Prognostic factors in patients with node-negative gastric carcinoma： A comparison with node-positive gastric carcinoma

AIM: To identify the clinicopathological characteristics of lymph node-negative gastric carcinoma, and also to evaluate outcome indicators in the lymph node-negative patients. METHODS: Of 2848 gastric carcinoma patients, 1524 (53.5%) were lymph node-negative. A statistical analysis was performed using the Cox model to estimate outcome indicators. RESULTS: There was a significant difference in the recurrence rate between lymph node-negative and lymph node-positive patients (14.4% vs 41.0%, P<0.001). The 5-year survival rate was significantly lower in lymph node-positive than in lymph node-negative patients (31.1% vs 77.4%, P<0.001). Univariate analysis revealed that the following factors influenced the 5-year survival rate: patient age, tumor size, depth of invasion, tumor location, operative type, and tumor stage at initial diagnosis. The Cox proportional hazard regression model revealed that tumor size, serosal invasion, and curability were independent, statistically significant, prognostic indicators of lymph node-negative gastric carcinoma. CONCLUSION: Lymph node-negative patients have a favorable outcome attributable to high curability, but the patients with relatively large tumors and serosal invasion have a poor prognosis. Curability is one of the most reliable predictors of long-term survival for lymph node-negative gastric carcinoma patients.     

Poorer prognosis in young patients with gastric cancer?

BACKGROUND/AIMS: Although the relationship between prognosis and age of patients with gastric cancer is controversial, a poorer prognosis in young patients has been suggested by most investigators. To further examine the hypothesis, a retrospective study was undertaken to analyze a large series of patients with gastric cancer in Taiwan. METHODOLOGY: A total of 1,642 consecutive patients diagnosed with gastric cancer and receiving further management at one medical center from 1988 to 1993 were reviewed. The gender, TNM tumor stage, rate of curative resection and survival of the patients were compared in the young age group (< or = 39 years) and the old age group (> 39 years). Survival was estimated with the product-limit method and difference in survival was tested by the log-rank test. Multivariate analysis was done by the Cox proportional hazard model. RESULTS: Among the 1,642 patients, 61 patients were in the young age group and 1,581 patients were in the old age group. There was no significant difference for the 2 groups of patients in the distribution of TNM stage (stage I: 20%; II: 8%; III: 13%; IV: 59% vs. 19%, 11%, 25% and 45% respectively, in the old age group, p = 0.098) and rate of curative resection (38% vs 51% in the old age group, p = 0.059). The overall 5-year survival showed no significant difference between the 2 groups (25% vs. 29% in the old). Subgroup analyses showed that survival after curative resection and survival without curative treatment (including palliative resection and no resection) also had no difference in the 2 groups. Multivariate analysis also showed that age was not an independent factor. CONCLUSIONS: Although most reports suggested a dismal prognosis in young patients with gastric cancer, based on our findings, young patients (< or = 39 years) do not have a worse prognosis than older patients.     

How labile is gastric infection with H pylori？

It is known that patients infected with H pylori can spontaneously become free from infection, and that the reverse change can occur. The time-scale of these conversions is expressed as percentages per year. Since they have been investigated in terms of serology, the changes are called sero-reversion and sero-conversion respectively. Using serological evidence to investigate these phenomena is open to the criticisms that positive serology can be present in the absence of all other evidence of infection, and that a time-lag of 6-12 mo or longer can occur between eradication of the infection and sero-reversion. Investigations using direct evidence of current infection are sparse. The few that exist suggest that some individuals can seroconvert or serorevert within six to twelve weeks. If these findings are confirmed, it means that some patients have an ability that is variable in time to resist, or spontaneously recover from, H pylori infection. Evidence suggests that the deciding factor of susceptibility is the level of gastric secretion of acid.     

Is gastric nodularity a sign for gastric inflammation associated with Helicobacter pylori infection in children?

The aim of this study was to investigate the accuracy of using gastric nodularity (GN) as a marker for gastric inflammation associated with Helicobacter pylori infection in children. A retrospective analysis of 395 upper endoscopies done in children between 1990-1996 was performed. Demographics, clinical symptoms, endoscopic features, rapid urease test (RUT), and histological results were collected from each report. GN was found in 13 (3.5%) children. GN showed a significant correlation with age but not with gender. Multiple regression analysis showed a significant correlation between GN and gastritis with RUT but not with other histological determinants alone (gastritis, RUT, or H. pylori organisms). Nevertheless, GN had a poor accuracy rate to determine H. pylori-associated gastritis (sensitivity, 61%; positive predictive value, 12%). GN is a poor predictor for gastric inflammation associated with H. pylori infection in children. During endoscopy, gastric biopsies should always be obtained in children to establish the presence of mucosal inflammation.     

Familial gastric cancers with Li-Fraumeni Syndrome： A case repast

TO THE EDITOR Although the incidence of gastric cancer has declined somewhat in recent years, it remains one of the most common cancers worldwide[1], and is the most common cancer in East Asian countries such as Korea and Japan[2].In terms of the genetics of gastric cancer, mutations in CDH1 (E-cadberin) have been associated with hereditary diffuse gastric cancer (HDGC). The first germline mutation in CDH1 was reported in a large Maori HDGC family[1],with subsequent corroborations in Western and Asian HDGC families[3-5], CDH1 mutations are believed to be associated with up to 50% of HDGC families[5], but have not been linked with sporadic or intestinal types of gastric cancer[5].     

Treatment of postoperative gastric cancer with Fuzheng Huoxue anticancer prescription

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Should gastric cancer with peritoneal metastasis be treated surgically?

BACKGROUND/AIMS: This study was attempted to elucidate the role of surgery in patients with gastric carcinoma and peritoneal dissemination. METHODOLOGY: A database of 128 patients was retrospectively examined with univariate and multivariate analyses after selecting 4 treatment factors, 7 tumor factors evaluated preoperatively, 2 tumor factors evaluated intraoperatively, and 2 patient factors. RESULTS: The overall median survival time was 188 days. Median survival time was 259 days for patients who underwent resection, 173 days for those who underwent bypass operation, and 108 days for those who underwent laparotomy alone. Multivariate analysis revealed only four significant factors for prognosis including computed tomography findings of metastases to the lymph nodes of groups 2 and 3, distant metastasis, ascites, and postoperative status of the patients. Among these factors, the patient status was the most important factor for survival. In 70 patients with a preoperative bad status, the clinical factors affecting survival were analyzed by multivariate analysis exclusive of the postoperative patient status; ascites, resection, bypass operation, and postoperative chemotherapy were significant independent factors. There was no significant difference in safety, efficacy, or prognosis, between the procedures of resection and bypass. CONCLUSIONS: Surgical treatment is not recommended for patients with gastric cancer and peritoneal dissemination when their preoperative status is good. Palliative surgery should be selected when their status is bad. The primary tumor should be resected only when the patient has anemia due to bleeding from the primary tumor.     

Evaluation of preoperative staging in advanced gastric cancer with MRI

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Familial gastric cancers with Li-Fraumeni Syndrome: A case repast

TO THE EDITOR Although the incidence of gastric cancer has declined somewhat in recent years, it remains one of the most common cancers worldwide, and is the most common cancer in East Asian countries such as Korea and Japan. In terms of the genetics of gastric cancer, mutations in CDH1 (E-cadherin) have been associated with hereditary     

Fatty acid composition of subcutaneous adipose tissue and gastric mucosa: is there a relation with gastric ulceration?

Background  

Both in vitro and epidemiological studies indicate that dietary polyunsaturated fatty acids may play a protective role against peptic ulcer in humans. Adipose tissue fatty acid composition is thought to reflect dietary fatty acid intake. The aim of the present study is to investigate adipose and gastric mucosa fatty acid levels in relation to gastric ulceration status.     

Impaired gastric myoelectricity in patients with chronic pancreatitis： Role of maldigestion

AIM: To investigate whether gastric myoelectrical activity was impaired in patients with chronic pancreatitis (CP) and to explore the role of pancreatic enzyme in regulating gastric myoelectrical activity. METHODS: Twenty CP patients and 20 controls participated in the study. Gastric myoelectrical activity was recorded by a homemade electrogastrography (EGG) device. Two experiments were carried out. In experiment one, EGG was recorded in both controls and CP patients. While in experiment two, either pancreatic enzymes or placebo was given together with test meals. Spectral analysis was used to generate various EGG parameters. RESULTS: The control subjects, but not the CP patients, showed typically increased postprandial dominant frequency. The postprandial dominant power (DP) increment (2.24±1.13 vs 5.35±0.96 dB, P= 0.04) and the percentage of normal 2-4 cpm slow waves (63.0±3.8% vs 77.4±3.1%, P<0.05) were lower in CP patients when compared with the control. In the 20 CP patients, the DP increment (4.76±1.02 vs 2.53±1.20 dB, P<0.05) and the postprandial percentage of normal 2-4 cpm (74.4±2.8% vs 64.8±5.7%, P<0.05) were significantly higher with pancreatic enzyme replacement than the placebo. CONCLUSION: CP patients have an abnormal postprandial stomach myoelectricity showing poor response in dominant frequency/power and regularity, whereas these abnormalities are corrected after pancreatic enzyme replacement. Maldigestion is likely to be the factor leading to abnormal postprandial gastric myoelectricity of CP patients.     

Sentinel lymph node concept in gastric cancer with solitary lymph node metastasis

AIM:To study the localization of the solitary metastases inrelation to the primary gastric cancers and the feasibilityof sentinel lymph node(SLN)concept in gastric cancer.METHODS:Eighty-six patients with gastric cancer,whohad only one lymph node involved,were regardedretrospectively as patients with a possible sentinel nodemetastasis,and the distribution of these nodes wereassessed.Thirteen cases with jumping metastases werefurther studied and followed up.RESULTS:The single nodal metastasis was found in thenearest perigastric nodal area in 65.1%(56/86)of thecases and in 19.8%(17/86)of the cases in a fairly remoteperigastric area.Out of 19 middle-third gastric cancers,3 tumors at the lesser or greater curvatures had transversemetastases.There were also 15.1%(13/86)of patientswith a jumping metastasis to N2-N3 nodes without N1involved.Among them,the depth of invasion was mucosal(M)in 1 patient,submucosal(SM)in 2,proper-muscular(MP)in 4,subserosal(SS)in 5,and serosa-exposed(SE)in 1.Five of these patients died of gastric cancerrecurrence at the time of this report within 3 years aftersurgery.CONCLUSION:These results suggest that nodalmetastases occur in a random and multidirectional processin gastric cancer and that not every first metastatic node islocated in the perigastric region near the primary tumor.The rate of“jumping metastasis”in gastric cancer is muchhigher than expected,which suggests that the blindexamination of the nodal area close to the primary tumorcan not be a reliable method to detect the SLN and that aextended lymph node dissection(ELND)should beperformed if the preoperative examination indicatessubmucosal invasion.     

Phase Ⅰ study of postoperative radiotherapy combined with capecitabine for gastric cancer

AIM:To determine the maximum tolerated dose(MTD)and dose-limiting toxicity(DLT)of capecitabine combined with postoperative radiotherapy for gastric cancer.METHODS:We enrolled patients with any T stage and node-positive gastroesophageal or gastric adenocarcinoma after complete resection with negative margins(R0)or microscopic(R1)or macroscopic(R2)resection.Intensity modulated radiotherapy(IMRT)using a fiveto-seven-field,coplanar,sliding window technique was delivered to the tumor bed(T4b),anastomosis site,duodenal stump and regional lymph nodes(LNs)to a total dose of 45 Gy(1.8 Gy/fraction,5 d/wk).Patients with R1 or R2 resection received 10.8 Gy as a boost.Capecitabine was administered twice daily on every radiotherapy treatment day in a dose-escalation schedule (mg/m2)of 625(levelⅠ,n=6),700(levelⅡ,n=6),800(levelⅢ,n=6),900(levelⅣ,n=0)and 1000(levelⅤ,n=0).DLT was defined as grade 4 leukopenia or neutropenia,grade 3-4 thrombocytopenia or anemia and grade 3-4 non-hematological toxicity.RESULTS:Between October 2007 and August 2009,18 patients(12 men,6 women;median age,54 years)were enrolled in the study.The median number of positive LNs was 6,and total number of resected LNs was19.Twelve patients underwent R0 resection(66.7%).Fifteen patients received adjuvant chemotherapy under the leucovorin,fluorouracil and oxaliplatin(FOLFOX4)regimen.Six patients each were enrolled at dose levelsⅠ,ⅡandⅢ.Grade 1-3 leukopenia(16 patients,88.9%),anorexia(15,83.3%)and nausea(15,83.3%)were the most common toxicities.Grade 3 anorexia/nausea and grade 4 vomiting occurred in one level-Ⅰpatient.Grade 3 anorexia and nausea occurred in one level-Ⅱpatient.One level-Ⅲpatient developed grade 4neutropenia,while another developed grade 3 radiation esophagitis.No abnormal liver or renal function examinations were observed.Three patients did not finish chemoradiotherapy because of DLTs and two without DLTs received sequential boosts(total dose,55.8 Gy).CONCLUSION:The MTD of capecitabine was 800 mg/m2twice daily concurrent with IMRT for gastric cancer after surgery.The DLTs were anorexia/nausea,vomiting,neutropenia and radiation esophagitis.