Prognostic significance of perinodal extension in gastric cancer

BACKGROUND: The grouping of patients who have a poor prognosis is important in determining a treatment strategy. The aim of this study was to investigate the clinicopathologic features and prognosis in patients with perinodal extension, with a focus on the difference of survival between homogenous groups. METHODS: This study included a total of 1,092 patients who underwent curative gastrectomy for gastric adenocarcinoma from 1997 to 2004 at the Department of Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine. RESULTS: One hundred sixty-one patients had perinodal extension. The incidence of perinodal extension was positively correlated for T and N stages. Perinodal extension was identified as an independent prognostic factor and had more influence on survival than T and N stages. Patients who had nodal metastasis without serosal exposure and who had serosal exposure without nodal metastasis were selected as homogenous groups, and there was no difference of survival between these groups. However, when the nodal metastasis group was subdivided according to the perinodal extension, perinodal extension subgroup had significant poorer prognosis than no perinodal extension subgroup. CONCLUSIONS: The perinodal extension was the most important independent prognostic factor in gastric cancer, and should be included in the TNM gastric cancer staging system.     

早期结外NK/T细胞淋巴瘤的预后分析

目的 分析早期上呼吸消化道结外NK/T细胞淋巴瘤(UADT ENKTCL)放疗联合以门冬酰胺酶/培门冬酶为主的化疗疗效及预后因素。方法 收集2003—2020年间贵州省肿瘤医院收治的 267例早期UADT ENKTCL患者,其中放疗或联合门冬酰胺酶/培门冬酶为主要方案化疗的 229例,单纯放疗或化疗的 38例。Kaplan-Meier计算总生存(OS)、无进展生存(PFS)并log-rank法检验和单因素分析,Cox模型多因素分析。结果 全组 5年OS、PFS分别为67.2%、61.5%;放化综合治疗、单纯放疗、单纯化疗的 5年OS分别为71.7%、35%、49%(P<0.001),5年PFS分别为66%、35%、28%(P<0.001)。放化疗患者基于NRI危险分层分为预后良好、预后不良组,5年OS分别为93.3%、64.3%(P<0.001),5年PFS分别为91.1%、56.7%(P<0.001);放疗剂量≥50Gy、<50Gy组 5年OS分别为72.4%、55.7%(P<0.001),5年PFS分别为68.3%、36.5%(P<0.001)。预后不良组化疗周期数≥4个、<4个的 5年OS分别为65.5%、59.2%(P=0.049),5年PFS分别为60.7%、50.6%(P=0.018)。单因素分析显示Ⅱ期、ECOG≥2分、超腔、单纯放疗、NRI≥1分、EB病毒-DNA≥2750 copies/ml、放疗剂量<50Gy,化疗周期数<4个为 5年OS及PFS的预后不良因素(均 P<0.05);CHOP类化疗方案仅为PFS的预后不良因素(P<0.05)。多因素分析显示超腔、ECOG≥2分、放疗剂量<50Gy均为OS和PFS的预后不良因素(均 P<0.05),Ⅱ期为OS的预后不良因素(P<0.05)。结论 早期低危UADT ENKTCL预后良好;足够剂量的扩大受累野放疗是早期UADT ENKTCL根治性手段;综合治疗较单纯放疗能改善早期预后不良组患者的预后;足疗程化疗能显著改善预后不良组的远期生存,门冬酰胺酶为基础的化疗均能较好的改善早期UADT ENKTCL的预后。     

Prognostic impact of dimensional factors in pT1 gastric cancer

BackgroundThe significance of the dimensional factors (tumor diameter, area and volume) as the prognostic factor has not been precisely evaluated in pT1 gastric cancer.ObjectivesThis study aimed to identify the clinical impact and to confirm the clinical feasibility of the dimensional factors as prognostic factors in pT1 gastric cancer.MethodsWe analyzed prognostic factors for disease-specific survival (DSS), overall survival (OS) using clinicopathological factors by univariate and multivariate analyses and the pattern of recurrence in 2011 pT1 gastric cancer (mucosal and submucosal cancers) undergoing R0 gastrectomy. The cut-off values of each dimensional factor was decided by the ROC curve.ResultsCox proportional hazard regression model showed that older age (≥75) and more advanced pN stage were adverse independent prognostic factors for DSS, and revealed that older age (≥75), greater preoperative co-morbid diseases, proximal and total gastrectomy, operative method and Clavien-Dindo classification (≥grade III) were independent adverse factors for OS. Any dimensional factors were not independent prognostic factors for any survival.ConclusionsThe dimensional factors do not influence both OS and DSS in pT1 gastric cancer patients and so it is difficult to apply these dimensional factors for conducting therapeutic strategies.     

诱导化疗联合放疗在早期结外NK/T细胞淋巴瘤的预后分析

目的 分析早期结外NK/T细胞淋巴瘤(ENKTCL)使用诱导化疗联合放疗的疗效及预后因素。方法 2003—2021年间贵州医科大学附属肿瘤医院收治287例早期ENKTCL患者,接受诱导化疗联合放疗的综合治疗,分析早期NKTCL的临床预后相关因素。Kaplan-Meier计算总生存(OS)、无进展生存(PFS)及log-rank法检验和单因素分析,Cox模型多因素分析。结果 全组5年OS、PFS分别为72.8%、68.9%;基于改良的Nomogram风险指数(NRI)预后模型分为低危组(0分)、中低危组(1分)、中高危组(2分)、高危组(3分)和极高危组(≥4分)的5年OS分别为95.6%、76.3%、69.5%、61.0%和23.3%(P<0.001),5年PFS分别为93,2%、69.8%、64.6%、60.2%和23.3%(P<0.001)。放疗剂量≥50Gy和<50Gy组5年OS分别为73.8%和65.9%(P=0.123),5年PFS分别为72.8%和45.3%(P=0.001)。诱导化疗近期疗效为CR、PR、SD、PD的5年OS分别为85.4%、74.0%、61.8%、28.5%(P<0.001),5年PFS分别为83.7%、66.8%、65.7%、27.4%(P<0.001)。单因素分析显示Ⅱ期、ECOG≥2分、超腔、放疗剂量<50Gy、诱导化疗近期疗效为5年OS及PFS的预后不良因素(均P<0.05),多因素分析显示超腔、ECOG≥2分、Ⅱ期为OS预后不良因素(均P<0.05),而超腔、ECOG≥2分为PFS的预后不良因素(均P<0.05)。结论 早期结外NK/T细胞淋巴瘤采用以诱导化疗联合足量放疗能取得较好疗效;对诱导化疗近期疗效能够达到完全缓解预后良好。     

Prognostic impact of positive lymph node ratio in gastric carcinoma

BACKGROUND AND OBJECTIVES: To evaluate the prognostic value of metastatic lymph node ratio in gastric carcinoma. METHODS: One hundred and sixty four patients who underwent D(2) dissection for gastric carcinoma at Ankara Oncology Hospital were reviewed retrospectively. The prognostic factors including Japanese classification, AJCC/UICC TNM classification and metastatic lymph node ratio (1-10% and >10%) were evaluated in univariate and multivariate Cox regression analysis. RESULTS: The multivariate analysis showed that Borrmann classification, pN-category of AJCC/UICC classification and metastatic lymph node ratio were the most significant prognostic factors and a higher hazard ratio was obtained for metastatic lymph node ratio than pN category of AJCC/UICC classification (4.5 vs. 11.4). When the metastatic ratio groups of 1-10% and >10% were subdivided into pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification, there was no statistical difference between survival curves. When pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification were subdivided into the ratio groups of 1-10% and >10%, the survival rate of ratio group 1-10% was better than ratio group >10%. CONCLUSION: With its simplicity and reproducibility, metastatic lymph node ratio can be used as a reliable prognostic indicator.     

Retrospective analysis of stage IV advanced gastric cancer treated with S-1 or other chemotherapy

Background We retrospectively analyzed the influence of various clinicopathologic factors on the survival of patients treated with chemotherapy. Methods A retrospective analysis was made of 110 patients with stage IV gastric cancer who were treated from January 1996 to June 2004. Results Median survival time was 429 days for patients treated with S-1 therapy and 236 days for patients without S-1 therapy. A better survival was demonstrated in patients who had good performance status, one metastatic site, or had been given a second-line chemotherapy (P < 0.01). But very few patients (17%; 5/29) with multiple metastatic sites were able to receive the second-line chemotherapy. Conclusion Patients treated with S-1 therapy had a better prognosis than patients without S-1. One metastatic site and being given second-line chemotherapy were other factors for better prognosis. For patients with only one metastatic site, a good prognosis can be obtained by second-line chemotherapy for those refractory to S-1. The prognosis of patients who had more than two metastatic sites remained poor; more effective chemotherapy might improve the survival of such patients if they retain good performance status.     

ERCC1表达与Ⅲ期胃癌术后预后的关系

目的探讨切除修复交叉互补基因(ERCC1)蛋白在Ⅲ期胃癌中表达及其与预后的关系。方法采用免疫组化En Vision二步法检测477例Ⅲ期胃癌组织中ERCC1蛋白的表达情况,并分析其与预后的关系。结果胃癌组织中ER-CC1蛋白阳性表达率为67.1%(320/477)。ERCC1阳性表达的320例患者中,化疗组中位生存期(MST)为30.9个月,5年生存率为30%;未化疗组MST为26.3个月,5年生存率为25%,差异无统计学意义(P=0.184)。ERCC1阴性表达的157例患者中,化疗组MST为33.0个月,5年生存率30%;未化疗组MST为18.5个月,5年生存率为9%,差异有统计学意义(P=0.000)。未行术后辅助化疗的131例患者中,ERCC1阳性表达者生存时间长于阴性者(P=0.034)。Cox多因素分析显示,肿块大小、浸润深度、有无脉管神经受侵、淋巴结转移、化疗与否为胃癌的独立预后因素。结论胃癌根治术后患者ERCC1阴性表达者可从含铂方案辅助化疗中获益;ERCC1阳性可能是预后良好的指标,但应用含铂药物化疗后患者似乎未能显著延长生存。     

KDM5B is overexpressed in gastric cancer and is required for gastric cancer cell proliferation and metastasis

Epigenetic alterations such as aberrant expression of histone-modifying enzymes have been implicated in tumorigenesis. KDM5B (also known as JARID1B) is a newly identified histone demethylase that regulates chromatin structure or gene expression by removing methyl residues from trimethylated lysine 4 on histone H3. Recent observations have shown oncogenic activity of KDM5B. However, the role of KDM5B in gastric cancer carcinogenesis remains unclear. In this study, we aimed to investigate the role of KDM5B in gastric cancer. Immunohistochemical analysis, western blotting, and qRT-PCR were used to measure the levels of KDM5B in gastric cancer cell lines, 45 pairs of gastric cancer tissues and the adjacent nonneoplastic tissues. KDM5B and shKDM5B were transfected into gastric cancer cells to investigate its role on regulating cell proliferation which was measured by MTT and colony formation assay. Cell’s migration and invasion were measured by Transwell and Matrigel analysis in vitro. PCNA expression was measured by immunofluorescence staining and immunohistochemical analysis. The in vivo tumorigenesis and metastasis assays were performed in SCID mice. In clinical gastric cancer samples, we found that KDM5B expression was significantly up-regulated in cancer lesions compared with paired normal gastric tissues. By silencing or overexpressing KDM5B in gastric cancer cells, we found that KDM5B could promote cell growth and metastasis in vitro. An in vivo assay showed that KDM5B not only dramatically promoted gastric cancer cell xenograft formation and growth but also promoted gastric cancer cell metastasis in a liver metastasis model. Moreover, we demonstrated that KDM5B promoted gastric cancer metastasis via regulation of the Akt pathway. Our study provided evidence that KDM5B functions as a novel tumor oncogene in gastric cancer and may be a potential therapeutic target for gastric cancer management.     

Evaluation of prognostic value and stage migration effect using positive lymph node ratio in gastric cancer

Aims

To detect the best cut-off value of the positive lymph node ratio (PLNR) for stratifying the prognosis and analyzing its value with regard to stage migration effect using PLNR in gastric cancer.

疗前血清Hb水平在早期结外鼻型NK/T细胞淋巴瘤中的预后价值

目的 探讨治疗前血清Hb水平对早期结外鼻型NK/T细胞淋巴瘤预后的影响。 方法 回顾分析2000—2015年间收治的 175例Ⅰ、Ⅱ期结外鼻型NK/T细胞淋巴瘤。纳入标准为原发病灶位于上消化呼吸道,不合并其他恶性疾病,治疗及随访记录完整病例纳入分析。接受单纯化疗 67例、单纯放疗 8例、放化疗 100例。Kaplan-Meier法计算生存率,Logrank法单因素分析,Cox模型多因素分析。 结果 175例患者的变量单因素分析显示疗前血清Hb水平(≥120 g/L)、LDH水平(正常)、ECOG评分(0~1)、Ann Arbor分期(Ⅰ_{E)、接受放疗显著提高PFS及OS (P=0.000~0.046)。多因素分析显示血清Hb水平、LDH水平、ECOG评分、Ann Arbor分期是患者PFS、OS影响因素(P=0.000~0.040)。 结论 疗前Hb≥120 g/L者预后好于<120 g/L者。}     

AKR1B10, a good prognostic indicator in gastric cancer

Background and objectives

The aim of the study was to investigate the correlation between AKR1B10 expression and clinicopathological features of gastric cancer (GC).

Methods

Real-time polymerase chain reaction (RT-PCR) was performed to determine AKR1B10 mRNA expression. AKR1B10 protein levels were measured by immunohistochemistry.

Results

RT-PCR analysis confirmed that AKR1B10 was significantly down-regulated in gastric cancer compared with paired, normal mucosa. Immunohistochemistry revealed that the percentage of AKR1B10-positive specimens was lower in gastric carcinoma compared with normal specimens. The frequency of AKR1B10-positive GC specimens was higher in patients with tumor size <5 cm, no lymph node metastasis, no distant metastasis and lower tumor stages The mean survival time for patients in the AKR1B10-positive group was significantly higher compared with the AKR1B1-negative group. The 5-year survival rate for the AKR1B10-positive group was also significantly higher than for the AKR1B1-negative group. Cox regression analysis revealed that AKR1B10 expression is an independent prognostic factor of GC.

Conclusions

Expression of AKR1B10 in gastric cancer was significantly associated with tumor size, lymph node metastasis, distance metastasis and TNM stage, and AKR1B10 may be a good prognostic indicator in gastric cancer.     

Prediction and prognostic significance of ALOX12B and PACSIN1 expression in gastric cancer by genome-wide RNA expression and methylation analysis

BackgroundStomach adenocarcinoma (STAD) is one of the common gastrointestinal cancers, characterized by late discovery and metastasis. However, research of gene methylation and expression in gastric cancer (GC) metastasis has been quite limited. This study aimed to investigate the altered gene expression patterns between metastasis and non-metastasis samples using high-throughput RNA and methylation profiles from a large number of patients. Another aim was to identify a specific potential metastasis biomarker, with the ability to predict the metastasis possibility and prognosis of patients with STAD.MethodsIn this study, we integrated The Cancer Genome Atlas (TCGA) program STAD datasets, analyzed the RNA expression and DNA methylation data between non-metastasis (M0) and distant metastasis (M1) samples, and evaluated the candidate biomarker in survival and prognosis of GC.ResultsAmong all patients enrolled, 329 with M0 and M1 information were positive for RNA analysis, and 353 with M0 and M1 information were positive for methylation analysis. We found 29 upregulated and 200 downregulated genes in RNA level, and 5,046 hypermethylated and 8,563 hypomethylated probes in methylation level. Among these genes, we found high RNA expression level and low DNA methylation level of ALOX12B and PACSIN1 in GC metastasis samples. Patients with high expression of these 2 genes had poor overall survival (OS), progression-free survival (PFS), and post-progression survival (PPS).ConclusionsThe expression levels of ALOX12B and PACSIN1 were higher in the metastasis than non-metastasis group, and participants with high expression of these 2 genes were found to have poor survival. The genes ALOX12B and PACSIN1 are potential biomarkers of metastasis and poor prognosis, especially in early stage GC, and provide additional information for subsequent comprehensive treatment of GC.     

High expression of cAMP responsive element binding protein 1 (CREB1) is associated with metastasis,tumor stage and poor outcome in gastric cancer

cAMP responsive element binding protein 1 (CREB1) has been reported to be implicated in tumor development and progression of human cancers. However, the clinical significance and regulatory mechanisms of CREB1 expression in gastric cancer remain largely unknown. In the present study, immunohistochemistry was performed to detect the expression of CREB1 protein in 185 primary gastric cancer tissues, 50 secondary lymph node metastatic foci and 50 nontumorous gastric tissues. A prognostic model combining CREB1 expression with TNM tumor stage was constructed by logistic regression analysis. Regulation of CREB1 by miRNAs was investigated by luciferase reporter assay and Western blot. It was shown that CREB1 was highly expressed and correlated with lymph node metastasis, distant metastasis and tumor stage and poor outcome in gastric cancer. The prognostic model was proven to be an independent prognosis predictor and performed better than CREB1 or tumor stage alone. CREB1 was identified as a direct target of miR-27b and miR-200b, and down-regulated by miR-27b/miR-200b. We conclude that CREB1 is a promising biomarker to predict tumor metastasis and patient outcome in gastric cancer, and the miR-27b/miR-200b-CREB1 pathway may serve as a potential molecular target for the treatment of gastric cancer.     

Sipa1在胃癌组织中的表达及临床意义

  目的  探讨Sipa1基因（signal-induced proliferation-associated gene 1）在胃癌组织中的表达水平及其与临床病理、预后之间的关系。  方法  分别应用实时荧光定量PCR方法和Western blot法检测43例新鲜胃癌组织及相应癌旁正常组织中Sipa1 mRNA及蛋白的表达量。应用免疫组织化学SP染色法检测122例胃癌和64例正常胃黏膜石蜡组织中Sipa1蛋白的表达水平。  结果  新鲜胃癌组织中Sipa1 mRNA（ΔCt:7.94±1.12）及蛋白（0.305 6±0.108 4）的表达水平较癌旁正常组织（ΔCt:0.531 9±0.072 0;0.531 9±0.072 0）显著下降。胃癌石蜡组织中Sipa1蛋白表达阳性率36.1%较正常胃黏膜石蜡组织中阳性率73.4%低,二者之间差异有统计学意义（P < 0.01）。Sipa1蛋白表达与胃癌分化程度、淋巴结转移、浸润深度、临床分期有关（P < 0.05）,与年龄、性别、肿瘤大小、部位等表达无关（P>0.05）。Sipa1蛋白阴性表达患者比阳性表达患者的5年生存率显著降低（P < 0.01）。  结论  Sipa1基因的表达与胃癌的生物学行为关系密切,对判断预后有参考作用。      

Usefulness of polysaccharide K (PSK) as postoperative adjuvant immunotherapy in patients with stage IV gastric cancer

Background. We investigated retrospectively the usefulness of polysaccharide K (PSK) administration for prolonging survival after noncurative resection in patients with stage IV gastric cancer who underwent surgery at our department. Methods. 357 patients with gastric cancer evaluated as stage IV according to thegeneral rules for gastric cancer study, 11th edn (1985) of the Japanese Research Society for Gastric Cancer, who were expected to succumb to surgical death or postoperative death within 2 months were studied. The patients were divided into two groups: total PSK dosage greater than or less than 180g. Survival rates were calculated for each group. Results. In these stage-IV gastric cancer patients, the 5-year and 10-year survival rates in the PSK group were both 13.9%. In the non-PSK group, the rates were 8.7% and 7.0%, respectively. The survival rates were significantly higher in the PSK group (p = 0.0001). The survival rate was also calculated with respect to the staging factors. Patients in the PSK group who had H0, P0, se or milder and n3 or n4 showed a significantly higher survival rate than those with these staging factors in the non-PSK group (p = 0.010). Conclusion. PSK administration prolonged survival in stage-IV gastric cancer patients, the effect being marked in patients with severe lymph node metastasis. We suggest that be administered as adjuvant therapy in stage-IV gastric cancer patients with severe lymph node metastasis (n3, n4).     

Prognostic impact of preoperative prognostic nutritional index in resected advanced gastric cancer: A multicenter propensity score analysis

BackgroundAdvanced gastric cancer (AGC) causes debilitating malnutrition and leads to deterioration of the immune response. However, the concept of the prognostic nutritional index (PNI) is controversial when applied to patients with AGC. The aim of the present study was to evaluate the effect of the PNI after gastrectomy in patients with AGC.Materials and methodsA multicenter retrospective study was conducted using propensity score matching (PSM) in gastric adenocarcinoma patients who underwent resection via laparoscopic or open surgery between 2014 and 2017. To overcome selection bias, we performed 1:1 matching using 5 covariates.ResultsThe resection margins (P < 0.001) and LNM (P = 0.004) were significantly different between the two groups. In univariate analysis, poor tumor differentiation (P = 0.038) (R1+R2, P = 0.004), vascular and neural invasion (P < 0.001), and a PNI<50 (P < 0.001) were associated with poor recurrence-free survival (RFS). In multivariate analysis, a PNI<50 (hazard ratio (HR), 12.993; P < 0.001) was a risk factor for RFS. Univariate analysis for overall survival (OS) revealed that a PNI<50 (P < 0.001) (R1+R2,P = 0.006) and vascular and neural invasion (P < 0.001) were risk factors. In subsequent multivariate analysis, a PNI<50 (HR, 24.501; P < 0.001) was a significant risk factor for OS. Clinical assessments performed during a 12.34 (±5.050) month follow-up revealed that OS (P < 0.001) and RFS (P < 0.001) were worse in patients with a low PNI (<50) than in matched patients with a high PNI.ConclusionA low PNI is a strong predictor of unfavorable RFS and OS in patients with AGC.     

Prognostic significance of neuroendocrine components in gastric carcinomas

BackgroundGastric neuroendocrine carcinomas (NECs) and mixed adenoneuroendocrine carcinomas (MANECs) are aggressive tumours but the prognostic significance of a neuroendocrine component in <30% of the tumour remains unclear. Here, the implication of neuroendocrine components in gastric carcinomas was assessed according to proportion.MethodsSurgically resected primary gastric carcinomas with neuroendocrine morphology (NEM; n = 88) from 2000 to 2012 at Asan Medical Center were retrospectively reviewed. Neuroendocrine differentiation (NED) was defined as immunopositivity for one of three neuroendocrine markers (synaptophysin, chromogranin or CD56) within the NEM area. To validate the prognostic significance of NED, these cases were compared with 650 randomly selected gastric adenocarcinomas without NEM from the same time period.ResultsGastric carcinomas with NEM were reclassified as NEC (⩾70% NED, n = 47), MANEC (30–70% NED, n = 10), gastric carcinoma with 10–30% NED (GCNED, n = 8) and carcinoma with <10% NED (n = 23). The survival rates of patients with ⩾10% NED were significantly poorer than those with <10% NED but no survival difference was observed between NEC and MANEC. In univariate analyses, older age (⩾60 years), larger tumour size (⩾4 cm), advanced stage group, ⩾10% NED and lymphovascular or perineural invasion were indicative of a poor prognosis. Stage group and ⩾10% NED remained as independent prognostic factors by multivariate analysis.ConclusionsA minor proportion (10–30%) of NED should not be overlooked in gastric carcinomas with NEM. NED should be carefully evaluated to predict patient outcomes and plan optimal additional therapies.     

Prognostic Impact of Extranodal Extension in Rectal Cancer Patients Undergoing Radical Resection After Preoperative Chemoradiotherapy

BackgroundExtranodal extension (ENE) of nodal metastasis has emerged as an important prognostic factor in many malignancies, including rectal cancer. However, its significance in patients with rectal cancer receiving preoperative chemoradiotherapy (PCRT) has not been extensively investigated. We therefore assessed ENE and its prognostic impact in a large series of consecutive rectal cancer patients with lymph node metastasis after PCRT and curative resection.Patients and MethodsBetween January 2000 and December 2014, a total of 1925 patients with rectal cancer underwent surgical resection after PCRT. Medical records of 469 patients with pathologic node positivity were retrospectively reviewed.ResultsOf the 469 patients, 118 (25.2%) presented with ENE. ENE was observed more frequently in those with advanced tumor stage (higher ypT, ypN, and ypStage), lymphovascular invasion, and perineural invasion. Five-year disease-free survival rate was lower in patients with ENE-positive tumors than those with ENE-negative tumors (36.1% vs. 52.3%, P = .003). Similarly, 5-year overall survival rate was lower in patients with ENE-positive tumors than those with ENE-negative tumors (60.2% vs. 70.6%, P < .001). Multivariate analysis revealed that the presence of ENE was an independent poor prognostic factor for disease-free survival (hazard ratio = 1.412; 95% confidence interval, 1.074-1.857; P = .013) and overall survival (hazard ratio = 1.531; 95% confidence interval 1.149-2.039; P = .004).ConclusionThe presence of ENE in patients with rectal cancer undergoing PCRT is a negative prognostic factor, reflecting poor survival outcome.     

Long term oncological outcome of patients with grossly early gastric cancer-mimicking advanced gastric cancer

BackgroundThe survival of grossly early gastric cancer-mimicking advanced gastric cancer (EGC-mimicking AGC) patients had not been investigated. We evaluated the prognosis of patients who were diagnosed as early gastric cancer before surgery and advanced gastric cancer after surgery.MethodsThis retrospective study reviewed 3592 gastric cancer patients who had radical surgery from January 2007 to February 2015. We used a 1:2 propensity score matching method for the analysis. The matching factors were age, sex, body mass index and the depth of cancer invasion. The 5-year overall survival (OS) and disease-free survival (DFS) of the two study groups were analyzed.ResultsThe 475 grossly EGC-mimicking AGC patients were matched to 910 Borrmann type advanced gastric cancer (AGC) patients. The 5-year OS and DFS of the EGC-mimicking AGC patients were significantly higher than the Borrmann type AGC patients, (89.2% versus 83.4%, p = 0.025; 93.0% versus 85.6%, p < 0.001, respectively). The proportion of patients with lymph node (LN) metastasis was 45.5% in the EGC-mimicking AGC group and 57.1% in the Borrmann type AGC patients (p < 0.001). The ratio of metastatic LNs of N1 and N2 station was 5.2% and 3.1%, respectively, in EGC-mimicking AGC patients; this was lower than in Borrmann type AGC patients (N1: 8.9%, p < 0.001; N2: 3.7%, p = 0.308).ConclusionsPatients with grossly EGC-mimicking AGC had better prognosis than patients with the Borrmann type AGC due to fewer LN metastases. This suggests that limited LN dissection of EGC-mimicking AGC patients may be feasible.