Does tumor size have an impact on gastric cancer? A single institute experience

Purpose  The present study investigated the prognostic significance of tumor size in gastric carcinoma patients. Methods  Nine hundred seventy-three gastric carcinoma patients who underwent curative gastrectomy were included and hospital records were reviewed to determine the relationship between tumor size and survival. Results  First, the patients were divided based on the mean value of the tumor size in respective stages to control selection bias. Only in stages I and III was tumor size a significant independent prognostic factor. Second, we analyzed the appropriate cutoff value for the large tumor. The minimum criterion for a large tumor, which was determined by the receiver-operating characteristic curve for cancer-related death, was 3.5 cm. There were significant differences between patients with large and small tumors with respect to depth of invasion, number of lymph node metastasis, and stage of disease. Conclusions  Tumor size serves as an indicator of prognosis in gastric cancer patients and a tumor size of 3.5 cm can be used as a significant lower limit of standard size criterion.     

Clinicopathological features of gastric carcinoma in younger and middle-aged patients: A comparative study

Gastric carcinoma is relatively rare in patients under the age of 40. This study was undertaken to clarify the clinicopathological characteristics and surgical outcomes of gastric carcinoma in younger patients compared with those of middle-aged patients. The surgical results from 131 younger patients (aged ⩽40 years) and 918 middle-aged patients (aged 55–65 years) were compared retrospectively. Female gender, undifferentiated tumor type and lymphatic invasion were significantly more common in the younger patients. Survival time did not differ between the two groups. The depth of tumor invasion was the only prognostic factor in younger patients, whereas macroscopic appearance, tumor diameter, depth of invasion, lymph node metastasis, and venous invasion were all significant prognostic factors in middle-aged patients. Peritoneal recurrence was significantly more common in younger patients. A family history of gastric adenocarcinoma was observed in 25.9% of younger patients, but this did not affect survival outcomes. As depth of invasion affects prognosis independently, and peritoneal metastasis is the predominant pattern of recurrence, it is essential to establish an optimal prophylactic treatment for peritoneal metastasis to improve surgical outcomes in younger patients with advanced gastric cancer.     

Preoperative Serum Carcinoembryonic Antigen Level as a Predictive Factor of Recurrence After Curative Resection of Colorectal Cancer

Background  We evaluated the prognostic value of the preoperative serum carcinoembryonic antigen (CEA) level in patients with colorectal cancer (CRC). Patients and Methods  The study group comprised 638 patients. The optimal cutoff value for the preoperative serum CEA level was determined. Predictive factors of recurrence were evaluated using multivariate analyses. The relapse-free time was investigated according to the CEA level. Results  All patients underwent potentially curative resection for CRC without distant metastasis, classified as stage I, II, or III. The optimal cutoff value for preoperative serum CEA level was 10 ng/ml. Elevated preoperative serum CEA level was observed in 92 patients. Multivariate analysis identified tumor–node–metastasis (TNM) stage and preoperative serum CEA level as independent predictive factors of recurrence. The relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml significantly differed in patients with stage II and III. However, there was no significant difference in relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml in patients with stage I. Conclusion  Preoperative serum CEA is a reliable predictive factor of recurrence after curative surgery in CRC patients and a useful indicator of the optimal treatment after resection, particularly for cases classified as stage II or stage III.     

Tumor size as a simple prognostic indicator for gastric carcinoma

Background: Tumor size can be measured easily before or during operation with no special tools, but its prognostic use in patients with gastric carcinoma is still unclear. Methods: Clinicopathologic data of 479 patients who underwent curative operation for gastric carcinoma were studied. The relationship between tumor size and survival of patients was investigated. Results: The patients were divided into three groups: 182 with tumors measuring <4 cm (group I), 252 with tumors of 4–10 cm (group II), and 45 with tumors of 10 cm (group III). The 10-year survival rates for group I, II, and III patients were 92%, 66%, and 33%, respectively (p<0.01), and the three groups were significantly different with regard to depth of invasion (p<0.01), number and level of lymph node metastasis (p<0.01), and stage of disease (p<0.01). Multivariate analysis indicated that tumor size independently influenced the survival of patients. Conclusions: Tumor size clinically serves as a simple predictor of tumor progression and survival of patients in gastric carcinoma.     

A Proposed Staging System for Gastric Carcinoid Tumors Based on an Analysis of 1,543 Patients

The lack of a clinically relevant staging system for gastric carcinoid tumors creates a persistent challenge for clinicians trying to provide patients with meaningful prognostic information. The purpose of this study was to identify the clinicopathologic factors that affect survival for patients diagnosed with gastric carcinoid, and use this information to create a staging system. A search of 15,983 patients with carcinoid tumors from the Surveillance Epidemiology and End Results (SEER) database identified 1,543 patients with gastric carcinoid tumors from 1973 to 2004. Patients were analyzed according to various clinicopathologic factors, and a tumor (T1, T2, T3), lymph node (N0, N1), and metastasis (M0, M1) staging system was created according to these parameters. Gastric carcinoid was the only primary malignancy in 74% of patients; 24% presented with one additional primary malignancy, and 2.7% had two or more additional malignancies. On multivariate analysis, age and depth of invasion were significant for patients with one tumor. Four stages were created according to statistically significant prognostic factors: 60% of patients were classified into stage I, 7.6% into stage II, 6.5% into stage III, and 26% into stage IV. Five-year survival rates were 82, 63, 21, and 5.5% for stages I–IV, respectively. We conclude that this tumor–node–metastasis (TNM) staging system accurately discriminates prognosis for all types of gastric carcinoid tumors, with size, depth of invasion, lymph node involvement, and distant metastasis having the greatest impact on survival. Incorporation of this staging system into clinical practice will allow better study of outcomes and development of stage-specific treatment recommendations.     

Clinicopathological analysis and prognostic significance of peritoneal cytology in Chinese patients with advanced gastric cancer

Background: The influence of peritoneal cytology on survival of patients with gastric cancer has not been consistent. This study was to identify risk factors for positive peritoneal cytology and to evaluate the predictive value of positive cytology among Chinese patients with advanced gastric cancer. Methods: The study included 139 patients with gastric cancer macroscopically invading the serosa, who underwent gastrectomy and intra‐operative peritoneal cytological examination. In these patients, the relationship between cytological positivity and various clinicopathological features was analysed, and survival analysis was performed to identify independent prognostic factors of significance. Results: Thirty‐eight (27.3%) of 139 patients had positive peritoneal cytology. Although tumour size, lymphovascular invasion, depth of tumour invasion, lymph node metastasis and peritoneal metastasis were correlated with positive cytology, multivariate analysis revealed the depth of tumour invasion and peritoneal metastasis as the independent features affecting the cytology. Patients with a positive cytology result were confirmed to have a greater risk for recurrence in the pattern of peritoneal carcinomatosis and a significant inferior prognosis. Multivariate analysis indicated that positive peritoneal cytology was an independent prognostic factor among the curatively resected patients with advanced gastric cancer and was the prognostic factor most predictive of death for these patients (risk ratio = 2.74). Conclusions: Positive peritoneal cytology correlated with advanced features of gastric cancer. It is an independent poor prognostic factor, and it may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer.     

Prognostic Significance of Tumor Size in T3 Gastric Cancer

Background  Clinical significance of tumor size remains elusive in gastric cancer. The aim of this study was to evaluate the prognostic value of tumor size in T3 gastric cancer. Methods  A total of 273 patients with T3 gastric cancer who underwent curative D2 gastrectomy between 1996 and 2005 were evaluated. In terms of average value of tumor size, patients were divided into two groups according to tumor size: small-size group (SSG, tumor ≤6 cm) and large-size group (LSG, tumor >6 cm). The prognostic value of tumor size and the correlation between tumor size and other clinicopathologic factors were investigated. Results  LSG accounted for 34.8% in all patients. Tumor size was correlated with histological type, lymphatic invasion, venous invasion, and resection type. The prognosis of LSG patients was worse than that of SSG patients. Multivariate analysis showed that type of resection, status of lymph nodes, metastatic lymph node ratio, and tumor size were defined as independent prognostic factors for patients with T3 gastric cancer. A comparison between LSG patients and SSG patients showed differences in the survival of those with stage IIIB and IV disease. Conclusions  Tumor size is a simple and reliable prognostic factor for patients with T3 gastric cancer; it might be a candidate for the gastric cancer staging system.     

Outcomes of Mass Screening for Gastric Carcinoma

Background Therapeutic results of gastric cancer have been improved by early detection of gastric cancer with the mass screening system in Japan. The objective of our study was to assess the efficacy of mass screening for gastric cancer by using a barium meal. Methods A series of 1050 patients (364 in the screened group and 686 in the nonscreened group) were included in this study from April 1992 to March 2000. Patient characteristics, therapeutic results, and prognostic factors were compared in the two groups. Results The screened patients tended to be younger and male, with tumors in the middle third of the stomach that were of a macroscopically superficial type, with a smaller diameter, and at an earlier stage. They had fewer metastatic lymph nodes and underwent more frequent curative resection. Among the screened patients with curatively resected disease, tumors tended to be of a smaller diameter, and there were fewer metastatic lymph nodes in both early and advanced cases. Disease-specific survival was significantly better in the screened cases among all registered and curatively resected patients. Mass screening achieved significantly better surgical results in early or advanced gastric cancer patients who received curative resection. Multivariate analysis revealed that mass screening was an independent prognostic factor (hazard ratio, .3949; P < .0001), together with depth of invasion, lymph node metastasis, age, and tumor diameter. Conclusions Mass screening by using barium meal examination for gastric cancer detects cancer at an early stage and produces good therapeutic results.     

Clinicopathological Features and Prognostic Factors of Adenocarcinoma of the Esophagogastric Junction According to Siewert Classification: Experiences at a Single Institution in Japan

Background

Treatment strategy for adenocarcinoma of the esophagogastric junction (AEG) remains controversial. The aims of this study are to evaluate results of surgery for AEG, to clarify clinicopathological differences according to the Siewert classification, and to define prognostic factors.

Methods

We retrospectively analyzed 179 consecutive patients with Siewert type I, II, and III AEG who underwent curative (R0) resection at the National Cancer Center Hospital East between January 1993 and December 2008.

Results

Patients with AEG were divided according to tumor: 10 type I (5.6%), 107 type II (59.8%), and 62 type III (34.6%). Larger, deeper tumors and nodal metastasis were more common in type III than type II tumors. No significant differences were seen in 5-year survival rates among the three types: type I (51.4%), type II (51.8%), and type III (62.6%). Multivariate analysis showed that depth of tumor and mediastinal lymph node metastasis were independent prognostic indicators. The recurrence rate for patients with mediastinal lymph node metastasis was 87.5%. The risk factors for mediastinal lymph node metastasis were length of esophageal invasion and histopathological grade.

Conclusions

Mediastinal lymph node metastasis and tumor depth were significant and independent factors for poor prognosis after R0 resection for AEG. Esophageal invasion and histopathological grade were significant and independent factors for mediastinal lymph node metastasis.     

多排CT对胃癌腹膜转移术前预测的单中心大宗病例研究

目的探讨多排CT（MDCT）对胃癌腹膜转移术前预测的价值,基于胃癌MDCT征象探讨合理的腹腔镜探查指征。方法对640例胃癌患者术前行MDCT检查,其结果与手术病理结果相对照：同时．分析胃癌MDCT征象（浸润深度、淋巴结转移状况、肿瘤大小和肿瘤厚度）与腹膜转移状况的关系。结果MDCT对胃癌腹膜转移术前预测的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为51．0％（25／49）、99．3％（587／591）、86．2％（25／29）、96．1％（587／611）和95．6％（612／640）。单因素分析显示。4项胃癌MDCT征象（浸润深度、淋巴结转移状况、肿瘤大小和肿瘤厚度）均与胃癌腹膜转移状况密切相关（P=0．000）,MDCT判断为T0-2NxM0或TxN0M0期的胃癌病例均无腹膜转移：受试者工作特征（ROC）分析进一步显示,肿瘤大小和肿瘤厚度对预测胃癌腹膜转移状况具有较高的临床应用价值（ROC曲线下面积分别为0．83和0．75）;多因素分析显示,仅肿瘤大小与胃癌腹膜转移状况密切相关。结论MDCT对胃癌腹膜转移术前预测具有较高的准确率和临床应用价值：对MDCT判断为T0～2NxM0或TxN0M0期,或肿瘤较小的胃癌病例,由于其腹膜转移的发生概率较小而无需行腹腔镜探查。     

EMA在pT1-3N0胃癌淋巴结微转移检测中的意义

目的pT1-3N0期胃癌术后临床病理因素（性别、年龄、肿瘤部位、肿瘤直径、大体分型、浸润胃壁深度、分化程度、血管侵润和淋巴管浸润）和淋巴结微转移对术后5年无瘤生存率的影响。方法纳入研究对象为pT1-3N0期胃癌共有108例,均为胃肠组医师行胃癌根治术。术后平均随访65.12个月（22～120个月）,每位患者淋巴结9枚至28枚不等,将所有淋巴结用EMA指标进行免疫组化染色。临床病理因素及微转移对5年无瘤生存率的影响进行统计分析。结果“肿瘤直径”（P=0.033）,“浸润胃壁深度”（P=0.024）和“是否有淋巴管浸润”（P=0.005）与淋巴结的上皮膜抗原（EMA）表达有正相关性,而其他临床病理因素与淋巴结EMA表达无明显相关性。临床病理因素对5年无瘤生存率无明显影响。淋巴结EMA表达阴性,孤立肿瘤细胞巢（Isolated Tumor Cells,ITCs）和微转移（Micrometastasis,MCM）的患者,5年无瘤生存率分别为88.50%,75.60%和44.40%。ITCs与EMA（-）的患者5年无瘤生存率无显著差别（P=0.360）,而MCM与EMA（-）的患者5年无瘤生存率出现明显差别（P=0.002）。结论对于pT1-3N0期胃癌,若淋巴结中检测出微转移,其预后较差,术后复发率较高,术后应予以积极的辅助治疗。     

Node-extranodal soft tissue stage based on extranodal metastasis is associated with poor prognosis of patients with gastric cancer

Background

The purpose of this study was to evaluate the effect of Node-Extranodal soft tissue（pNE） stage based on Extranodal Metastasis (EM) on recurrence and survival in patients with gastric cancer (GC).

Materials and methods

A total of 642 patients were divided into two groups according to statue of EM. Clinicopathologic features were compared among the two groups, the log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified by the Cox proportional hazards regression model. According to the number of EMs, EM was incorporated into the pN stage of gastric carcinoma. The 5-y overall survival (OS) and disease free survival (DFS) rates were 48.1% and 17.4%, 44.5% and 14.3% between the two groups. Patients with EM had a deeper tumor invasion and more number of lymph node metastases. Peritoneal dissemination and distant metastasis were more frequent with EM. EM is an independent risk factor for distance recurrence (odds ratio = 1.605), and it is the highest risk factor for peritoneal recurrence (odds ratio = 2.448). Multivariate analysis showed that depth of tumor invasion (P = 0.025), lymph node metastasis (P <0.001), and EM (P = 0.006) were independent factors associated with OS. Furthermore, EM (P = 0.0039) was also an independent prognostic factor for DFS. The differences in prognostic prediction between the seventh edition of the pN classification and the pNE classification were directly compared. We found the pNE classification (hazard ratio = 1.730, P <0.001) was more appropriate for predicting the OS of GC patients after curative surgery, and the −2 loglikehood of the pNE staging (4533.991) is smaller than the value of pN.

Conclusions

EM was closely associated with cancer aggressiveness and the presence of EM was a significant independent predictor of reduced DFS and OS in GC patients. EM is an independent risk factor for distance recurrence, especially for peritoneal recurrence, the selection of postoperative adjuvant therapy in systemic (intravenous or intra-arterial) and regional (intraperitoneal) based on EM may be a reasonable approach. The lymph node imaging techniques such as injecting nanocarbon during surgery should be applied. As an important prognostic factor, EM should be incorporated into N stage according to its number retrieved in postoperative samples.     

胃癌患者淋巴结转移危险因素分析及患者预后分析

目的分析胃癌患者淋巴结转移的相关危险因素，以及对患者生存状况的影响。 方法选取2014年3月至2016年3月收治的125例胃癌患者作为此次研究对象，对其进行回顾性分析，所有研究对象均经病理确诊行根治手术治疗。依照淋巴结是否转移进行分组，91例患者纳入未转移组，34例纳入转移组。将研究数据均纳入SPSS20.0软件中进行整理分析，两组患者各临床指标的计数资料用"例"表示，行χ²检验，首先将P<0.05各项指标进行Logistic单因素回归分析，得出淋巴结转移的危险因素，后进行Logistic多因素分析。以P<0.05表示差异具有统计学意义。 结果单因素分析结果显示：肿瘤病灶直径、分化程度、浸润深度、有无脉管侵犯以及有无神经侵犯等因素是淋巴结转移的危险因素(P<0.05)；多因素回归分析证实，肿瘤直径、肿瘤浸润深度、有无脉管侵犯以及有无神经侵犯是影响淋巴结转移的独立危险因素(P<0.05)；随访结果表明，发生淋巴结转移的患者2年生存率均明显低于未转移患者，差异有统计学意义(P<0.05)。 结论在胃癌患者中，肿瘤大小、脉管侵犯、神经侵犯以及肿瘤的浸润深度是胃癌患者淋巴结转移的独立危险因素，发生淋巴结转移患者其生存时间以及生存率均有明显降低，对患者的预后造成一定的影响和威胁。     

Clinical Significance of DNA Ploidy Pattern in Stage III Gastric Cancer

p value and Hazard ratio of the DNA ploidy patterns were 0.001 and 2.099, respectively. Consequently, it was a valuable independent prognostic factor that could be used in addition to lymph node metastasis and depth of invasion. For the most advanced subclass of stage III gastric cancer the 5-year survival rate of patients with a diploid tumor was significantly higher than that for those with aneuploid tumor. No difference was observed for the other subclasses. These results indicate that the DNA ploidy pattern is a valuable independent prognostic factor for gastric cancer, and that it is more useful for evaluating the prognosis of patients with more advanced lesions undergoing “curative resection.”     

Characteristics of Gastric Cancer with Esophageal Invasion and Aspects of Surgical Treatment

Background  Gastric cancer with esophageal invasion (GCE) is a disease of poor prognosis, and issues pertaining to surgical treatment still remain unresolved. Particularly problematic areas in GCE cases include the need for lower mediastinal lymph node (MSLN) dissection, the most effective surgical approach, and the optimal extent of the esophageal resection. In this study, we evaluate the characteristics of GCE and investigate aspects of surgical treatment. Methods  Sixty-five patients with GCE were surgically treated in our department from 1990 to 2007. Fifty-two patients with M0 were evaluated for clinicopathological factors, disease recurrence pattern, and prognosis, and 47 patients with R0 resection were evaluated for operative factors. Results  Patients with MSLN metastasis had significantly poor prognosis. The survival rate significantly differed among patients depending on T-factor, LN metastasis, MSLN metastasis, and lymphatic vessel invasion, but operative factors were not significant prognostic factors. Multivariate analysis indicated that T-factor and MSLN metastasis were independent prognostic factors. The peritoneum was the site of the highest recurrence rate (26.9%), followed by the liver (9.6%). Peritoneal recurrence correlated with T-factor and lymphatic vessel invasion and liver recurrence correlated with MSLN metastasis. Conclusions  It seems that radical MSLN dissection and extended esophageal resection by thoracotomy have little therapeutic purpose for Siewert Types II or III tumors in GCE if the length of esophageal resection is within 6 cm. Patients with GCE have a poorer prognosis than those with common gastric cancer, and early detection and multimodal treatments for distant metastases are vital for ameliorating clinical outcome in patients with GCE.     

Is Adenocarcinoma of the Esophagogastric Junction Different between Japan and Western Countries? The Incidence and Clinicopathological Features at a Japanese High-Volume Cancer Center

Background  We clarified the incidence of adenocarcinoma of the esophagogastric junction (AEG) at a Japanese high-volume cancer center and its clinicopathological features between the Siewert subtypes. Methods  Patients with AEG were selected from a prospective database of gastric and esophageal tumors established by Kanagawa Cancer Center. The Siewert subtypes were determined retrospectively by examining pathological pictures of the resected specimens and by evaluating the pathology and endoscopy findings. Results  From January 1986 to December 2005, 147 (4.0%) patients were determined to have AEG; 2,794 (75.8%) were diagnosed to be true gastric cancer, whereas 745 (20.2%) were true esophageal cancer. Of these 147 patients with AEG, 5 (3.4%) were classified as type I, 82 (55.8%) as type II, and 60 (40.8%) as type III tumors. The depth of tumor invasion was deeper and the nodal metastases were more frequent in type III compared with type II. The risk factors for nodal metastases included the depth and size of the tumor, but not the Siewert subtypes itself. Mediastinal nodal metastases were strongly influenced by a thoracotomy and the extent of the dissection. The pathological grade was higher in type III than in type II. Although the 5-year survival rate was significantly higher in type II than in type III tumors, the survival difference disappeared when the patients were restricted to an R0 resection, even though type III patients demonstrated a more advanced stage. Conclusions  The proportions of AEG were strikingly different between Japan and western countries. Although each Siewert subtype had some different characteristics, nodal metastases were determined by both the tumor progression and the extent of the nodal dissection. An R0 resection was a key for the survival in AEG.     

Surgical Outcome and Prognostic Factors in Intrahepatic Cholangiocarcinoma

BACKGROUND: The clinicopathologic features and surgical outcome of intrahepatic cholangiocarcinoma are not fully understood. METHODS: Fifty-six consecutive patients with intrahepatic cholangiocarcinoma who underwent surgical resection at the National Cancer Center Hospital East between October 1992 and July 2007 were retrospectively analyzed. Intrahepatic cholangiocarcinomas were subdivided into solitary tumors and tumors with intrahepatic metastasis. RESULTS: Complete tumor removal (R0 resection) was performed in 42 patients (75%). The 5-year survival rate for patients with intrahepatic cholangiocarcinoma (n = 56), patients with a solitary tumor (n = 46), and patients with intrahepatic metastasis (n = 10) were 32, 38, and 0%, respectively. There was a significant difference in survival between patients with a solitary tumor and those with intrahepatic metastasis (p < 0.0001). The 5-year survival rate for patients with stage I (n = 3), II (n = 9), III (n = 15), and IV disease (n = 26) was 100, 67, 37, and 0%, respectively. There was a significant difference in survival between stage I and stage IV (p = 0.011), between stage II and stage IV (p = 0.0002), and between stage III and stage IV (p = 0.0015). The most frequent site of recurrence was the liver. Univariate analysis showed that intrahepatic metastasis, portal vein invasion, hepatic duct invasion, lymph node metastasis, perineural invasion, and positive surgical margin (R1) were significantly associated with poor survival. Multivariate analysis confirmed that intrahepatic metastasis was a significant and independent prognostic indicator after surgical resection for intrahepatic cholangiocarcinoma (p = 0.001). No patient with intrahepatic metastasis survived more than 10 months in this study. CONCLUSIONS: Intrahepatic metastasis was the strongest predictor of poor survival in intrahepatic cholangiocarcinoma.     

Prognostic Significance of Perineural Invasion in Patients with Gastric Cancer Who Underwent Curative Resection

Background

The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection.

Materials and Methods

We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis.

Results

PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P = .001 and P < .001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P = .001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P = .02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12–3.13) as were classical clinicopathological features.

Conclusion

Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.     

胃癌转移规律研究新进展

胃癌转移方式按好发程度依次为淋巴结转移、腹膜种植转移和血行转移。淋巴结转移的高危因素包括浸润深度,大体类型,生长方式,癌灶长径>4cm,低分化,淋巴管受侵阳性等。有无淋巴结转移是影响早期胃癌预后最重要的独立危险因素。术中腹腔冲洗液脱落癌细胞（ECC）检查是诊断或检测潜在腹膜转移的常用方法和金标准。不同的浆膜分型是预测胃癌根治术后腹膜复发的独立危险因素。CEA、肝素酶等肿瘤标记物对检测或预测腹膜转移具有较好的临床意义。胃癌的血行转移多发生于肝、肺、骨等脏器。隆起型、高分化、AFP阳性的肝样腺癌、团块状生长、静脉癌栓阳性病例易发生肝转移。浸润型、低分化、静脉癌栓阳性是胃癌肺、骨转移的病理生物学特征。     

Lymph Node Status in Patients with Submucosal Gastric Cancer

Background The aim of this study was to clarify the lymph node status in patients with submucosal gastric cancer.Methods Between April 1994 and December 1999, 615 patients with histologically proven submucosal gastric cancer who underwent curative resection were included in this study. The results of the surgery and predictive factors for lymph node metastasis were evaluated by univariate and multivariate analyses. The accuracy of the predictive factors was assessed in a second population of a further 186 patients.Results Lymph node metastasis was observed in 119 patients (19.3%). Multivariate analysis showed that pathologic tumor diameter (≥20 mm) and lymphatic invasion were independent predictive factors for lymph node metastasis. The incidence of lymph node metastasis without these 2 predictive factors was 1.8% (2 of 113), and it was 51.2% (85 of 166) with the 2 predictive factors, 9.5% (14 of 148) in tumors <20 mm in diameter, and 5.3% (22 of 414) in tumors without lymphatic invasion. Among patients with a tumor <20 mm in diameter, the incidence of lymph node metastasis was significantly reduced in those with a differentiated tumor: 4.2% (4 of 95). These results were almost identical to those observed in the second population.Conclusions Lymph node status can be accurately predicted on the basis of pathologic tumor diameter <20 mm, lymphatic invasion (absence), and histological type (differentiated) in patients with submucosal gastric cancer. Less extensive surgery for these patients might be reconsidered after confirmation of the reproducibility of the results of this study by an appropriately designed prospective clinical trial.