Pre-operative serum levels of sialyl Tn antigen predict liver metastasis and poor prognosis in patients with gastric cancer

AIMS: To clarify the prognostic value of preoperative serum levels of sialyl Tn antigen (STN) for survival of gastric cancer patients. METHODS: Pre-operative serum levels of STN, sialyl Lewis(a)antigen (CA19-9) and carcinoembryonic antigen (CEA) were examined in 180 patients who underwent resection of gastric cancer. Patients were divided into high and low antigen groups on the basis of a selected diagnostic-based cut-off value. Correlation between high antigen serum levels, established clinicopathologic factors and prognosis was examined by univariate and multivariate analysis. RESULTS: Twenty-eight patients (15.6%) were classified as high STN; 37 (20.6%) as high CA19-9; and 33 (18.3%) as high CEA. The survival time of the high STN, CA19-9 or CEA group was shorter than that of the respective low-antigen group (P<0.0001, P=0.0008 or P=0.0002, respectively). Patients with stage III/IV tumours with high STN had a shorter survival time that those with low STN (P=0.0004). Cox's regression with multiple covariates showed that high serum STN is an independent factor predicting a worse outcome in gastric cancer patients. Multiple logistic regression analysis revealed that high serum STN is an independent predictor for the development of liver metastasis. CONCLUSIONS: Pre-operative high serum levels of STN predict both liver metastasis and poor prognosis after resection for gastric cancer.     

Clinicopathologic study of patients with Borrmann type iv gastric carcinoma

Between 1979 and 1993, 665 Japanese patients with advanced gastric cancer underwent surgery at our hospital. These patients were divided into two groups, consisting of 102 patients with Borrmann type IV carcinoma, and the remaining 563 patients with all other types of gastric carcinoma, which were then compared clinicopathologically. In the patients with Borrmann type IV carcinoma, 77.4% of the lesions demonstrated poorly differentiated adenocarcinoma, and 99 patients were classified as Stage III or IV. The resection rate was 87.2% (89/102) with only 39 curative operations despite the fact that 70 total gastrectomies were performed. The incidence of peritoneal dissemination (29.4%) and serosal invasion (97.0%) was significantly higher in these patients. Microscopic lymph node metastasis was positive in 86.5%. The 5-year survival rate was 23.4% in the patients with a curative operation and 5.0% in those with a noncurative operation (p < 0.01). Peritoneal dissemination was most frequently noted in the recurrence patterns. We conclude that early detection and a curative operation are both essential to improve the prognosis of patients with Borrmann type IV gastric cancer. The addition of a potent postoperative chemotherapy regimen is also recommended. © 1995 Wiley-Liss, Inc.     

Efficacy of intraperitoneal chemotherapy for advanced Borrmann type IV gastric carcinoma

We report four patients with advanced Borrmann type IV gastric carcinoma, in whom intraperitoneal chemotherapy with low-dose CDDP and 5-FU plus MMC via a peritoneal port was effective against peritoneal metastasis. However, none of the four patients survived for a long period. During treatment, they were followed on an outpatient basis and received intraperitoneal chemotherapy biweekly with good control of peritoneal metastasis. The ratio of the outpatient follow-up period was more than 50% in all these patients. Intraperitoneal chemotherapy may be effective for controlling peritoneal metastasis of advanced Borrmann type IV gastric carcinoma, and contribute to maintaining the patient's quality of life.     

Correlation of DNA ploidy and clinical outcome in Borrmann type 4 gastric carcinoma

The correlation between DNA ploidy pattern and clinical outcome was studied in 76 patients with Borrmann type 4 gastric carcinomas. Twenty-six tumors were diploid, and 50 tumors were aneuploid. There was no correlation among DNA ploidy and histologic type, lymph-node status, wall invasion, or clinical stage. The incidence of vascular invasion in the aneuploid tumors was significantly higher than that in the diploid tumors. Five year survival was achieved in 28% of the patients with diploid tumors and 8% of those with aneuploid tumors, respectively. Among the patients undergoing curative resection, 5 year survival rate was 54% in the patients with diploid tumors compared to 28% with aneuploid tumors. There was a significant survival advantage in patients with diploid tumors. These results indicate that DNA ploidy might be an important prognostic factor in Borrmann type 4 gastric carcinomas.     

Different expression of sialyl Tn antigen between polypoid and nonpolypoid growth types of advanced colorectal carcinoma

Colorectal tumors can be classified based on their growth pattern into the polypoid growth type (PG-type) and nonpolypoid growth type (NPG-type). We examined sialyl Tn antigen expression in advanced colorectal carcinomas that were classified as PG-type and NPG-type cancers in order to ascertain whether or not such expression correlates with other biologically and clinically important differences. A total of 94 advanced colorectal carcinomas were examined for sialyl Tn antigen expression, which was immunohistochemically detected by the monoclonal antibody TKH2. Univariate and multivariate analyses using logistic regression models were performed. Forty carcinomas (42.6%) were negative and 54 (57.5%) were positive for sialyl Tn antigen. Eighteen carcinomas (19.2%) were of PG type and 76 (80.8%) of NPG type. NPG-type cancers had a higher proportion of positive lymph node metastasis than PG-type cancers. Furthermore, sialyl Tn antigen was less often detected in NPG-type cancers (39 of 76; 51.3%) than in PG-type cancers (15 of 18; 83.3%; p = 0.0167). Multivariate analysis showed that two variables, lymph node metastasis and sialyl Tn antigen expression in carcinoma, were independently related to tumor growth patterns, that is NPG type and PG type. These data suggest that the difference in sialyl Tn antigen expression between two kinds of tumor growth patterns of advanced colorectal carcinomas, PG type and NPG type, may reflect different biological behaviors during tumor progression.     

Clinical significance of serum sialyl Tn antigen in patients with gynecological cancer. STN Study Group

Serum sialyl Tn antigen was assayed in gynecological cancer and benign patients by means of "STN OTSUKA" kits. Fifty-eight of 140 (41.1%) ovarian cancer patients showed a significant elevation of sialyl Tn antigen in serum above the cut-off level of 45 unit/ml (mean +2SD) determined from normal controls. There was no feature of positive frequency in tissue type, including serious carcinoma (47.6%), mucinous carcinoma (45.5%), clear cell carcinoma (30.4%) and endometrioid carcinoma (55.6%), but the positive frequency of mucinous carcinoma (36.8%) was higher than that of serous carcinoma (11.1%) in stage I. Compared with other markers, sialyl Tn antigen showed a very much lower false-positive rate (3.6%) in benign gynecological diseases. In the diagnosis of ovarian cancers, the combination assay of sialyl Tn antigen and CA 125 increased diagnostic efficiency compared with any other combination assays. Therefore, sialyl Tn antigen will be a useful tumor marker for ovarian cancers.     

Clinical evaluation of circulating serum sialyl Tn antigen levels in patients with epithelial ovarian cancer.

Sialyl Tn antigen (NeuAc alpha 2----6GalNac alpha 1----0-Ser/Thr [STN]) with antigenic specificity in the core structure of mucin-type carbohydrate chains has been determined. In the present study, we evaluated the clinical significance of this new carbohydrate antigen, STN, in patients with epithelial ovarian cancer. With the use of a radioimmunoassay developed to detect STN antigen in serum, elevated (greater than or equal to 32.6 U/mL) antigen levels were observed in 50.0% of patients with ovarian cancer. In contrast, 3.8% of healthy individuals had STN antigen levels greater than or equal to 32.6 U/mL. In 9.6% of patients with benign gynecologic diseases and 0% of pregnant women, there were elevated levels of STN antigen. There was a significant difference (P less than .001) in STN antigen levels between patients with ovarian cancer and patients with benign gynecologic diseases, pregnant women, or the controls. The mean +/- SD for all evaluated samples of ovarian cancer was 109.2 +/- 146.8 U/mL. Both the mean values and the positive rate increased as the stage advanced. Classified according to the histologic type, the highest positive rate (61.0%) was observed in mucinous adenocarcinoma. The usefulness of STN antigen as a circulating tumor marker in ovarian cancer was estimated as follows: sensitivity 50.0%, specificity 93.5%, positive predictive value 72.2%, negative predictive value 84.7%, and diagnostic value 46.8%. Serum STN antigen levels were elevated in 12 of 33 patients with ovarian cancer who had serum CA 125 antigen levels less than 35 U/mL. While CA 125 antigen levels were elevated in 74.6% and STN antigen levels were elevated in 50.0% of the same population, the use of both assays indicated the sensitivity of detection of 83.8% in the population studied.     

An effective case of intraperitoneal and intra-arterial combined chemotherapy for unresectably advanced Borrmann type IV gastric carcinoma

We report an effective case of intraperitoneal and intra-arterial combined chemotherapy for unresectably advanced Borrmann type IV gastric carcinoma. A 59-year-old man was admitted with advanced Borrmann type IV gastric carcinoma in June 1999. With informed consent, the patient underwent laparotomy, which revealed far advanced Stage IV gastric carcinoma of T4, N3, P1, H0, M1, CY1 for resection. Three ports to both subphrenic pouches and Douglas' pouch were placed for intraperitoneal infusion chemotherapy. Pathological findings of omental lesions were metastatic gastric carcinomas of por 2-histological type. Intraperitoneal and intravenous infusion combined chemotherapy with a modified low-dose CDDP and 5-FU regimen were started. The artery-side port was placed in the aorta at the Th. 9/10 levels for arterial infusion chemotherapy in September 1999. The patient was followed-up as an outpatient and continued to receive the intraperitoneal and intra-arterial combined chemotherapy. We report an effective case of intraperitoneal and intra-arterial combined chemotherapy for unresectably advanced Borrmann type IV gastric carcinoma, who could be followed-up as an outpatient while maintaining his quality of life.     

Proliferative activity as a prognostic factor in Borrmann type 4 gastric carcinoma.

Proliferative activities in 181 primary Borrmann type 4 gastric carcinomas were investigated using percentage labelling of proliferating cell nuclear antigen (PCNA) and an argyrophilic nucleolar organiser region (AgNOR) count. Tumours with a high proliferative activity often metastasised to lymph nodes (P < 0.01), and these patients had a lower survival rate (P < 0.05). A significant correlation was recognised between the PCNA labelling percentage and AgNOR count (r = 0.452, P < 0.001). Cox''s regression analysis showed that PCNA labelling percentage is an independent prognostic factor. These results indicate that estimating proliferative activity may be useful in predicting lymph node metastasis and patients'' prognosis in cases of Borrmann type 4 gastric carcinoma.     

结直肠癌组织趋化因子受体CXCR4表达及其与淋巴结和肝转移相关性的探讨

目的:研究趋化因子受体CXCR4在结直肠癌组织中的表达,探讨其与淋巴结、肝转移及预后的关系.方法:应用免疫组化方法(SP法)检测20例正常结直肠黏膜组织、64例结直肠癌组织、34例区域淋巴结转移癌组织以及18例肝转移组织CXCR4表达情况.同时应用逆转录聚合酶链反应(RT-PCR)检测其mRNA在4株大肠癌细胞株中的表达.结果:正常结直肠黏膜、结直肠癌、区域淋巴结转移癌以及肝转移组织中CXCR4阳性率分别为15.0%、51.6%、72.2%和73.5%;转移组织阳性表达率明显高于原发肿瘤.CX-CR4 mRNA高表达于2株人大肠癌细胞株.结直肠癌组织CXCR4阳性表达率与Duke临床分期、淋巴结转移和肝转移密切相关,P<0.05,而与患者年龄、性别、肿瘤所在部位及病理分化程度无关.CXCR4阳性表达组3年生存率明显低于阴性表达组,P<0.05.结论:CXCR4阳性表达与结肠直肠癌的淋巴结、肝转移有关,有助于预后判断.     

胃癌淋巴结转移枚数与手术后放射治疗效果的相关性

目的探讨分析胃癌淋巴结转移枚数与术后放疗疗效及相应病理检查结果的相关性。方法 2006年5月至2008年5月收治的胃癌患者,均行胃癌根治性手术治疗,术后诊断为胃癌伴淋巴结转移的患者214例。所有组内淋巴结转移行D2或D3式清扫,且治疗前后均予以放射治疗。结果胃癌患者淋巴结转移枚数与性别、年龄等一般因素无关系,而与肿瘤大小、浸润深度及分期呈正相关。淋巴结转移1⁵个、65个、6⁹个及>9个的胃癌患者,其术后及放疗后5年生存率分别为50%、30%和<10%,三者之间差异有统计学意义(P<0.05)。结论胃癌患者胃周阳性淋巴结转移数与预后有关,结合肿瘤大小及生长浸润方式可以简便而准确地判断胃癌术后患者的预后情况。     

环氧化酶-2的表达与胃癌浸润转移的关系

目的　探讨环氧化酶 - 2 (cyclooxygenase- 2 ,COX- 2 )在胃癌组织中的表达与胃癌浸润转移的关系。方法　采用免疫组化 S- P法检测 4 5例胃癌手术切除标本 COX- 2的阳性表达。结果　胃癌组织 COX- 2的阳性表达率(77.8% )明显高于癌旁组织 (33.3% ,P<0 .0 1)。有局部淋巴结转移者 COX- 2的阳性表达率明显高于无转移者 (分别为 86 .1%和 4 4 .4 % ,P<0 .0 5 ) ;浸润达浆膜层者明显高于未达浆膜层者 (分别为 87.9%和 5 0 .0 % ,P<0 .0 5 ) ; 、 期胃癌组织明显高于 、 期 (分别为 90 .9%和 4 1.7% ,P<0 .0 5 )。结论　 COX- 2与胃癌的发生有关 ,COX- 2的表达在胃癌浸润和转移过程中显示重要作用     

Carcinoembryonic antigen in patients with gastric carcinoma

Carcinoembryonic antigen (CEA) was quantified pre- and post-operatively in plasma from 171 patients with gastric carcinoma. The pre-operative plasma concentration was above the normal reference value (3.5 micrograms/l) in 18% of the patients in stage I-III (pTNM) and in 57% of the patients in stage IV. Pre-operative concentrations above 10 micrograms/l indicated metastatic or inoperable disease. The concentrations were not different between the stages I, II and III. However, the pre-operative CEA concentrations were related to survival after potentially curative resection. At recurrence most of the patients had markedly increased CEA, often with increasing CEA in the months before clinical recurrence. Most of the patients clinically disease-free at the end of the follow-up period had a transitory or prolonged post-operative elevation of CEA. This made the post-operative evaluation of CEA difficult. Serial determination of CEA in the follow-up of gastric cancer patients therefore had little or no clinical value, whereas the pre-treatment levels were of clinical significance.     

胃癌组织VEGF-D的表达与淋巴管生成和淋巴转移的关系

目的研究胃癌组织中血管内皮生长因子-D（vascular endothelial growth factor-D,VEGF-D）表达与淋巴管生成和淋巴结转移的关系,探讨其在胃癌淋巴转移中的作用和意义。方法采用免疫组化方法检测胃癌及癌旁正常胃组织中VEGF-D的表达,酶组织化学方法行胃癌组织淋巴管染色并计数,分析胃癌淋巴结转移及其它临床病理特征。结果胃癌组织VEGF-D表达阳性率（46.6%）显著高于癌旁正常胃组织（22.4%）（P〈0.01）。VEGF-D阳性表达的胃癌组织淋巴管计数（28.86±6.32）显著高于阴性表达的胃癌组织（21.27±5.66）（P〈0.01）。VEGF-D表达与胃癌患者性别、年龄及肿瘤大小、浸润深度无关（P〉0.05）,但其表达在低分化组（53.3%）、有淋巴结转移组（54.5%）、＋期组（56.1%）显著高于高、中分化组（39.3%）、无淋巴结转移组（31.3%）和＋期组（41.2%）,差异有显著性（P〈0.05）。结论VEGF-D与胃癌的发生、发展有关,VEGF-D可刺激胃癌组织淋巴管生成,促进淋巴道转移。     

Sialyl Tn antigen is an independent predictor of outcome in patients with gastric cancer

The prognostic value of the immunohistochemical expression of Sialyl Tn antigen (STn) was evaluated in 242 patients with gastric carcinoma. Formalin-fixed, paraffin-embedded specimens of gastric adenocarcinomas were stained with the monoclonal antibody C1282, produced by immunization with ovine submaxillary mucin (OSM). Positive immunoreactivity for STn was observed in 149 (62%) patients. The expression of STn did not correlate with stage of disease (TNM), tumour location, presence of lymph-node or distant metastases, histological type, age or gender. STn immunoreactivity correlated strongly with overall survival in univariate analysis. The median survival in the STn-positive group was 21 months, in comparison to 38 months in the STn-negative group. The difference in survival between STn-negative and STn-positive tumours was significant in patients with stage-1 cancer, but not in patients with stage-II -III or -IV disease. STn immunoreactivity emerged as an independent prognostic factor in Cox multivariate analysis. It is concluded that the immunohistochemical expression of STn is a good marker in the prediction of survival in patients with stage-1 gastric carcinoma. © 1996 Wiley-Liss, Inc.     

Correlation of estrogen receptor protein and carcinoembryonic antigen with lymphnodal metastasis in breast carcinoma

Estrogen receptor protein (ERP) content and carcinoembryonic antigen (CEA) positivity were analysed in 50 cases of primary breast carcinoma. Relationship of pathological features known to be of prognostic significance and combined CEA and ERP status were examined. It was found that CEA + ERP--tumours had significantly higher frequency of axillary lymphnodal metastasis in comparison to CEA - ERP + cases. Presence of CEA - or ERP + status showed significant lower frequency of metastasis in comparison to CEA + ERP - tumours.     

喉癌颈淋巴结转移行颈清扫术后的疗效观察

目的:评估喉癌颈淋巴结转移行颈清扫术后的疗效.方法:统计分析我院1990年6月至2000年6月资料完整的喉癌病例356例,病理均为鳞状细胞癌,其中全喉切除73例,近全喉切除11例,喉部分切除256例,拒绝手术而接受放疗或放弃治疗16例(其中3例行气管切开术).术前颈部触诊、超声、CT、MR、细针穿刺及术中冰冻等方法确定转移淋巴结,同时或之后行颈淋巴清扫术共48例,其中N1 35例、N2 9例、N3 4例,术式:根治性颈清扫8例,改良根治性颈清扫13例(Ⅰ型1例、Ⅱ型4例、Ⅲ型9例,其中双侧清扫2例),选择性颈清扫27例(颈侧清扫17例, Ⅱ、Ⅲ区清扫10例 ),术后放疗60Gy5例,50Gy23例,40-46Gy8例, 12例未行放疗.结果:随访3年以上42例,随访5年35例.术后肿瘤原发部位复发3例,颈部复发6例(术侧5例,对侧1例) ,远处转移2例(肺和纵隔各1例),死亡5例(2年1例,3-5年4例).结论:根据肿瘤位置、范围及颈部淋巴结转移情况选择不同的颈清扫术式加术后放射治疗,虽然仍存在复发,但在减少创伤、预防颈清扫术的并发症和疗效等方面收到了较好的效果.