胃癌组织MMP-9基因与血清中蛋白相关性研究

目的了解胃癌组织中基质金属蛋白酶-9（MMP-9）基因表达与术前血清中蛋白水平关系，探讨MMP-9表达与胃癌临床病理参数之间相关性。方法45例胃癌组织通过半定量逆转录聚合酶链反应（semi-RT-PCR）、免疫组织化学染色（IHC）、酶联免疫吸附（ELISA）方法检测组织中mRNA及蛋白表达情况，测定术前血清中蛋白水平。结果肿瘤组织基质金属蛋白酶-9mRNA表达程度、蛋白染色阳性率、血清中蛋白水平均显著高于正常对照组（P〈0．01）；胃癌组织蛋白表达阳性率与肿瘤是否侵犯至浆膜层相关（P〈0．05）；术前血清中蛋白水平与肿瘤TNM分期、淋巴结转移显著相关（P〈0．01）。结论检测基质金属蛋白酶-9表达对胃癌有一定诊断意义；胃癌组织中蛋白表达率及术前血清中蛋白水平对临床肿瘤病情评估具有指导意义；也许多种机制参与了胃癌术前血清中MMP-9蛋白的分泌。     

超声内镜在胃癌食管癌术前诊断中的应用

为探讨超声内镜（ＥＵＳ）在胃癌、食管癌术前诊断中的应用价值，对３６例胃癌、１５例食管癌术前进行ＥＵＳ检查，将其结果与术后病理对照。根据肿瘤新ＴＮＭ分期，ＥＵＳ对胃癌、食管癌术前Ｔ分期判断的准确率分别为８１％，８７％；对Ｎ分期判断的准确率分别为７２％，８０％。对胃癌、食管癌术前可切除性分期（Ｒ０）判断的准确率分别为９５％，９３％。提示ＥＵＳ能较准确地判断胃癌、食管癌的分期；能准确地判断早期癌，为早癌的内镜切除提供可靠的依据；对ＢｏｒｒｍａｎｎⅣ型癌的诊断也有重要意义。     

内镜超声检查在胃癌诊断和分期中的临床应用

目的评价内镜超声检查(EUS)对胃癌患者术前诊断和分期的准确性,以指导临床治疗方案的选择。方法22例经胃镜加活检病理检查确诊(17例)和疑诊为胃癌但常规活检阴性的患者(5例),同时行EUS、腹部螺旋CT检查,疑诊者在EUS检查的同时行EUS引导下细针穿刺活检(FNAB)以明确诊断。确定肿瘤侵犯深度(T)、局部淋巴结转移(N)、周围及远处器官转移(M)等分期情况,并与手术及病理对照,以评价EUS对胃癌诊断及TNM临床分期的准确性。结果5例疑诊者行EUS引导下FNAB全部成功取得肿瘤组织,病理诊断腺癌4例,印戒细胞癌1例。1例术前EUS诊断为T1N0M0期的患者行内镜下黏膜切除术,其余患者全部行外科胃癌根治术。与手术和病理结果比较,EUS对于TNM分期诊断总的敏感性和特异性分别为T:84.9%,74.2%;N:92.1%,77.1%;M:63.4%,87.5%。螺旋CT对于胃壁是否增厚及N、M分期的敏感性和特异性分别为T:27.3%,75%;N:31.5%,100%;M:50%,100%。其中EUS对于T和N分期的敏感性较CT高(P<0.05)。结论EUS术前评价胃癌临床分期具有显著的优越性,尤其是对于肿瘤侵犯深度和局部淋巴结转移的诊断,对指导临床治疗方案的选择及术后随访具有重要的参考价值。     

内镜超声在胃癌术前TNM分期中的临床应用

TNM分期对胃癌疗效评估和预后判断至关重要。目的：评价内镜超声（EUS）在胃癌术前TNM分期中的临床应用价值。方法：87例胃癌患者术前1周行EUS和螺旋CT（HCT）检查．参考手术和术后病理评价EUS和HCT行胃癌TNM分期的准确性。结果：EUS判断胃癌T分期的总体准确率为81．6％：EUS判断NO和N1分期的准确率与HCT接近（P〉0．05）,但判断N2和N3分期的准确率较HCT明显下降（P〈0．05）：EUS判断M分期的总体准确率低于HCT（P=0．000）,但判断MO分期的准确率与HCT相当。结论：EUS在评价胃癌术前T分期中的临床应用价值较高。但判断N2、N3和M分期的准确性还有待提高．要获得较准确的胃癌术前TNM分期以指导临床治疗方案的选择．有必要联合CT等检查。     

Significance of lymphatic invasion and cancer invasion-related proteins on lymph node metastasis in gastric cancer

Background and Aims:  Cancer invasion and metastasis are critical events for patient prognosis; however, the most important step in the whole process of lymph node (LN) metastasis in gastric cancer remains obscure. In this study, the significance of cancer cell behaviors, such as cell detachment, stromal invasion and lymphatic invasion on regional LN metastasis in gastric cancer was investigated by comprehensive immunohistochemistry.
Methods:  A total of 210 cases with gastric cancer were selected. These consisted of 105 cases with regional LN metastasis (LN[+] group) and 105 cases without LN metastasis (LN[–] group). Both groups exhibited the same depth of invasion. Cancer tissues were subjected to immunohistochemistry with antibodies against claudin-3, claudin-4, β-catenin, matrix metalloproteinase (MMP)-1, and MMP-2, as well as endothelial markers of lymphatic vessel endothelial hyaluronan receptor-1 and von Willebrand factor for the objective discrimination between lymphatics and blood vessels. The expression of each protein as well as the histopathological parameters were compared between LN(+) and LN(−) groups.
Results:  Along with lymphatic invasion by cancer cells and gross tumor size, MMP-1 expression in cancer cells at the invasive front of the primary tumor was a significant, independent predictor of LN metastasis. The expression of claudins and β-catenin was associated with the histopathological type of cancer, but not with LN status.
Conclusion:  Among the cancer invasion-related proteins examined, MMP-1 plays a vital role in LN metastasis of gastric cancer. Tumor size, lymphatic invasion and MMP-1 expression level at the invasive front were the predictive factors of LN metastasis of gastric cancer.     

Preoperative staging of gastric cancer by endoscopic ultrasound: the prognostic usefulness of ascites detected by endoscopic ultrasound

BACKGROUND: Endoscopic ultrasound (EUS) is the standard modality in local preoperative staging of gastric cancers and is reputedly able to detect ascites. However, the association between ascites detected by EUS and local tumor staging, peritoneal carcinomatosis, or survival after surgery is not well documented. GOALS: To assess the accuracy, sensitivity, and specificity of EUS in the preoperative staging and detection of ascites in gastric cancers. We also try to correlate ascites with histologic staging, tumor differentiation, and survival rate of gastric carcinoma after surgery. STUDY: The retrospective analysis was made in 57 consecutive patients with histologically confirmed gastric adenocarcinomas that underwent EUS before surgery. The accuracy of EUS was compared with the final surgical-pathologic findings. We estimated the prognostic usefulness by analyzing the clinicopathologic features of gastric adenocarcinomas and following up their survival rates. RESULTS: The overall T staging was 88% accurate by EUS. The accuracy for T staging was as follows: T1, 100%; T2, 33%; T3, 93%; and T4, 100%. About 50% of T2 cases were overstaged. The overall accuracy, sensitivity, and specificity of detecting lymph node metastasis by EUS were 79%, 79%, and 80%, respectively. One of the seven T1 cancers had regional lymph node metastasis, and it was missed by EUS, although the T classification was precisely staged based on finding submucosal invasion. A total of 22 patients (39%) had ascites detected by EUS; both the sensitivity and specificity of EUS in demonstrating ascites were 100% in our study. Ascites was significantly correlated with the depth of tumor invasion ( = 0.036), lymph node metastasis ( = 0.008), and poor cellular differentiation ( = 0.007), but it was not significantly correlated with macroscopic peritoneal carcinomatosis. The survival rate after surgical treatment was poor in those with gastric cancers with lymph node metastasis, ascites, or poorly differentiated tumors ( < 0.05). However, multivariate analysis showed that lymph node metastasis was the only significant prognostic predictor ( = 0.004). CONCLUSIONS: Endoscopic ultrasound is a valuable diagnostic tool in the local staging of gastric cancers and demonstration of ascites. Although the surgical treatment of gastric cancers with lymph node metastasis, ascites, or poor differentiation had poorer survival rate, only lymph node metastasis was proved to be a significant prognostic predictor in multivariate analysis.     

胃癌组织中PTEN,MMP-9和Caspase-3表达的关系

目的:研究PTEN,MMP-9和Caspase-3在胃癌及正常胃组织中的表达,探讨他们在胃癌的发生、发展、浸润和转移中的作用．方法:选择临床病理资料齐全的胃癌蜡块标本54例,另取正常胃黏膜标本15例作对照．采用SP免疫组化方法检测PTEN,MMP-9和 Caspase-3在其中的表达．结果:胃癌中PTEN低表达(28/54,51．9％),且肿瘤浸润深(P=0．004)、有淋巴(P=0．003) 和远隔转移(P=0．01 5)、临床分期高(P= 0．001)、病理分化低(P=0．008)时降低．胃癌中MMP-9高表达(41／54,75．9％),且肿瘤浸润深(P=0．040)、有淋巴转移(P=0．025)、临床分期高(P=0．039)、病理分化低(P=0．009)时增高．胃癌中Caspase-3低表达(12／54,22．2％), 且有淋巴转移(P=0．045)、临床分期高(P= 0．015)、病理分化低(P=0．035)时降低．胃癌中PTEN与MMP-9(r=-0．543,P=0．001), Caspase-3与MMP-9的表达负相关(r=0．741, P=0.001),PTEN与Caspase-3的表达正相关(r =0．515,P=0．001)．结论:胃癌中PTEN,Caspase-3低表达,MMP-9 高表达;PTEN、MMP-9和Caspase-3可作为胃癌诊断和预后判断的指标．     

Superficial Esophageal Carcinoma: Evaluation by Endoscopic Ultrasonography

Objectives: The aim of this study was to evaluate the usefulness of endoscopic ultrasonography (EUS) in the staging of superficial esophageal carcinoma (SEC). Methods: We examined the histopathologic findings of 28 patients with SEC which was confirmed in the postoperative histologic evaluation. The EUS results preoperatively estimated were compared with them. Results: There were nine patients with mucosal carcinoma (two intraepithelial carcinomas and seven carcinomas limited to the mucosal layer) and 19 patients with submucosal carcinoma. The mucosal carcinomas revealed no lymph node metastasis or vessel permeation, whereas the submucosal carcinomas revealed lymph node metastasis (71%) and vessel permeation (lymphatic, 58%, vascular, 21%). The accuracy rates of depth of invasion by EUS were mucosa, 67% (6/9); submucosa, 79% (15/19); and total, 75% (21/28). EUS could not detect microinvasion to the submucosa. The overall accuracy rate of EUS in the evaluation of periesophagogastric lymph node metastasis was 72%: sensitivity 58% and specificity 85%. Conclusions: It has been clinically proved important to differentiate mucosal carcinoma from submucosal carcinoma in the staging of SEC, and EUS is recommended in differentiating between them.     

Pre-operative staging of recto-sigmoid colon carcinoma by upper gastrointestinal endoscopic ultrasonography.

BACKGROUND/AIMS: To assess the accuracy of a new generation endoscopic ultrasonography (EUS)(GF-M200) in pre-operative staging of recto-sigmoid colon carcinoma invasion and lymph node metastasis. METHODOLOGY: Seventy-three patients with biopsy proven colon cancer were included in this study. These comprised 60 patients with rectal carcinoma and 13 patients with sigmoid carcinoma. All patients were pre-operatively examined by EUS. Pathological findings of the depth of tumor invasion and presence of lymph node metastasis were correlated with EUS. RESULTS: EUS has an overall accuracy rate of 89% in staging of recto-sigmoid cancer. The diagnostic accuracy rate was 83% for T1, 83% for T2, 93% for T3, and 71% for T4. Understaging and overstaging occurred in 6% and 6%, respectively. In determining lymph node metastasis, the overall accuracy rate was 77%, with a sensitivity and specificity rate of 77% and 76%, respectively. CONCLUSIONS: EUS is a valuable staging modality in the staging of the depth of tumor invasion, not only for rectal carcinoma but also for tumors located at the sigmoid colon.     

Comparison of preoperative TN staging of gastric carcinoma by endoscopic ultrasonography with CT examination

ＣｏｍｐａｒｉｓｏｎｏｆｐｒｅｏｐｅｒａｔｉｖｅＴＮｓｔａｇｉｎｇｏｆｇａｓｔｒｉｃｃａｒｃｉｎｏｍａｂｙｅｎｄｏｓｃｏｐｉｃｕｌｔｒａｓｏｎｏｇｒａｐｈｙｗｉｔｈＣＴｅｘａｍｉｎａｔｉｏｎＧＵＯＷｅｎ１,ＺＨＡＮＧＹａＬｉ１,ＬＩＧｕｏＸｉｎ...     

超声内镜对胃癌术前分期的诊断价值

目的评估超声内镜在胃癌术前分期的价值。方法 75例经胃镜及病理证实的胃癌患者于术前进行超声内镜检查,并与术后组织病理分期比较。结果超声内镜分期结果与病理学分期结果比较,超声内镜对胃癌术前T分期判断的准确率为82.7%、N分期判断的准确率为86.7%。结论超声内镜能较准确地判断胃癌分期,有助于制订合理的手术方案。     

超声内镜对壶腹癌及肝外胆管癌术前分期诊断

超声内镜对手术前Ｖａｔｅｒ＇ｓ壶腹癌及肝外胆管癌的原发病变范围、浸润深度、是否有区域淋巴结转移及远隔转移作出诊断及分期，将有助于选择最佳治疗方案及判断预后。对２８例Ｖａｔｅｒ＇ｓ壶腹癌及１８例肝外胆管癌于手术前进行了超声内镜检查，并按照国际ＴＮＭ分期方案进行了手术前分期。其中２２例Ｖａｔｅｒ＇ｓ壶腹癌及１８例肝外胆管癌进行了根治性切除及详细的病理组织学检查，有可能将超声内镜与病理诊断结果进行对照以检验超声内镜诊断的准确性。超声内镜判断Ｖａｔｅｒ＇ｓ壶腹癌及肝外胆管癌病变范围及浸润深度的准确性分别为８１．８％及７２．２％；判断其区域淋巴结转移的准确性分别为５９％及６１．６％。Ｖａｔｅｒ＇ｓ壶腹癌伴门静脉受侵的３例中有２例于术前超声内镜检查中获得了正确诊断，但３例肝转移均未能发现。     

Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector‐row computed tomography

Background and Aim: The aim of this study was to determine the accuracy of endoscopic ultrasonography (EUS) and multidetector‐row computed tomography (MDCT) for the locoregional staging of gastric cancer. EUS and computed tomography (CT) are valuable tools for the preoperative evaluation of gastric cancer. With the introduction of new therapeutic options and the recent improvements in CT technology, further evaluation of the diagnostic accuracy of EUS and MDCT is needed. Methods: In total, 277 patients who underwent EUS and MDCT, followed by gastrectomy or endoscopic resection at Bundang Hospital, Seoul National University, from July 2006 to April 2008, were analyzed. The results from the preoperative EUS and MDCT were compared to the postoperative pathological findings. Results: Among the 277 patients, the overall accuracy of EUS and MDCT for T staging was 74.7% and 76.9%, respectively. Among the 141 patients with visualized primary lesions on MDCT, the overall accuracy of EUS and MDCT for T staging was 61.7% and 63.8%, respectively. The overall accuracy for N staging was 66% and 62.8%, respectively. The performance of EUS and MDCT for large lesions and lesions at the cardia and angle had significantly lower accuracy than that of other groups. For EUS, the early gastric cancer lesions with ulcerative changes had significantly lower accuracy than those without ulcerative changes. Conclusions: For the preoperative assessment of individual T and N staging in patients with gastric cancer, the accuracy of MDCT was close to that of EUS. Both EUS and MDCT are useful complementary modalities for the locoregional staging of gastric cancer.     

The expression of matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs) and angiogenesis in relation to the depth of tumor invasion and lymph node metastasis in submucosally invasive colorectal carcinoma]

BACKGROUND/AIMS: Lymph node (LN) metastasis occurs in approximately 10% of patients with submucosally invasive colorectal carcinoma. This study was performed to determine the role of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs) production and microvessel formation on the LN metastasis in submucosally invasive colorectal carcinoma. METHODS: A total of forty-one subjects with surgically resected submucosally invasive colorectal carcinoma were included in this study. Immunohistochemical staining of MMP-2, MMP-9, TIMP-1, TIMP-2, and urokinase-type plasminogen activator were performed. Angiogenesis was evaluated by counting the number of microvessels in each pathologic specimen as identified by CD34 immunohistochemical staining. RESULTS: The depth of submucosal invasion was not significantly correlated with the expression of MMP-2, MMP-9, TIMP-1, TIMP-2, or urokinase-type plasminogen activator, but the microvessel count was significantly correlated with the absolute depth of invasion (r=0.312, p<0.05). Upregulation of TIMP-2 was positively correlated with adjacent lymphatic invasion (p<0.05) and increased TIMP-2 expression was correlated with LN metastasis in submucosally invasive colorectal carcinoma (p=0.088). CONCLUSIONS: These results suggest that the expression of TIMP-2 and the microvessel count may be useful parameters for considering additional surgery after endoscopic treatment of submucosally invasive colorectal carcinoma.     

胃癌组织Maspin,uPA,MMP-7表达的意义

目的:观察胃癌及正常胃黏膜Maspin,uPA, MMP-7表达的意义．方法:应用免疫组化SP法检测胃管状腺癌30 例,胃印戒细胞癌30例,正常胃黏膜组织20例中Maspin,uPA,MMP-7的表达情况．结果:在胃管状腺癌中Maspin,uPA,MMP-7 阳性表达率分别为50％,70％和80％;胃印戒细胞癌中阳性表达率分别为46．7％,76．7％和 90％;正常胃黏膜组织中阳性表达率分别为 90％,35％和30％．Maspin的表达与浸润深度、淋巴结转移相关,而与肿块的大小和TNM分期无关．uPA和MMP-7的表达与浸润深度、淋巴结转移、TNM分期相关,而与肿块的大小无关．Maspin的表达与uPA和MMP-7的表达呈负相关(P=0．012,r=-0．322;P=0．008,r= -0．341);uPA的表达与MMP-7的表达呈正相关 (P=0．034,r=0．274)．结论:Maspin在胃癌中表达下调,uPA和 MMP-7在胃癌中过表达,他们在胃癌的浸润转移中起重要作用,可作为反应胃癌病理生物学行为的有效指标．     

胃癌组织中MMP-9和TIMP-1的表达及其临床意义

背景：有关胃癌组织中基质金属蛋白酶（MMPs）和金属蛋白酶组织抑制剂（TIMPs）表达的研究不多且结果不一。目的：探讨胃癌组织中MMP-9和TIMP-1的表达及其临床意义。方法：收集临床病理资料完整的98例胃癌患者。应用免疫组化法检测组织中MMP-9和TIMP-1表达．并分析其与临床病理特征的关系以及各参数对胃癌患者预后的影响。结果：胃癌组织中MMP-9高表达与浸润深度、淋巴结转移和TNM分期显著相关（P〈0．01）。单因素分析显示胃癌患者预后与MMP-9高表达（P=0．014）、浸润深度（P〈0．001）、淋巴结转移（P〈0．0001）和TNM分期（P〈0．0001）相关。TIMP-1表达与胃癌患者临床病理特征和预后无关。结论：MMP-9高表达与胃癌的发生、进展有关,可作为胃癌患者预后指标之一。     

Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

Endoscopic ultrasound(EUS) devices were first designed and manufactured more than 30 years ago,and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers.We review the present status,the methods,and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer.EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma.The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer,and 83%-94% for submucosal invasive cancer.But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low,making it difficult to confirm minute submucosal invasion.The accuracy of EUS using highfrequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS,although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions,undifferentiated cancer,concomitant ulceration,expanded indications,type 0-Ⅰ lesions,and lesions located in the upper-third of the stomach.A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification.Although EUS using high-frequency ultrasound probes has limitations,it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.     

DNA ploidy analysis and expression of MMP-9, TIMP-2, and E-cadherin in gastric carcinoma

AIM: To investigate DNA ploidy and expression of MMP-9, TIMP-2, and E-cadherin in gastric carcinoma and to explore the mechanism of invasion and metastasis of gastric carcinoma. METHODS: Immunohistochemical methods were used to detect the expressions of MMP-9, TIMP-2, and E-cadherin in 156 cases, including 99 cases of gastric carcinoma, 16 cases of adjacent noncancerous mucosa, 16 cases of distant metastases and 25 cases of metastatic lymph node (LN) from gastric carcinoma. Flow cytometry DNA ploidy and S-phase fraction (SPF) analysis were performed on 57 cases, including 47 cases of gastric cancer, 6 cases of adjacent noncancerous mucosa, and 4 cases of distant metastatic cancer. RESULTS: The expression of MMP-9 was significantly correlated with Lauren's classification, Borrmann's classification, LN metastasis, tumor metastasis, and TNM stage, as well as depth of invasion (all P<0.05). The positive rate was lower in noncarcinoma than in carcinoma (31.3% vs66.7%, P<0.01). The expression of TIMP-2 was significantly correlated with Borrmann's classification, LN metastasis, and the depth of invasion (all P<0.05), The expression of E-cadherin was significantly correlated with differentiation, Lauren's classification, Borrmann's classification, and LN metastasis, as well as the depth of invasion (P<0,01 or P<0.05). E-cadherin was less expressed in carcinoma than in noncarcinoma (42.4% vs87.5%, P<0.01). There was a positive correlation between MMP-9 and TIMP-2 and a negative correlation between MMP-9 and E-cadherin, but no correlation between TIMP-2 and E-cadherin. Also there was a positive correlation between DNA aneuploid rate and differentiation and LN metastasis. SPF that was higher than 15% was positively correlated with tumor size, differentiation and LN metastasis. And there was a significant difference between carcinoma and noncarcinoma in DNA aneuploid rate and SPF. CONCLUSION: With tumor progression and development of heterogeneity, the abnormal expressions of MMP-9, TIMP-2, and E-cadherin or DNA aneuploid rate or high SPF gradually increases, suggesting that they play a crucial role in gastric carcinoma progression.     

胃癌组织中KISS-1和MMP-9的表达及其意义

目的探讨肿瘤转移抑制基因K ISS-1及基质金属蛋白酶9（MMP-9）与胃癌侵袭、转移的关系,为研究胃癌的转移机制及治疗提供理论基础。方法采用逆转录聚合酶链反应（RT-PCR）检测36例胃癌组织及36例正常胃组织中K ISS-1 mRNA及MMP-9 mRNA的表达情况,分析其与胃癌患者各临床病理指标的关系及二者的相关性。结果 K ISS-1 mRNA在胃癌组织中的阳性表达率及表达水平均低于正常胃组织（P均〈0.01）,并且其低表达与淋巴结转移密切相关（P〈0.05）;MMP-9 mRNA在胃癌组织中的阳性表达率及表达水平均高于正常胃组织（P均〈0.05）,MMP-9 mRNA的高表达与癌的浸润深度和淋巴结转移密切相关（P均〈0.05）;K ISS-1与MMP-9表达呈负相关（P〈0.05）。结论 K ISS-1表达缺失和MMP-9过表达可能与胃癌的侵袭相关。     

Clinical significance of changes in tumor markers, extracellular matrix, MMP-9 and VEGF in patients with gastric carcinoma

BACKGROUND/AIMS: The aim of this study was to evaluate the prognostic significance of some serum tumor marker level, extracellular matrix (ECM), matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF) in patients with gastric cancer. METHODOLOGY: The serum tumor markers included CEA, CA50 and CA19-9, ECM included laminin (LN), hyaluronic acid (HA), and collagen type III and IV were measured in 40 patients with gastric carcinoma and 20 matched healthy controls by radioimmunoassay. MMP-9, VEGF and MVD were measured with immunohistochemical methods and the computer image analyzer. Microvascular density (MVD) in tissues of patients with gastric carcinoma was detected. RESULTS: The levels of CEA, CA50, CA19-9, HA, LN and collagen type IV in the patients with metastasis were significantly higher than those in the patients without metastasis (p < 0.05). The expression of MMP-9 and collage type IV in the patients with metastasis and poorly differentiated carcinomas were significantly higher than those in the patients without metastasis whose tumors were well/moderately differentiated (p < 0.05). CONCLUSIONS: CEA, CA50, CA19-9, HA, LN and collagen type IV levels can be used as a signal of metastasis and disease progression in patients with gastric carcinoma. When a gastric carcinoma expresses a high level of MMP-9 and VEGF with high MVD, the power of infiltration and metastasis of the gastric carcinoma is enhanced.