Serial determinations of carcinoembryonic antigen for early detection of recurrent gastric cancer

In attempts to predict the recurrence of gastric cancer, postoperative changes in serum carcinoembryonic antigen (CEA) levels are monitored in our clinic by radioimmunoassay (Dainabot, Japan). Recurrences are suspected when serum CEA levels are 4 ng/ml, in the postoperative period. Out of 34 patients in whom there were increases in serum CEA, 18 were confirmed to have a recurrence and 15 of these 18 patients were assessed accurately by serial postoperative levels of CEA, two patients died of a recurrence after elevation of serum CEA levels. Thus, recurrence was predicted in 17 out of 34 patients (50 per cent) and in 12 out of 17 patients there was a metastasis to the liver. In 14 out of 34 patients there are no signs of recurrence 9 to 25 months after serum CEA elevations.     

The usefulness of CEA as an indicator for early detection and a guide to the treatment of recurrent gastric cancer

The usefulness of carcinoembryonic antigen (CEA) as an indicator for recurrence and a guide to the treatment was evaluated from a retrospective analysis of 88 patients with recurrent gastric cancer. Sixty-two of these patients (70.5 per cent), 25 of whom had a preoperative positive assay, and 37 a negative assay, had elevated levels of CEA after disease progression. Averaged CEA level in patients with liver metastasis was significantly higher (872 ng/ml) than in those with peritoneal metastasis (68 ng/ml), with lymph node metastasis (103 ng/ml) or with local metastasis (93 ng/ml) (p less than 0.01). An elevation of CEA was found prior to the clinical manifestation of recurrence, and the average lead time was 4 months. In 25 patients with a lead time of more than 4 months, survival time after CEA elevation was 13.3 months, which was longer than the 6.5 months of 28 patients with less than 4 months. Thirty-seven of the 88 patients were treated after recurrence. The average survival period after the detection of recurrence was 9.4 months in patients with surgical treatments followed by chemotherapy, 5.9 months in those with chemotherapy alone and 3.8 months in those with surgery alone. The average survival period of 26 patients with positive CEA assays in recurrence was 5.1 months longer than of patients with negative assays. This fact suggested that early detection of recurrence followed by various treatments, in the elevated CEA group, contributes to favorable results.     

The clinical usefulness of preoperative CEA determination in gastric cancer

Between 1980 and 1984, preoperative serum carcinoembryonic antigen (CEA) was determined in 468 patients with gastric cancer to evaluate its clinical usefulness. The positive rate of preoperative CEA was 20.9 per cent in these 468 patients. A significantly higher CEA positive rate was obtained in those patients with liver metastasis (69.2 per cent), n_3–4 (40.0 per cent), stage IV gastric cancer (37.0 per cent) and Pap, Tub₁ histological type (26.3 per cent) (p<0.01). It is interesting that the positive rate of the 49 unresectable patients was 51.0 per cent, which was significantly higher than 17.4 per cent of the 419 resectable cases (p<0.01). CEA levels in 16 of the 39 patients with liver metastasis were more than 100 ng/ml. In contrast, serosal invasion and peritoneal metastasis were less correlated to the CEA positive rate. In the 419 resected cases, the 5 year survival rate in the higher CEA group of more than 50 ng/ml (35 cases) was 4.4 per cent, which was significantly lower than 64.0 per cent in the negative group (346 cases) (p<0.01). These results show that CEA determination in patients with gastric cancer is useful for the prediction of prognosis, as well as for a diagnostic tool to discover the presence of liver or lymph node metastasis.     

Serum CEA levels facilitate detection of recurrences of cancer in patients after gastrectomy

In an attempt to assess the usefulness of carcinoembryonic antigen (CEA) for predicting the progression of gastric cancer, CEA productivity was evaluated according to serum CEA levels, at the time of recurrence or relapse. In cases of a recurrence, abnormal CEA levels were observed in 14 of 17 (82.4 per cent) with differentiated carcinoma and in 9 of 21 (42.9 per cent) with undifferentiated carcinoma. Preoperative abnormal CEA levels were observed in only 6 of 41 patients (14.6 per cent). A median lead time of manifestation of recurrence was 5 months. In those with relapse, 9 of 11 (81.8 per cent) patients with differentiated carcinoma and 13 of 18 (72.2 per cent) with an undifferentiated carcinoma had abnormal CEA levels. Preoperative abnormal CEA levels were observed in 24 of these 89 patients (27.0 per cent). Postoperative monitoring of CEA seems to be useful for early recognition of gastric cancer progression, irrespective of the preoperative CEA levels.     

The usefulness and limitations of CEA assay in the management of colorectal cancer

We investigated the usefulness and limitations of the measurement of CEA in the evaluation of tumor resection and the detection of recurrence in colorectal cancer patients. Preoperatively, 46 of 90 patients (51.1%) had CEA values of 5.0 ng/ml or higher. The percentage of patients with elevated CEA in whom the CEA values returned to normal one month postoperatively was significantly higher in those who had undergone a curative resection than in those who had undergone a non-curative resection (p<0.02). Among patients with normal CEA values, the changes were nil or only slight in CEA values, one month postoperatively Among 28 with recurrences, 24 (85.7%) had CEA values of 5.0 ng/ml or higher. All 11 with liver recurrences had values of 10.0 ng/ml or higher. In 4 with liver recurrences and in cases where CEA measurements were made, CEA values were found to be abnormal 3 to 10 months before the recurrences and a rapid elvation occurred for a short period. However, 4 out of 10 with local or lymphnode recurrences showed normal CEA values. CEA measurement was useful in detection of liver recurrences, but not so useful in detecting local or lymphnode recurrences.     

Prognostic factors of early gastric cancer —Results of long-term follow-up and analysis of recurrent cases—

The prognosis of early gastric cancer (EGC) is generally excellent, however, EGC is not an exception to recurrence. In order to know what type of EGC is liable to recur, long-term results were studied in 304 cases of resection. The cumulative 10-year survival rate was poorer in patients with positive lymph nodes than in those with negative nodes (52.8±15.8 per centvs 94.1±2.4 per cent; p<0.05). It was also less favorable when the EGC was greater than 5 cm in diameter (61.5±13.2 per centvs 92.9±2.4 per cent;p<0.05). Among 50 cases which died postoperatively, six deaths were due to recurrence. A predominant mode of recurrence was hematogenous metastasis (4/6). The characteristics of EGC which recurred later included large cancer (≧5 cm) (6/6), macroscopically combined-type cancer (5/6), cancer of depth invasion to the submucosa (4/6) and histologically differentiated cancer (6/6). Lymph node dissection was not carried out in two of these patients at their primary operation. Adjuvant therapy should be added in the EGC bearing risk factors depicted above. Primary cancer in other organs, either metachronous or synchronous, was found in 13 cases (4.3 per cent). Colonic cancer, in particular, was seen in three, and it was 4.8 times as frequent as the expected number of the general population, calculated using the person-year method.     

Clinicopathologic evaluation of recurrence in early gastric cancer

Five hundred ninety-two patients with early gastric cancer underwent surgical resection from 1970 to 1986 in our hospital, and 13 died from a recurrence of their disease. A careful analysis of these 13 patients suggests that carcinomas which invaded to the submucosa tend to recur more often than those confined to the mucosa. Well differentiated and papillary adenocarcinomas characterized by protruded or elevated lesions tend to recur earlier than poorly differentiated or signet-ring cell carcinomas characterized by depressed or excavated lesions. However, both types recurred from hematogenous metastases, with the liver being the most common site. Therefore, the macroscopic and histological features presently used to characterize early gastric cancer do not provide sufficient information to accurately predict which patients are at most risk for recurrence.     

胃癌术后局部复发原因分析及其对策（附127例分析）

目的 探讨胃癌复发的部位、时间和危险因素,为预防胃癌术后复发提供依据。 方法 回顾性分析2000年1月至2006年1月中国人民解放军105医院收治127例复发性胃癌的临床资料,对其复发部位、复发时间及其病理类型和手术方法进行探讨。结果 复发原因与肿瘤病理类型及手术根治范围有关。局部复发病例中以腹膜腔复发多见,胃外复发次之;Bormann分型以2、3、4型复发多见;低分化肿瘤复发多见,全胃切除后除腹膜腔复发外局部复发少;胃外复发病例中以贲门周围和肝十二指肠韧带即第No.1、12淋巴结复发多见。 结论 完善围手术期处理可以减少胃癌术后局部复发,对于胃癌局部复发病例应积极行手术治疗。     

腹腔镜根治术在早期胃癌治疗中应用价值

目的探讨腹腔镜早期胃癌根治性手术的临床应用价值。方法回顾性分析2004年10月至2007年5月上海交通大学医学院附属瑞金医院31例早期胃癌行腹腔镜辅助胃癌根治术的临床资料,包括手术方式、手术时间、术中失血、术后排气时间、术后住院天数、并发症、术后病理和随访等。结果所有手术均在腹腔镜下完成,其中腹腔镜辅助远端胃切除术28例,近端胃切除术2例,全胃切除术1例。腹腔镜下胃周围淋巴结清扫(D1 α)16例,胃周围淋巴结 肝动脉旁淋巴结清扫(D1 β)2例,扩大淋巴结清扫(D2)13例。手术时间195(90~280)min,术中失血146(40~800)mL,术后排气时间1.8(1~4)d,术后住院天数10.8(7~20)d,1/31例(3.2%)病人出现术后吻合口瘘,经非手术治疗后痊愈。手术上、下切缘距离肿瘤为3.8(1~8)cm和3.5(1.5~7.0)cm,手术清扫淋巴结9.6(2~19)枚。术后随访14(2~32)个月,均无肿瘤复发和远处转移。结论腹腔镜辅助胃癌根治术是治疗早期胃癌安全、可行、微创、有效的方法。     

Metastasis of cancer to cancer: Report of a case of esophageal carcinoma metastasizing to early gastric cancer

A rare case of esophageal carcinoma metastasizing to early gastric cancer is reported herein. A 66 year old man who had experienced dysphagia for 8 months was preoperatively diagnosed as simultaneously having esophageal and gastric cancers. Thus, a lower esophagectomy and total gastrectomy with paraesophageal and paragastric lymph node dissection were performed. The surgical specimen revealed an ulcerative tumor in the lower esophagus and a slightly depressed lesion with a central elevation similar to that of early type IIc+IIa¹ gastric cancer in the upper part of the stomach. Microscopically, the esophageal tumor was revealed to be well differentiated squamous cell carcinoma while the gastric tumor was found to be early gastric cancer with a metastatic focus of esophageal cancer in the center. Though less than one hundred cases of metastasis of cancer to cancer have previously been reported, metastasis from cancer of one digestive organ to that of another digestive organ is very rare. To our knowledge, this report represents the first case of an esophageal carcinoma metastasizing to a gastric carcinoma.     

Omental transfer for mediastinitis in a patient with early gastric cancer

We encountered a patient with mediastinitis after coronary artery bypass grafting and early gastric cancer requiring surgical resection. We treated the patient’s mediastinitis by omental transfer since complete resection of the malignancy did not require omentectomy. However, in the procedure for harvesting an omental flap, lymph nodes along the gastroepiploic artery (GEA) were left in the stomach for dissection after recovery from mediastinitis; the greater omentum was divided along the outside of the GEA, and was used as a flap based on the left GEA. After mediastinitis was successfully treated, the patient underwent distal gastrectomy and resection of lymph nodes, including those along the GEA. Although indication for omental transfer must be carefully considered when selecting this procedure for mediastinitis patients with malignancies of the abdomen, this technique of harvesting the greater omentum was useful in the present case of a mediastinitis patient with surgical indications of early gastric cancer.     

Distant lymph node metastasis of early gastric cancer

Among 601 patients with early gastric cancer (EGC), the clinicopathological findings of 5 patients (invasion of the mucosal layer in 2 and of the submucosal layer in 3) with distant lymph node metastasis according to TNM classification (third-or fourth-tier lymph node metastasis according to the Japanese classification) were investigated. The proliferating-cell nuclear antigen (PCNA) expression of EGC was also examined immunohistologically. The sites of distant metastasis were the nodes at the root of the mesentery, in the hepatoduodenal ligament, and the paraaortic nodes, while the PCNA-positive rate of EGC with distant lymph node metastasis (35.4%) was significantly higher than that of EGC without lymph node metastasis (14.7%,P=0.01), it was similar to that of EGC with perigastric lymph node metastasis. The cumulative survival rate of the EGC patients with distant lymph node metastasis (5-year survival rate 20.0%) was significantly lower than that without lymph node metastasis (88.2%,P<0.0001), first-tier lymph node metastasis (76.9%,P<0.04), or second-tier lymph node metastasis (77.1%,P<0.04). Thus, although the prognosis of EGC patients with distant lymph node metastasis was poor, a dissection of the distant lymph nodes should be performed when metastasis is suspected.     

胃黄色瘤与根治幽门螺旋杆菌后早期胃癌的相关性分析

目的 通过胃黄色瘤与根治幽门螺旋杆菌后早期胃癌相关性的回顾性、单中心观察性研究,最终确定胃黄色瘤对诊断根治幽门螺旋杆菌后早期胃癌发生的预测价值。方法 选择2018~2021年在我院成功根治幽门螺旋杆菌且进行胃镜随访的病人,收集相关病例资料。所有病例。根据胃镜下检查并经病理最终证实为早期胃癌,归为病例组,其余归为对照组,分析胃黄色瘤与根治幽门螺旋杆菌后早期胃癌的相关性。结果 病例组胃黄色瘤患者比例显著高于对照组（71.1% vs. 13.9%;P < 0.05）。logistic回归分析发现,萎缩、肠上皮化生和胃黄色瘤是幽门螺旋杆菌根治后早期胃癌检测的独立预测因素。萎缩匹配对照分析也确定胃黄色瘤为独立预测因子。结论 胃黄色瘤可作为幽门螺旋杆菌根治后早期胃癌的预测指标。     

早期胃癌行内镜黏膜下剥离术指征及评价

内镜黏膜下剥离术（ESD）是一种内镜下整块切除病变黏膜的治疗方法,已经成为早期胃癌的治疗选择之一。目前ESD治疗早期胃癌较为积极的指征为：（1）分化型黏膜内癌如果表面未形成溃疡,则病变大小不受限制;（2）分化型黏膜内癌如果表面已经形成溃疡,则病变直径≤30mm;（3）分化型sm1癌,病变直径≤30mm;（4）未分化型黏膜内癌,表面未形成溃疡,且病变直径≤20mm。尽管长期随访的资料较少,但目前看来,如果合理地把握ESD治疗指征,早期胃癌的治愈率与手术相当,但可减少并发症,提高病人生活质量,具有安全、可行、有效的特点。     

伴远隔转移的早期胃癌临床病理特征

目的分析原发病灶局限于黏膜或黏膜下层,但同时伴有远隔转移早期胃癌的临床病理特征。方法回顾性分析1973年4月至1998年11月,中日两家大学8所附属医院的4420例(每家医院220~1270例)早期胃癌,其中22例伴有远隔转移。分析伴远隔转移的早期胃癌(远转组)和不伴远隔转移的早期胃癌(无转组)在性别、年龄、肿瘤大小、浸润深度、分化类型、长期存活率等方面的差异。结果远转组肿瘤与无转组在性别、肿瘤大小、浸润深度、5年存活率(远转组34.7%,无转组91.3%)方面差异有非常显著性意义(P<0.01);两组在年龄、分化程度方面差异无显著性意义。结论早期胃癌也可能发生远隔转移并导致预后不佳。女性、肿瘤浸润至黏膜下层且肿瘤直径>4cm可能是早期胃癌发生远隔转移的危险因素。     

Pseudomyxoma peritonei concomitant with early gastric cancer: Report of a case

The preoperative diagnosis of both appendiceal carcinoma and pseudomyxoma peritonei is difficult because of the nonspecific nature of the associated symptoms. More than 50% of all patients with carcinoma of the appendix are diagnosed with and treated for acute appendicitis. In addition, there have been few reports on patients with an appendiceal carcinoma or pseudomyxoma peritonei in association with other synchronous or metachronous malignancies of the alimentary tract. We herein report the first known patient with synchronous early gastric cancer and pseudomyxoma peritonei, in which the origin was correctly identified preoperatively.     

The macroscopic diagnosis of lymph node metastasis from early gastric cancer

As the proportion of early gastric cancers (EGC) has been steadily increasing, modifications of the radical lymphadenectomy approach to stomach cancer have been attracting considerable attention; however, accurate pre- and intraoperative evaluations of tumor extent are essential for the successful application of this method. We examined the reliability of macroscopically diagnosing node involvement by reviewing the operative and pathological records of 522 patients with EGC. Of 59 patients histologically diagnosed as node-positive (n+), only 19 (32%) had been macroscopically diagnosed as node-positive (N+). In contrast, of 61 N+ patients, 42 (69 %) were in fact n-. Metastases from histologically diffuse type carcinomas were less accurately diagnosed than those from intestinal type tumors. In 44% of the false-positive (N+/n-) patients, the tumor had been preoperatively diagnosed as advanced, which seemed to have lead to intraoperative overdiagnosis. These results suggest that lymph node metastases from EGC cannot be reliably diagnosed during surgery. The indications for a modified radical operation should thus be decided according to preoperative tumor evaluation based on the depth of invasion.     

Simultaneous early gastric cancer in identical twins: Report of a case

We report the unusual case of identical male twins developing early gastric cancers that were found almost simultaneously. A 39-year-old man underwent a barium-swallow examination to investigate the cause of right hypochondrial discomfort; the examination revealed evidence of gastric cancer in the upper body of the stomach. A diagnosis of adenocarcinoma was confirmed by endoscopic biopsy, and a total gastrectomy was performed. Subsequent screening of the patient's asymptomatic identical twin revealed gastric cancer in the lower body of the stomach, for which distal gastrectomy with Billroth I reconstruction was performed. The histopathological types of the two cancers were similar and both had infiltrated the submucosa. The relevant etiological factors contributing to the development of gastric adenocarcinoma in these identical twins is discussed, following the case report.     

Clinical and pathological features of early gastric cancer in Singapore

Objective: The incidence of early gastric cancer (EGC) is increasing gradually in countries such as Japan and Korea. Knowledge of EGC in other Asian countries, however, is limited. This study aims to describe the characteristics of this disease in Singapore. Method: A retrospective analysis of the operative results of a personal series of EGC was undertaken. The clinical and pathological characteristics were examined. Results: From 1979 to 1997, 226 patients with gastric cancer were operated on and 21 patients (9.3%) were diagnosed as having EGC by histological examination. All 21 patients received radical gastrectomy and lymphadenectomy. There were 12 males and 9 females with a median age of 59 years (range: 36–65). The presenting symptom was epigastric pain (15 patients), bleeding (two patients), weight loss (two patients), vomiting and incidental (one patient each). The majority of the tumours (76%) were located at the antrum and were intestinal type. Macroscopically, most of the tumours were either depressed (type IIc) or excavated (type III) type. Four cases were combined type. The lesion was limited to the mucosa in 10 cases. Only one patient had lymph node metastasis. There was no operative mortality and the morbidity rate was 14%. Nineteen patients had complete follow up for 3 months to 13 years. No patient developed tumour recurrence in the series. Conclusion: Early gastric cancer remains uncommon in Singapore. However, for these patients, radical gastrectomy yields excellent results with minimal morbidity.      

青老年人早期胃癌的临床与预后分析

目的 了解青年人与老年人早期胃癌的特点和差异,采取更为合理的治疗手段。方法 对比分析1990～1999年经外科手术治疗且病理证实的30岁以下早期胃癌20例、60岁以上早期胃癌39例的临床及随访资料。结果 青年组发病年龄平均(25.1±2.3)岁,老年组发病年龄平均(64.9±4.4)岁。青年组男:女=1:1.5,老年组男:女=3.9:1(P<0.05)。青年组胃底贲门癌2例(10.0％),老年组12例(30.8％);青年组胃体癌8例(40.0％),老年组16例(41.0％);青年组胃窦癌10例(50.0％),老年组11例(28.2％)(P<0.01)。青年组分化较好的胃癌6例(30.0％),老年组23例(59.0％),P<0.05。多数病例经D_2根治术。青年组术后5年生存率85.7％,老年组90.5％(P>0.05)。结论 青年人早期胃癌以女性多见,多位于胃窦部且分化较差;老年人早期胃癌以男性多见,多位于胃底贲门且分化较好。二者5年生存率相似,因而早期诊断、早期行根治性手术,可能是影响胃癌预后最重要的一个因素。