (6) lymphatic invasion, (7) vascular invasion and (8) tumor site. However, a multivariate analysis revealed that macroscopic type, depth of invasion, lymph node involvement and tumor site are independent risk factors for the prognosis of gastric cancer patients. Among these factors, the prognosis of patients with gastric cancer was most strongly influenced by lymph node involvement (odds ratio, 4.632). According to a multiple logistic regression model, depth of cancer invasion and lymphatic invasion was significantly correlated with lymph node metastases. CONCLUSIONS: Lymph node involvement has the strongest influence on the prognosis of gastric cancer. Among the clinicopathological factors, depth of invasion and microscopically lymphatic invasion are important factors in predicting lymph node metastases. Thus, the ability to perform gastrectomy with dissection of lymph nodes is a basic requirement for gastric cancer surgeons.     

Clinicopathological features associated with lymph node metastasis in early gastric cancer: Analysis of a single-institution experience in China

BACKGROUND:

An accurate assessment of potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the number of invasive procedures used in cancer therapy is critical for improving the patient’s quality of life.

OBJECTIVE:

To evaluate the clinicopathological features associated with lymph node metastasis of early gastric cancer in patients from a single institution in China.

METHODS:

A retrospective review of data from 410 patients surgically treated for early gastric cancer at the First Affiliated Hospital (Nanjing, China) between 1998 and 2007, was conducted. The clinicopathological variables associated with lymph node metastasis were evaluated.

RESULTS:

Lymph node metastasis was observed in 12.20% of patients. The macroscopic type, tumour size, location in the stomach, depth of gastric carcinoma infiltration, and presence of vascular or lymphatic invasion showed a positive correlation with the incidence of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For intramucosal cancer, tumour size was the unique risk factor for lymph node metastasis. For submucosal cancer, histological classification and tumour size were independent risk factors for lymph node metastasis.

CONCLUSIONS:

Histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in patients with early gastric cancer in China. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible for highly selected cancers.     

Peritoneal recurrence of gastric adenocarcinoma after curative resection

BACKGROUND/AIMS: Death from gastric carcinoma after curative resection is mostly due to recurrence. The most common recurrence is peritoneal dissemination, which represents 33 to 50% of total recurrence after curative gastrectomy. Since survival after peritoneal dissemination is very poor, selection of high-risk patients for further management after resection may contribute to better survival. METHODOLOGY: Based on a prospective database, a total of 1,092 patients with gastric carcinoma who underwent curative resection were included in this study. The incidence of peritoneal recurrence, disease-free interval and survival after peritoneal recurrence were determined. The clinicopathological factors including sex, age, tumor location, size, gross appearance, histological findings, depth of tumor invasion, lymph node status, tumor cell infiltration pattern were analyzed to see if there is any relationship with peritoneal dissemination. RESULTS: The incidence of peritoneal recurrence after curative resection was 13.46%. The mean disease-free interval was 14.2 months and the survival after peritoneal recurrence was 4.9 months in average. Almost all the clinicopathological factors were related with peritoneal recurrence, but only depth of tumor invasion, gross appearance and tumor infiltration pattern are closely associated with peritoneal tumor dissemination after multivariate analyses. CONCLUSIONS: Since the prognosis after peritoneal recurrence is so poor, selection of high-risk patients for further management after gastrectomy may be based on these three factors.     

Clinical results and prognostic factors of radiologically node-positive gastric carcinoma

Lymph node metastasis determined by histologic examination is an important prognostic indicator in gastric carcinoma. However, prognostic value of lymph node metastasis detected by computed tomography (CT) is unknown. The aim of this study was to evaluate clinical results and prognostic factors of patients with radiologically node-positive gastric carcinoma. The study included 78 patients with primary gastric carcinoma and lymph node metastasis confirmed by CT. The level of lymph node metastasis was simply graded as follows: level I included perigastric nodes; level II included intermediate nodes along the left gastric, common hepatic, and celiac arteries; and level III included distant nodes along the hepatoduodenal ligament, pancreas, spleen, and abdominal aorta. Sixty patients (79%) had stage IV tumors showing one or more of the following: level III lymph node metastasis in 37, pancreatic invasion in 27, peritoneal dissemination in 23, and liver metastasis in 19. Overall 1- and 5-year survival rates were 29% and 6%, respectively, and the 1-year survival rate was significantly influenced by the level of lymph node metastasis on CT (55% for level I, 27% for level II, 7% for level III, P < 0.01). In patients with gastrectomy, prognostic factors were tumor size (<10 cm versus >10 cm, P < 0.01), gross type (localized versus infiltrative, P < 0.01), histologic type (well differentiated versus poorly differentiated, P < 0.01), and curability of the disease (curative versus noncurative, P < 0.01). Our study indicates that prognosis of patients with radiologically node-positive gastric carcinoma is poor because of high frequency of extensive tumor spreads. Patients having only positive level I nodes on CT are candidates for curative gastrectomy, which may offer long-term survival.     

Predictive factors of lymph node metastasis in patients with undifferentiated early gastric cancers

BACKGROUND: For intramucosal differentiated early gastric cancer that has little risk of lymph node metastasis, local treatment such as endoscopic mucosal resection has been generally accepted as an adequate treatment. We studied clinicopathological characteristics of undifferentiated early gastric cancer at our institution to identify the predictive factors for lymph node metastasis and qualify lesions that should be referred for gastrectomy and not endoscopic mucosal resection. METHODS: We retrospectively analyzed the clinicopathological features (patient age and gender, tumor size, location, macroscopic type and histological type, presence of ulceration, depth of tumor invasion, and lymphatic-vascular involvement) in 332 patients with undifferentiated early gastric cancer who underwent gastrectomy with regional lymph node dissection. RESULTS: Lymph node metastasis was observed in 45 patients (14%). Univariate analysis revealed that depth of tumor invasion (submucosa), tumor size (>30 mm), and lymphatic-vascular involvement (positive) were associated with lymph node metastasis. Only lymphatic-vascular involvement (positive) was found to have a significant association (odds ratio, 7.4; 95% confidence interval, 2.9-19.0) by multivariate analysis. CONCLUSIONS: Lymphatic-vascular involvement was the only independent predictive risk factor for lymph node metastasis. This pathologic factor was not useful for identifying patients at high risk of lymph node metastasis who should be offered gastrectomy rather than endoscopic mucosal resection.     

Prognostic factors of advanced gastric carcinoma without serosal invasion (pT2 gastric carcinoma).

BACKGROUND/AIMS: The purpose of this study was to investigate the prognostic factors of advanced gastric carcinoma without serosal invasion (pT2 gastric carcinoma), for the planning of therapeutic strategy. METHODOLOGY: Prognostic factors were evaluated by univariate and multivariate analysis in a total of 304 curatively resected pT2 gastric carcinoma patients in whom the tumor invaded the muscularis propria or the subserosa. RESULTS: Macroscopic type, depth of invasion, lymph node metastasis and venous invasion were significantly related to outcome, using univariate analysis. Lesions resembling early gastric carcinoma had better prognosis than lesions belonging to one of the Borrmann types. Multivariate analysis (Cox's proportional hazards model) demonstrated that macroscopic type, lymph node metastasis and venous invasion, but not depth of invasion, were significant prognostic factors. CONCLUSIONS: Macroscopic appearance, lymph node metastasis and venous invasion were the important prognostic factors of pT2 gastric carcinoma. Extensive lymph node dissection and aggressive post-operative chemotherapy should be performed, especially in Borrmann type lesions with lymph node metastasis.     

Invasive carcinoma derived from intraductal papillary mucinous carcinoma of the pancreas

BACKGROUND/AIMS: Most patients with intraductal papillary mucinous tumors of the pancreas have a favorable prognosis after surgical treatment. However, recurrent disease frequently occurs in patients with invasive carcinoma derived from intraductal papillary mucinous carcinoma. The objective of this study was to clarify the clinicopathological features of invasive carcinoma derived from intraductal papillary mucinous carcinoma. METHODOLOGY: We performed a retrospective review of the 29 patients with intraductal papillary mucinous tumor including 10 patients with invasive carcinoma who underwent pancreatic resection between June 1995 and December 2001 at the National Cancer Center Hospital East. RESULTS: Of 10 patients with invasive carcinoma derived from intraductal papillary mucinous carcinoma, 7 patients had lymph node involvement and 8 patients had retroperitoneal invasion. The overall 1-, 2-, 4-year actuarial survival rate for invasive carcinoma derived from intraductal papillary mucinous carcinoma was 39%, 26%, 13%. Recurrence occurred as liver metastasis in 3 patients, carcinomatous peritonitis in 3, local recurrence in 3, and lung metastasis in 1. All patients with adenoma, non-invasive carcinoma, and minimally invasive carcinoma are alive without recurrent disease after pancreatic resection. CONCLUSIONS: Patients with invasive carcinoma derived from intraductal papillary mucinous carcinoma had a worse prognosis. Margin-negative pancreatic resection is essential for treating this disease.     

Clinicopathological investigation of early gastric carcinoma; is less invasive surgery right for early gastric carcinoma?

BACKGROUND/AIMS: The detection of early gastric carcinoma (EGC) has increased worldwide in recent years due to advances in endoscopic techniques and equipment. The objectives of this study were to compare the clinicopathological findings of patients with N1 node-negative and positive EGC, and then consider the treatment options. METHODOLOGY: A total of 814 cases of gastric carcinoma in patients who underwent surgical procedures between 1981 and 1999 at Kochi Medical School were studied. In 375 patients with EGC, surgicopathological parameters were analyzed. RESULTS: Lymph node metastasis was observed in 28 patients (7.4%) with EGC. EGC of the flat type with submucosal invasion, lymphatic permeation, and tumor size larger than 4 cm was associated with higher risk factors of lymph node metastasis. In this study, the location and histological classification of EGC were not related to lymph node metastasis. However, lymph node metastasis was not recognized in submucosal invasive gastric carcinomas less than 1 cm in size. CONCLUSIONS: In the EGC limited to the mucosa or smaller than 1 cm, when the tumor infiltrated the submucosal layer, it could be managed by less invasive surgery without standard lymphadenectomy, and gastrectomy with lymphadenectomy was necessary for patients with EGC who had a high risk of lymph node metastasis.     

血管内皮生长因子与血小板衍化内皮细胞生长因子在老年人胃癌组织中的表达

目的　探讨老年人胃癌术前活检标本血管内皮生长因子 (VEGF)和血小板衍化内皮细胞生长因子 (PD ECGF)的表达及其与老年胃癌患者预后的关系。　方法　采用免疫组化法检测 92例老年胃癌VEGF、PD ECGF表达情况 ,并分析它们与胃癌临床病理特征关系及对预后的影响。　结果　VEGF、PD ECGF在胃癌组织的表达明显高于慢性萎缩性胃炎 ,进展期癌的表达又高于早期癌(P <0 0 1) ,VEGF、PD ECGF表达呈显著正相关 (相关系数R =0 4 0 5 4 )。VEGF、PD ECGF的阳性表达随着肿瘤大小、浸润深度、TNM分期的递增而呈上调表达 ,有淋巴结转移、血管癌栓的患者表达也明显高于无淋巴结转移、血管癌栓者 (P <0 0 1)。VEGF、PD ECGF阳性表达者总体生存率明显低于VEGF、PD ECGF阴性表达者 (P <0 0 1) ,VEGF、PD ECGF共同表达者生存率更低 (P <0 0 1)。多因素分析表明 ,淋巴结转移、TNM分期、VEGF的表达是老年人胃癌独立的预后因素。　结论　VEGF与PD ECGF表达呈正相关 ,均与胃癌生长、浸润转移关系密切 ,可作为估计老年人胃癌预后的重要因素。     

Risk factors for lymph node metastasis and evaluation of reasonable surgery for early gastric cancer

AIM: To give the evidence for rationalizing surgical therapy for early gastric cancer with different lymph node status. METHODS: A series of 322 early gastric cancer patients who underwent gastrectomy with more than 15 lymph nodes retrieved were reviewed in this study. The rate of lymph node metastasis was calculated. Univariate and multivariate analyses were performed to evaluate the independent factors for predicting lymph node metastasis. RESULTS: No metastasis was detected in No.5, 6 lymph nodes (LN) during proximal gastric cancer total gastrectomy, and in No.10, 11p, 11d during for combined resection of spleen and splenic artery and in No.15 LN during combined resection of transverse colon mesentery. No.11p, 12a, 14v LN were proved negative for metastasis. The global metastastic rate was 14.6% for LN, 5.9% for mucosa, and 22.4% for submucosa carcinoma, respectively. The metastasis in group Ⅱ?was almost limited in No.7, 8a LN. Multivariate analysis identified that the depth of invasion, histological type and lymphatic invasion were independent risk factors for LN metastasis. No metastasis from distal cancer (≤ 1.0 cm in diameter) was detected in group Ⅱ?LN. The metastasis rate increased significantly when the diameter exceeded 3.0 cm. All tumors (≤ 1.0 cm in diameter) with LN metastasis and mucosa invasion showed a depressed macroscopic type, and all protruded carcinomas were > 3.0 cm in diameter. CONCLUSION: Segmental/subtotal gastrectomy plus D1/D1 No.7 should be performed for carcinoma (≤ 1.0 cm in diameter, protruded type and mucosa invasion).Subtotal gastrectomy plus D2 or D1 No.7, 8a, 9 is the most rational operation, whereas No.11p, 12a, 14v lymphadenectomy should not be recommended routinely for poorly differentiated and depressed type of submucosa carcinoma (> 3.0 cm in diameter). Total gastrectomy should not be performed in proximal, so does combined resection or D2 /D3 lymphadenectomy.     

黏膜下层早期胃癌淋巴结转移290例

目的:研究黏膜下层早期胃癌淋巴结转移的预测因素.方法:回顾性分析解放军总医院1996-2010年手术治疗的290例黏膜下层早期胃癌中与淋巴结转移相关的临床病理资料.结果:黏膜下层早期胃癌淋巴结转移率为21.4%.单因素分析表明影响黏膜下层早期胃癌淋巴结转移的因素主要有肿瘤大小、组织学类型、浸润深度和脉管浸润.多因素分析显示肿瘤大小、组织学类型和脉管浸润与黏膜下层早期胃癌淋巴结转移独立相关.结论:黏膜下层早期胃癌淋巴结转移与肿瘤大小、组织学类型和脉管浸润因素有关.内镜治疗等微创治疗可考虑应用于肿瘤<2cm同时为分化型的黏膜下层早期胃癌中.     

Lymph node metastasis as a single predictor in patients with Borrmann type I gastric cancer

BACKGROUND/AIMS: Borrmann type I gastric cancers are rare. Its clinicopathological features have never been reported. METHODOLOGY: A total of 33 patients with Borrmann type I gastric cancer was evaluated. 570 patients with Borrmann type II, III and IV were used as references. RESULTS: Borrmann type I gastric cancer occurred preferably in upper stomach, and had more T1 and T2 cancer invasion and early TNM stages, but less lymph node metastasis. Histologically, it had more intestinal type and less scirrhous stromal reaction. Five-year disease-free and overall survival rates in patients with Borrmann type I tumors were significantly higher than that of other types (73.3% vs. 45.8%; P = 0.02, and 72.6% vs. 47.8%; P = 0.01, respectively). Analysis of the relation between clinicopathological factors and survival showed that only lymph node metastasis significantly affected on disease-free survival with a relative risk of 8.4. Lymph node metastasis also affected overall survival rate at a marginal level (p = 0.05). CONCLUSIONS: Borrmann type I gastric cancer has higher survival rate. Lymph node metastasis is a single prognostic indicator for survival.     

Clinical prognostic factors for ovarian metastasis in women with gastric cancer

BACKGROUND/AIMS: Krukenberg's tumor is considered to be a metastatic carcinoma to the ovary derived from a primary malignancy, usually from the gastrointestinal tract. This retrospective study tries to evaluate the clinicopathologic characteristics of ovarian metastasis in female gastric cancer and to define the prognostic factors. METHODOLOGY: Of 1,890 female patients with gastric cancers, 37 patients with metastatic ovarian carcinomas were analyzed. RESULTS: Patients with ovarian metastasis were younger in age, higher in primary tumor location, and far advanced in depth of invasion and lymph node metastases. Ovarian metastasis was largely related to the peritoneal seeding, which was statistically significant on survival time. A multivariate analysis of prognostic factors indicated that the presence of peritoneal seeding was the only significant independent factor. The young female patients with far advanced gastric cancer were vulnerable to recurrence of ovarian metastasis and were considered to undergo prophylactic oophorectomy with gastrectomy. The prognosis of ovarian metastasis is dismal, because this is frequently associated with the peritoneal disseminations. CONCLUSIONS: It is essential to treat the peritoneal disseminations in order to improve the survival rate of female gastric cancer patients with ovarian metastasis.     

结直肠腺癌病理分型的临床意义及预后分析

目的 探讨结直肠黏液腺癌、印戒细胞癌与乳头状、管状腺癌临床病理的差异和预后.方法 收集1994年8月至2007年3月结直肠手术患者2089例,其中黏液腺癌144例,印戒细胞癌25例,乳头状腺癌和管状腺癌1837例,剔除其他类型肠道肿瘤83例.比较三组的临床病理特点.对影响结直肠预后的部分临床病理指标,如年龄、肿瘤部位、分期、腹膜、病理分型进行单因素和非条件Logistic回归分析.对三组进行总体生存分析.结果 黏液腺癌患者发病的中位年龄为(54.20±16.25)岁,印戒细胞癌患者为(40.43±12.88)岁,乳头状腺癌和管状腺癌患者为(58.73±13.62)岁,印戒细胞癌发病年龄最低(P<0.001).三组男女比例、肿瘤直径、肿瘤部位、TNM分期、腹膜转移、淋巴结转移和脏器侵犯差异均有统计学意义(P值均<0.05).经单因素和非条件Logistic回归分析发现,黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素,而印戒细胞癌是预示结直肠癌预后的独立因素.三组总体生存时间和生存率间差异有统计学意义(P<0.001).结论 结直肠黏液腺癌和印戒细胞癌预后较乳头状、管状腺癌差.黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素.     

Clinicopathologic characteristics of early-stage mucinous gastric carcinoma

GOALS: Early mucinous gastric carcinoma (MGC) is very rare, and the clinicopathologic features are not well understood. The aim of this study is to clarify the clinicopathologic characteristics of early MGC. STUDY: A total of 806 patients with gastric cancer underwent gastrectomy between 1983 and 2002 at our department. Of these patients, 7 were found to have early MGC. MGC was defined as a tumor in which more than 50% of the tumor area contained extracellular mucin pools. Microscopic examination was performed, and particular attention was paid to the mucin component of the tumor and histologic subtype (ie, well-differentiated or poorly-differentiated). RESULTS: The incidence of early MGC among all gastric carcinomas in our series was 0.9% (7/806). Tumors ranged in size from 1.0 cm to 7.2 cm, with a mean of 3.7 cm, and 4 appeared macroscopically elevated and 3 appeared depressed. Histologically, 3 tumors were considered well-differentiated type and 4 were considered poorly differentiated type. Microscopic features were thickening of the submucosal layer due to accumulation of abundant mucin and elevation of the surrounding normal mucosa. Tumor invaded the submucosa in 6 cases, and lymph node metastasis occurred in 1 case. However, no patient died of recurrence during follow-up periods ranging from 4 to 85 months. CONCLUSIONS: Early MGC is characterized as an elevated lesion resembling submucosal tumor due to abundant mucin pools in the submucosa. Cases of early MGC have a good outcome similar to that of early non-MGC.     

Therapeutic strategy for scirrhous type gastric cancer

BACKGROUND/AIMS: As no appropriate therapeutic strategy has yet been established in scirrhous type gastric cancer, we retrospectively analyzed the therapeutic outcomes in patients with this type of cancer. METHODOLOGY: A total of 183 patients with scirrhous type gastric cancer were enrolled in the study. 127 of them underwent resection; 61 potentially curative gastrectomy; 66 palliative resection; and 56 had no surgery. RESULTS: Univariate analysis revealed that the number of metastatic lymph nodes and the depth of invasion influenced prognosis in curatively resected cases, whereas no factor did so after palliative resection. Multivariate analysis showed that prognosis was affected independently by peritoneal metastasis and non-regional lymph node metastasis in all resected cases, but by the number of metastatic lymph nodes in curatively resected cases. There was no significant difference in survival between patients undergoing and those not undergoing palliative gastrectomy. Prophylactic (6) and therapeutic CHPP (12) had no efficacy on peritoneal metastasis. Furthermore, left upper abdominal evisceration (LUAE) (9) did not improve long-term results in curatively resected cases. CONCLUSIONS: In scirrhous type gastric cancer, gastrectomy including extended lymph node dissection is justified only in patients with limited lymph node metastasis, and palliative gastrectomy should be not performed because it has no efficacy on survival.     

Factors affecting recurrence in node-negative advanced gastric cancer

Background and Aim:  Prognostic factors of lymph node-negative gastric adenocarcinoma after curative resection have been discussed. Recurrent pattern of advanced lymph node-negative gastric cancer after curative resection has rarely been described.
Methods:  Recurrent sites and correlated clinicopathological factors of 372 patients with lymph node-negative advanced gastric adenocarcinoma that underwent R0 resection from 1988 to 2005 were analyzed.
Results:  Recurrence was noted in 51 (13.7%) patients. Recurrent rates according to site of recurrence were 26 peritoneal seeding (51.0%), 26 locoregional (51.0%), 17 hematogenous (33.3%), and 4 lymph node metastasis (7.8%). Clinicopathological factors to predict peritoneal seeding were serosal exposure, lymphovascular invasion, Lauren's diffuse type differentiation and scirrhous stromal reaction. Serosal exposure, tumor size, microscopic infiltrating growth type predicts locoregional recurrence. Tumor had only lymphovascular invasion predict hematogenous spreading.
Conclusion:  Node-negative advanced gastric cancer has more peritoneal seeding and locoregional recurrence. Aggressive cell behavior predicted the route of tumor cell spreading.