The characters of AFP-producing early gastric cancer]

During the last decade, we have experienced 525 cases of gastric cancer. Within these, 195 were early gastric cancer (37.1%). Five and eight year survival rates were 86.9 and 77.2%. There were seven cases of recurrence, all of which were liver metastasis of submucosal cancers. Two combined with pulmonary metastasis. Three of the recurrent cases had serum AFP raised (greater than 20ng/ml) before or after partial gastrectomy. When these gastric specimens were reviewed, AFP positive cells were stained by PAP method. Compared with the AFP negative group of 168 early gastric cancers, invasion of lymphatic and venous vessels of the stomach and incidence of the liver metastasis were significantly higher in the stained group. 1.3 and 4.5 year survival rates of the cases (including ours) of AFP producing early gastric cancer, which had been reported in Japanese literatures, were 76.1, 45.7 and 22.9%, respectively. Liver metastasis was found in 7 of 12 cases (58.3%). It is clear that AFP producing early gastric cancer has the same tendency for liver metastasis as the AFP producing advance gastric cancer does. To prevent its recurrence, early diagnosis by PAP method for specimens with hepatic picture and aggressive adjuvant chemotherapy are mandatory.     

Resection of liver metastasis from alpha-fetoprotein-producing early gastric cancer: Report of a case

We herein present a case of resected synchronous solitary liver metastasis from alpha-fetoprotein (AFP)-producing early gastric cancer. A 61-year-old woman, who was diagnosed at a routine medical checkup as having early gastric cancer with a liver tumor, came to our hospital for surgery. Her serum AFP level was high at 910ng/ml. An examination was performed to determine whether the liver tumor was primary hepatocellular carcinoma or metastasis from early gastric cancer. She had no evidence of either a hepatitis B or C virus infection, and her liver function was normal. A biopsy specimen from the gastric cancer predominantly revealed moderately differentiated adenocarcinoma, but a focally trabecular pattern compatible with AFP-producing gastric cancer was also observed. Preoperatively, it was concluded that the liver tumor was metastasis from an AFP-producing early gastric cancer. We thus performed distal gastrectomy and a posterior segmentectomy of the liver. Her serum AFP level decreased to the normal range within 2 weeks after the operation. An immunohistological examination revealed that AFP-positive cells were present in both the gastric cancer and liver tumor. One year after the operation, there was no sign of recurrence.     

Long-Term Survival Achieved by Repeated Resections of Metachronous Pulmonary and Adrenal Metastases of α-Fetoprotein-Producing Gastric Cancer: Report of a Case

We report a case of long-term survival achieved by repeated resections of metastases from -fetoprotein (AFP)-producing gastric cancer. A 59-year-old man initially underwent total gastrectomy with lymph node dissection and resection of the spleen and left adrenal gland, for an advanced AFP-producing gastric cancer. A solitary pulmonary metastasis was resected 2 years later, and then a right adrenal gland metastasis, an inferior vena cava thrombus, and another pulmonary metastasis were resected 6 months, 1 year, and 8 months after each other, respectively. Thus, the patient has survived for 7 years and no further evidence of disease was found at his last follow-up examination. To the best of our knowledge, this is the first case of AFP-producing gastric cancer resulting in metachronous solitary pulmonary and adrenal gland metastases, but not liver metastasis. We report this case to show that for selected cases, surgical resection of these metastases is feasible and may extend survival.     

Alpha-fetoprotein-producing renal cell carcinoma

Alpha-fetoprotein (AFP) is recognized as a tumor marker of yolk sac tumors, liver cancer and some other cancers of the digestive organs. Renal cell carcinoma (RCC) producing AFP is a rare entity. A case of AFP-producing RCC with solitary bone metastasis, but without liver involvement, is reported. The stain specific to AFP proved the presence of AFP in the cytoplasms of more cells of the renal tumors. Additionally, the other published cases are reviewed. These cases indicate that mesoderm-originating malignant tumors such as RCCs can produce AFP in some situations. So, AFP is probably more universal than believed, although it is generally a popular and useful tumor marker for hepatocellular carcinomas and yolk sac tumors.     

Alpha-Fetoprotein-Producing Early Gastric Cancer of the Remnant Stomach: Report of a Case

A 67-year-old man initially underwent a distal gastrectomy for early gastric cancer (T1, N0, M0; Stage IA) in March 1995. During the follow-up period, an elevation of the serum α-fetoprotein (AFP) level (98.8 ng/ml) and a liver tumor (S4) were detected. A left hepatectomy was performed in December 1996. Immunohistochemically, AFP-positive cells were present in both the primary gastric tumor and metastasized liver tumor. The serum AFP level normalized immediately, but it elevated again to 22.4 ng/ml. An endoscopic examination revealed a protruding lesion in the remnant stomach. A total resection of the remnant stomach was performed in February 2005. The tumor was evaluated T1, N0, M0; Stage IA, with positive staining for AFP. The patient has survived without any sign of recurrence for more than 11 years after the first diagnosis of cancer. To the best of our knowledge, this is the first case of a long-term survival of AFP-producing gastric cancer with successfully resected metachronous liver metastasis and gastric remnant carcinoma.     

The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P₀H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P₀H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.     

The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P0H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P0H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.     

Recurrence in early gastric cancer

In a retrospective study of 503 cases of early gastric cancer, 17 of the patients had died of a recurrence of the gastric cancer and 72 had died of unrelated causes. The cumulative recurrence mortality rates were 2.2% at 9 years for mucosal cancer and 8.4% at 8 years for submucosal cancer. The recurrence patterns of early gastric cancer were hematogenic metastasis to the liver, lung, or bone (nine cases), recurrence from lymph nodes (three cases), and recurrence in the residual stomach (five cases). Submucosal cancers with a macroscopically elevated appearance, lymph node metastasis, and evidence of vessel invasion were the high-risk cancers for hematogenic recurrence, and adjuvant chemotherapy should be prescribed. Two cases of lymph node recurrence were attributed to inadequacy of lymph node dissection. Because metastasis to the group 2 lymph nodes was noted in 1.5% of cases of early gastric cancer and a macroscopic diagnosis of nodal status was inaccurate, complete dissection should be performed regardless of identification of metastasis. Five cases of recurrence in the residual stomach were attributed to overlooked lesions of multiple carcinoma and were detected at an advanced stage. Careful and regular postoperative follow-up is required to detect these recurrences at an early stage.     

Significance of extended radical surgery for stage IV gastric cancer

Forty percent of patients with gastric cancer with direct infiltration to adjacent organs survived for more than 5 years after curative resection. Favorable results were obtained in cases in which combined resection of the body of the pancreas or the liver was performed due to cancer infiltration. However, patients who had undergone gastrectomy with combined colectomy or pancreatoduodenectomy showed a poor survival rate. The postoperative 5-year survival rate was 29% for patients who had presented with group 3 lymph node metastasis and undergone potentially curative surgery. Particularly, favorable results were obtained in cases with metastases confined to lymph nodes in the hepatoduodenal ligament. In dissection of the deepest nodes, lymph nodes in the hepatoduodenal ligament is the most important to remove in surgery for stage IV gastric cancer. We have performed gastrectomy combined with dissection of group 1 and 2 lymph nodes in the treatment of patients with gastric cancer with peritoneal metastasis. Results obtained so far revealed that only patients with a lesser extent of serosal invasion survived longer after operation. We are presently conducting a trial of hyperthermia combined with anticancer chemotherapy as a possible method for prolongation of survival of patients with peritoneal metastasis of gastric cancer.     

血清甲胎蛋白阳性胆囊癌的临床病理特征及预后分析

目的 分析血清甲胎蛋白(AFP)阳性胆囊癌患者的临床特点及预后分析.方法 回顾性分析第二军医大学东方肝胆外科医院2003年1月-2013年12月收治的20例血清AFP阳性胆囊癌患者资料(研究组),并以同期收治的140例血清AFP正常胆囊癌作为对照组.对两组胆囊癌患者的临床病理特征和随访资料进行统计学分析.结果 研究组与对照组相比,淋巴结转移明显增多(P=0.001),肝侵犯明显增多(P=0.002),手术根治率明显减低(P=0.001).研究组患者的1年、3年、5年生存率分别为45.0％、20.0％、7.5％,中位生存时间10.93个月.对照组患者的1年、3年、5年生存率分别为68.4％、47.6％、36.2％,中位生存时间为27.06个月.研究组患者的1年、3年、5年生存率以及中位生存时间明显低于对照组患者(P=0.007).单因素分析显示,术前血清AFP、TNM分期、组织分化、意外胆囊癌、术前黄疸、肝侵犯、手术方式、肿瘤部位与预后有关(P＜0.05);多因素分析显示:N分期(HR=1.566,95％ CI:1.090 ～2.250,P=0.015)、手术方式(HR=1.450,95％CI:1.053 ～1.997,P=0.023)是胆囊癌患者的独立预后危险因素(P＜0.05).而术前血清AFP水平并不是影响预后的独立危险因素(P＞0.05).结论 血清AFP阳性胆囊癌更易发生淋巴结转移和肝侵犯,手术根治率降低;但血清AFP水平并不是影响患者预后的独立危险因素.     

Liver perfusion chemotherapy for selected patients at a high-risk of liver metastasis after resection of duodenal and ampullary cancers

OBJECTIVE: To evaluate the prognostic benefit of postoperative liver perfusion chemotherapy (LPC) in patients who undergo curative resection of duodenal and ampullary cancers. SUMMARY BACKGROUND DATA: Both nodal involvement and pancreatic invasion are poor prognostic indicators after curative resection of ampullary or duodenal cancers due to high incidences of liver metastasis. Therefore, we have performed postoperative LPC on a number of such "high-risk" patients. METHODS: During the period of 1990 to 2005, 72 consecutive patients successfully underwent curative (R0) resection of duodenal or ampullary carcinomas at our institution, The Osaka Medical Center for Cancer and Cardiovascular Diseases. Of these 72 patients, 38 were found to have positive nodal involvement and/or pancreatic invasion based on an intraoperative inspection, and of these, 28 were deemed to be suitable candidates for intraoperative catheterization: 1 catheter was placed into the gastroduodenal artery; another into the portal vein (group A). Postoperatively, they received an infusion of 5-fluorouracil (5-FU: 125 mg/d) via each of the 2 catheters for a period of 28 continuous days. The remaining 44 patients (group B) did not receive any other adjuvant therapy. The survival rates and patterns of disease failure were compared between these 2 groups and their subgroups. RESULTS: All 72 patients survived the operation, and all 28 patients in group A completed their courses of LPC without showing any significant adverse signs. Postoperative histopathology was later performed to get a more accurate picture regarding the degree of nodal involvement and/or pancreatic invasion: In group A, 21 patients (group A1) proved positive for nodal and/or pancreatic invasion whereas 7 patients (group A2) proved negative; and in group B, 16 patients proved positive (group B1) whereas 28 proved negative (group B2). Although group A displayed higher incidences of nodal involvement and pancreatic invasion, the 5-year survival rates for the 2 groups varied only slightly. The 5-year survival rate was 70% in group A1, 85% in group A2, 35% in group B1, and 92% in group B2, respectively. The difference between B1 and B2 and the difference between A1 and B1 were statistically significant, and these differences were conclusively found to be attributable to the different incidences of liver metastasis. CONCLUSION: Through this research, both nodal involvement and pancreatic invasion were confirmed to be reliable predictors of liver metastasis after curative resection of ampullary and duodenal cancers. Since LPC was proven to be effective in preventing the postoperative development of liver metastasis, it should be more actively performed for patients with a high-risk of liver metastasis.     

胃癌肝转移的高危因素和预后

胃癌肝转移是胃癌死亡的主要原因之一。胃癌肝转移多因合并其他非治愈性因素包括腹膜转移、淋巴结转移和肝内广泛转移等而致肝切除率低,患者预后不佳。胃癌肝转移的高危因素主要有原发灶的浆膜浸润、淋巴结转移（N3～N4）、分化型癌、髓样型的低分化腺癌和脉管侵袭以及VEGF、P53、c-erbB-2等的过表达等。无论同时性或异时性的胃癌肝转移．肝切除患者的5年生存率为11％-42％。如能选择合适的肝切除适应证,或会改善胃癌肝转移的预后。     

双镜联合治疗早期胃癌的临床体会

目的:探讨胃镜、腹腔镜双镜联合治疗早期胃癌的安全性与可行性。方法:回顾分析近6年双镜联合治疗78例早期胃癌患者的临床资料。胃体、远端胃肿瘤非溃疡患者行内镜黏膜下剥离术,近端胃及胃体、远端胃肿瘤合并溃疡患者行双镜联合下腹腔镜胃楔形切除术。标本送快速病理检查。结果:为早期胃癌浸润至黏膜下层及肌层、伴有脉管癌栓、肿瘤直径>20 mm、低分化腺癌(包括印戒细胞癌)的30例患者行腹腔镜胃癌D2根治术,5例近贲门或幽门部位肿瘤患者行单纯胃大部切除术,43例患者仅行内镜黏膜下剥离术或单纯胃楔形切除术。根治患者术后淋巴结转移占全部病例的11.5%,术后均无并发症发生,患者痊愈出院。结论:双镜联合治疗早期胃癌安全、患者创伤小、康复快、疗效确切,更加体现了微创优势,避免了部分患者不必要的根治切除甚至全胃切除的痛苦,值得临床推广。     

133例结直肠癌肝转移外科手术疗效评价

目的评价手术治疗结直肠癌肝转移的疗效。方法分析复旦大学附属中山医院2000年1月1日至2005年12月31日收治的470例结直肠癌肝转移患者的资料,评价手术治疗对其生存的影响。结果196例同时性肝转移患者中手术30例（15．3％）,274例异时性肝转移患者中手术103例（37．6％）。同时性肝转移组手术死亡率（3．3％）高于异时性肝转移组（1．9％）（P〈0．05）。以2006年6月31日为随访终点,随访率100％,手术患者中同时性肝转移组1、3、5年生存率和中位生存时间与异时性肝转移组相似（P〉0．05）,但术后复发率较高（36．7％比20．4％,P=0．030）。49例具有手术指征而未手术的患者其1、3、5年生存率明显低于手术患者（P=0．003）。同时性肝转移组中22例Ⅰ期手术切除原发灶和肝转移灶和8例Ⅱ期手术患者的1、2．3年生存率和中位生存时间相似（P〉0．05）。生存因素风险分析发现手术切缘达1cm（P=0．036）和复发后再次手术（P=0．041）是生存的保护性因素,而术后复发（P=0．023）是生存的危险因素。结论手术治疗是结直肠癌肝转移的首选治疗措施,可以明显改善患者的术后生存。     

Significance of Long-Term Follow-Up of Early Gastric Cancer

Background Therapeutic outcomes for most patients with early gastric cancer are favorable. However, mortality among these patients remains a concern. Improvements in therapeutic outcomes are being sought by studying the timing and causes of death. Here, the results of surgery were evaluated to assess the appropriate treatment and follow-up schedule for early gastric cancer. Methods A total of 1169 patients with early gastric cancer underwent curative gastrectomy between 1992 and 1999. Survival time, prognostic factors, cause of death, and time of death were evaluated retrospectively. Results Multivariate analysis of disease-specific survival identified lymph node metastasis as an independent prognostic factor. The anatomical extent of lymph node metastasis and the number of metastatic lymph nodes influenced the rate of recurrence. Multivariate analysis of overall survival identified age as a prognostic factor. A total of 91 patients (7.8%) from the study group died: 56 from comorbid diseases, 21 from gastric cancer, and 14 from other second primary cancers. Death from gastric cancer was frequently observed within 5 years of surgical resection, whereas death from other diseases usually occurred after 5 years. Patients who died as a result of diseases other than gastric cancer tended to be older. Conclusions Appropriate lymph node dissection is necessary for patients with early gastric cancer, particularly those with risk factors associated with lymph node metastasis. Meticulous follow-up protocols that can detect second primary cancers, together with the development of treatments for comorbid diseases, are required to improve survival.     

胃肝样腺癌的临床特征与预后

胃肝样腺癌（HAS）是一种具有肝样分化区域的特殊类型胃癌。血清甲胎蛋白（AFP）的产生是HAS一种特征性表现。HAS的发生机制尚不明确,目前相关研究大多为病例报告,缺少大样本病例的研究。HAS的预后很差,肝转移率较高,其生物学行为与普通胃癌有明显区别。无肝转移灶时,胃癌根治术是主要的治疗手段,但目前对于肝转移灶的治疗方案尚无一致结论,血清AFP检测对此类肿瘤的早发现、早诊断以及对患者疗效监控、预测肿瘤的复发与转移均有重要临床意义。     

Alpha-fetoprotein in the treatment of primary liver cancer

α-fetoprotein (AFP) was measured, by single radial immunodiffusion (SRID) and radio immunoassay (RI), in 36 cases with histologically proven hepatocellular cancer. The histological types of AFP-positive hepatocellular cancer were found to be mainly an intermediate type; Edmondson's Grade III. The serum AFP levels of AFP-producing cancers can be used in evaluating the effectiveness of the treatment, i.e. hepatic resection, infusion of anticancer agents and hepatic arterial ligation.     

Relative non curative resection of gastric cancer

Relative non curative resection of gastric cancer was studied according to The General Rules of Japanese Research Society for gastric cancer. The five year survival rate was 31.2%, while 39.6% for relative curative resection and 4.9% for absolute non curative resection. The cases whose relative non curative factor was due to lymph nodes (n greater than R) resulted in a fair prognosis, but the prognosis of those concerned with peritoneal dissemination (P1) or liver metastasis (H1) was very poor. Surgical achievement to improve postoperative results may be obtained when a systemic (13), (14v) (16) lymph node dissection is performed whenever only one of them was involved in metastasis.     

胃癌同时性肝转移手术患者的预后分析

目的分析经手术治疗的胃癌同时性肝转移患者的预后因素。方法回顾性分析1998年1月至2012年12月间在大连医科大学附属第一医院胃肠外科手术治疗的胃癌同时性肝转移53例患者的临床病理学资料,对单发和多发肝转移患者的生存率进行比较并进行预后分析。结果本组53例患者5年总体生存率为11．3％。单发肝脏转移患者34例,5年生存率14．7％,明显高于19例多发肝转移患者的0（P=-0．000）。单因素分析结果显示,浆膜侵犯（P=0．000）、淋巴结转移（P=0．000）、手术根治度（P=0．044）、发生肝转移数目（P=0．000）和肝转移肿瘤直径（P=0．031）是影响胃癌肝转移患者预后的因素。其中浆膜侵犯（RR：3。355,P=0．012）和肝转移数目（RR：7．664,P=0．000）是影响胃癌肝转移患者预后的独立因素。结论手术治疗可以提高无浆膜侵犯的胃癌单发肝转移患者的预后。