Analysis of prognostic factors and outcomes of gastric cancer in younger patients:A case control study using propensity score methods

AIM:To understand the clinicopathological and prognostic features of gastric cancer in younger and older patients.METHODS:Between January 2002 and December2008,1667 patients underwent curative gastric surgery.For comparative purposes,the patients were divided into two groups:younger patients who were less than 40 years old(112 patients),and older patients who were 40 years old and older(1555 patients).In both groups,propensity scoring methods were used to select patients with similar disease statuses.A total of224 matched cases,with 112 patients in each group,were included in the final analysis.RESULTS:Compared to the older group,the younger group with gastric cancer had a significantly higher percentage of females(P=0.007),poorly differentiated or signet ring cell carcinoma(P<0.001),advanced T stage gastric cancer(P=0.045),and advanced tumornode-metastasis stage cancer(P=0.036).The older group with gastric cancer had more comorbidities(P<0.001).With the exception of the number of lymph node dissection(P<0.001)and retrieved lymph node(P=0.010),there were no statistically significant differences between the postoperative outcomes of the two groups.During the follow-up period,there were19 recurrences in the younger group and 11 recurrences in the older group.The overall five-year survival rates in the younger and older groups were 84.3%and89.6%,respectively(P=0.172).There were no significant differences(P=0.238)in the overall survival of patients with advanced T stage gastric cancer in the two groups,with five-year survival rates of 70.8%in the younger group and 79.5%in the older group.With regard to the age-adjusted survival rate,there was significant difference between the two groups(P=0.225).CONCLUSION:In spite of aggressive cancer patterns in the younger group with gastric cancer,the younger group did not have a worse prognosis than the older group in our study.     

胃镜检出胃恶性病变3460例分析

目的:探索胃镜检出胃恶性病变患者的发病及胃镜、病理特点。方法:对我院1990～2009年胃镜诊断的3460例胃恶性病变患者按不同年龄分组进行胃镜及病理资料的回顾性分析、总结。结果:3460例胃恶性病变患者中,男性多于女性(2.26∶1),但年龄≤40岁组男女差别不大。50岁以上发病明显增高,特别是60～70岁发病率最高。胃窦部为胃癌的高发部位,年龄≤40岁组以胃体和胃窦为主,而60岁以上患者胃贲门食管连接部癌的发病率显著上升。年龄≤40岁组病理类型以分化差、恶性程度高的低分化腺癌和印戒细胞癌为主,随着年龄增长,病理类型逐渐趋向于以中分化管状腺癌、高分化管状腺癌为主。胃淋巴瘤多发于胃体、胃窦部,胃镜下表现以多发性溃疡病灶为主。结论:胃恶性病变的发病与年龄、性别密切相关,不同年龄组胃癌的发生部位、病理特点各不相同,应引起重视,同时应提高对青年人胃癌的认识,提倡和重视胃镜检查普及,做到早期发现、早期诊断、早期治疗。     

Prognosis of patients with gastric cancer and solitary lymph node metastasis

AIM:To investigate the relationship of solitary lymph node metastasis(SLNM)and age with patient survival in gastric cancer(GC).METHODS:The medical records databases of China’s Beijing Cancer Hospital at the Peking University School of Oncology and Shanghai Tenth People’s Hospital affiliated to Tongji University were searched retrospectively to identify patients with histologically proven GC and SLNM who underwent surgical resection between October 2003 and December 2012.Patients with distant metastasis or gastric stump carcinoma following resection for benign disease were excluded from the analysis.In total,936 patients with GC+SLNM were selected for analysis and the recorded parameters of clinicopathological disease and follow-up(range:13-2925 d)were collected.The Kaplan-Meier method was used to stratify patients by age(≤50 years-old,n=198;50-64 years-old,n=321;≥65 years-old,n=446)and by metastatic lymph node ratio[MLR<0.04(1/25),n=180;0.04-0.06(1/25-1/15),n=687;≥0.06(1/15),n=98]for 5-year survival analysis.The significance of intergroup differences between the survival curves was assessed by a log-rank test. RESULTS:The 5-year survival rate of the entire GC+SLNM patient population was 49.9%.Stratification analysis showed significant differences in survival time(post-operative days)according to age:≤50 yearsold:950.7±79.0 vs 50-64 years-old:1697.8±65.9 vs≥65 years-old:1996.2±57.6,all P<0.05.In addition,younger age(≤50 years-old)correlated significantly with mean survival time(r=0.367,P<0.001).Stratification analysis also indicated an inverse relationship between increasing MLR and shorter survival time:<0.04:52.8%and 0.04-0.06:51.1%vs≥0.06:40.5%,P<0.05.The patients with the shortest survival times and rates were younger and had a high MLR(≥0.06):≤50 years-old:496.4±133.0 and 0.0%vs 50-65 years-old:1180.9±201.8 and 21.4%vs≥65 years-old:1538.4±72.4 and 37.3%,all P<0.05.The same significant trend in shorter survival times and rates for younger patients was seen with     

Clinicopathologic and molecular features associated with patient age in gastric cancer

AIM: To compare characteristics and prognosis of gastric cancer based on age.METHODS: A retrospective study was conducted on clinical and molecular data from patients(n =1658) with confirmed cases of gastric cancer in Seoul National University Bundang Hospital(Seoul, South Korea) from 2003 to 2010 after exclusion of patients diagnosed with lymphoma, gastrointestinal stromal tumor, and metastatic cancer in the stomach. DNA was isolated from tumor and adjacent normal tissue,and a set of five markers was amplified by polymerase chain reaction to assess microsatellite instability(MSI). MSI was categorized as high, low, or stable if ≥ 2, 1, or 0 markers, respectively, had changed.Immunohistochemistry was performed on tissue sections to detect levels of expression of p53, human epidermal growth factor receptor(HER)-2, and epidermal growth factor receptor. Statistical analysis of clinical and molecular data was performed to assess prognosis based on the stratification of patients by age(≤ 45 and 45 years).RESULTS: Among the 1658 gastric cancer patients, the number of patients with an age ≤ 45 years was 202(12.2%; 38.9 ± 0.4 years) and the number of patients 45 years was 1456(87.8%; 64.1 ± 0.3 years).Analyses revealed that females were predominant inthe younger group(P 0.001). Gastric cancers in the younger patients exhibited more aggressive features and were at a more advanced stage than those in older patients. Precancerous lesions, such as atrophic gastritis and intestinal metaplasia, were observed less frequently in the older than in the younger group(P 0.001). Molecular characteristics, including overexpression of p53(P 0.001), overexpression of HER-2(P = 0.006), and MSI(P = 0.006), were less frequent in gastric cancer of younger patients. Cancer related mortality was higher in younger patients(P= 0.048), but this difference was not significant after adjusting for the stage of cancer.CONCLUSION: Gastric cancer is distinguishable between younger and older patients based on both clinicopathologic and molecular features, but stage is the most important predictor of prognosis.     

不同年龄组胃癌患者的临床病理特征和预后分析

目的探讨不同年龄组胃癌患者的临床病理特征和预后。方法回顾性分析大连医科大学附属第一医院1995年1月至2004年12月行手术治疗的1526例胃癌患者的临床资料,按不同年龄段将患者分为3组,A组:≤40岁,B组:40岁～70岁,C组:≥70岁。对全组和各分组的临床病理特征和预后等情况做统计分析。结果全组患者中男性患者占多数,临床表现以不同程度的腹痛和腹胀及腹部不适多见。胃癌的好发部位以胃窦多见。全组早期胃癌约10.6%,Borrmann分型中以Ⅲ型多见,病理学检查以低/未分化为主,TNM分期全组以Ⅲ期和Ⅳ期多见,手术切除率全组为96.4%。随着患者年龄的增长,术后并发症和死亡率也增加。各组间生存率比较经Logrank检验,差异无显著性。结论各年龄组胃癌患者在性别分布、临床表现、病理类型、手术并发症及围手术期死亡率有差异,在肿瘤的发生部位、大小、Borrmann分型、TNM分期、早期诊断、手术切除率及生存率方面无明显差异。因此,行手术治疗的各年龄组胃癌患者的预后无明显差异,手术及早期诊断是决定胃癌患者预后的重要因素。     

Characteristics of and risk factors for colorectal neoplasms in young adults in a screening population

AIM: To investigate prevalence and risk factors for colorectal neoplasms in adults aged 50 years, for whom screening is not recommended.METHODS: This cross-sectional study compared prevalence and characteristics of colorectal and advanced adenomas in patients aged 50 years who underwent colonoscopy screening with subjects aged ≥ 50 years. To evaluate risk factors for colorectal and advanced adenoma in young adults, we used multivariable logistic regression models. Colorectal neoplasm characteristics were evaluated and compared with those in older patients.RESULTS: Among 2819 patients included, prevalences of colorectal adenoma and advanced adenoma were 19.7% and 1.5%, respectively. As patient age increased, so did the prevalence of colorectal neoplasm. However, prevalence of advanced adenoma did not differ between age-groups 45-49 years and ≥ 50 years(OR = 0.43, 95%CI: 0.17-1.07, P = 0.070). In younger age-group( 50 years), colorectal adenoma was significantly associated with older age, waist circumference(OR = 1.72, 95%CI: 1.15-2.55, P = 0.008), and current smoking(OR = 1.60, 95%CI: 1.07-2.41, P = 0.023). Alcohol consumption was an independent risk factor for colorectal advanced adenoma(OR = 3.69, 95%CI: 1.08-12.54, P = 0.037). Multiple neoplasms and large neoplasms(≥ 1 cm) were more prevalent in subjects ≥ 50 years.CONCLUSION: Current screening strategies for colorectal cancer may need to be amended to account for patient age, especially in young subjects with abdominal obesity, current smoking and alcohol consumption.     

Clinicopathologic characteristics of gastric carcinoma in elderly patients： A comparison with young patients

AIM: To examine the clinicopathologic features of elderly patients with gastric carcinoma and to investigate the relationship between prognosis and age. METHODS: We reviewed the hospital records of 2 014 patients with gastric carcinoma retrospectively to compare the clinicopathologic findings in elderly (age＞70 years) and young (age＜36 years) patients during the period from 1986 to 2000 in a tertiary referral center in Gwangju, Korea. Overall survival was the main outcome measure. RESULTS: Of the 2 014 patients, 194 (9.6%) were in the elderly group and 137 (6.8%) were in the young group. The elderly and young patients had similar distributions with respect to depth of invasion, nodal involvement, hepatic metastasis, peritoneal dissemination, tumor stage at the initial diagnosis, and type of surgery. Synchronous multiple carcinomas were found in 14/194 (7.2%) of the elderly group and 4/137 (2.9%) of the young group (P＜0.05). Using the Borrmann classification, type Ⅳ was more frequent in the young patients than in the elderly patients (P＜0.05). Significantly more elderly patients had a well or moderately differentiated histology, and more young patients had a poorly differentiated histology and signet ring cell carcinoma (P＜0.001). The 5-year survival rates of elderly and young patients did not differ statistically (52.8% vs 46.5%, P=0.5290). Multivariate analysis showed that the histologic type, nodal involvement and operative curability were significant prognostic factors, and age itself was not an independent prognostic factor of survival for elderly gastric carcinoma patients. CONCLUSION: Elderly patients with gastric carcinoma do not have a worse prognosis than young patients. The important prognostic factor is whether the patients undergo a curative resection.     

Measuring of Gastric Emptying in Egyptian Pediatric Patients with Portal Hypertension by Using Real-time Ultrasound

Background/Aim:

Among the various methods for evaluating gastric emptying, the real-time ultrasound is safe, does not require intubation, or rely on either radiologic or radionuclide technique. The aim of our work was to measure the gastric emptying in pediatric patients with portal hypertension by using the real-time ultrasound.

Patients and Methods:

Forty patients with portal hypertension with mean age 7 ± 2.8 years and 20 healthy children as a control group underwent gastric emptying study by using real-time ultrasound. The cross-sectional area of the gastric antrum was measured in the fasting state and then each subject was allowed to drink tap water then calculated by using formula area (π longitudinal × anteroposterior diameter/4). The intragastric volume was assumed to be directly proportional to the cross-sectional area of the antrum.

Results:

The mean gastric emptying half-time volume was significantly delayed in portal hypertension patients (40 ± 6.8 min) compared with the control subjects (27.1 ± 3.6) min (P<0.05). Patients with extrahepatic portal vein obstruction had significant delayed gastric emptying in comparison to patients with portal hypertension due to other etiologies (36.14 ± 4.9 vs 44.41 ± 6.04 min; P<0.01).

Conclusion:

Ultrasound is a noninvasive and a reliable method for measuring gastric emptying in pediatric patients. Gastric emptying was significantly delayed in patients with portal hypertension. Etiology of portal hypertension may influence gastric emptying time in patients with chronic liver disease.     

Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy

AIM: To re-evaluate the recent clinicopathological features of remnant gastric cancer (RGC) and to develop desirable surveillance programs.METHODS: Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Japan. Of these, 33 patients underwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gastric cancer. The hospital records of these patients were reviewed retrospectively.RESULTS: Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter interval [P < 0.05; gastric cancer vs benign disease: 12 (2-22) vs 30 (4-51) years] and were more frequently reconstructed by Billroth-I procedure than those following benign lesions (P < 0.001). Regarding reconstruction, RGC following Billroth-II reconstruction showed a longer interval between surgical procedures [P < 0.001; Billroth-II vs Billroth-I: 32 (5-51) vs 12 (2-36) years] and tumors were more frequently associated with benign disease (P < 0.001) than those following Billroth-I reconstruction. In tumor location of RGC, after Billroth-I reconstruction, RGC occurred more frequently near the suture line and remnant gastric wall. After Billroth-II reconstruction, RGC occurred more frequently at the anastomotic site. The duration of follow-up was significantly associated with the stage of RGC (P < 0.05). Patients diagnosed with early stage RGC such as stage I-II tended to have been followed up almost every second year.CONCLUSION: Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.     

Body mass index is associated with age-at-onset of HCV-infected hepatocellular carcinoma patients

AIM: To identify factors associated with the age at onset of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). METHODS: Five hundred and fifty-six consecutive patients positive for HCV antibody and treatment-nafive HCC diagnosed between 1995 and 2004 were analyzed. Patients were classified into three groups according to age at HCC onset: < 60 years (n = 79), 60-79 years (n = 439), or ≥ 80 years (n = 38). Differences among groups in terms of sex, body mass index (BMI), lifestyle characteristics...     

Clinicopathologic features of remnant gastric cancer over time following distal gastrectomy

AIM: To investigate remnant gastric cancer(RGC) at various times after gastrectomy, and lay a foundation for the management of RGC.METHODS: Sixty-five patients with RGC 2 years and 10 years after gastrectomy(RGC Ⅰ) and forty-nine with RGC 10 years after gastrectomy(RGC Ⅱ) who underwent curative surgery were enrolled in the study.The clinicopathologic factors, surgical outcomes, and prognosis were compared between RGC Ⅰ and RGC Ⅱ.RESULTS: There was no significant difference in surgical outcomes between RGC Ⅰ and RGC Ⅱ. For patients reconstructed with Billroth Ⅱ, significantly more patients were RGC Ⅱ compared with RGC(71.9%vs 21.2%, P 0.001), and more RGC Ⅱ patients had anastomotic site locations compared to RGC Ⅰ(31.0%vs 56.3%, P = 0.038). The five-year survival rates for the patients with RGC Ⅰ and RGC Ⅱ were 37.6%and 47.9%, respectively, but no significant difference was observed. Borrmann type and tumor stage were confirmed to be independent prognostic factors in both groups.CONCLUSION: RGC Ⅱ is located on the anastomotic site in higher frequency and more cases develop after Billroth Ⅱ reconstruction than RGC Ⅰ.     

Impact of Age on Transcatheter Aortic Valve Implantation Outcomes: Comparison Between Patients Aged ≤80 Years versus Patients >80 Years

Objective To investigate the procedural outcomes and the long-term survival of patients undergoing transcatheter aortic valve implantation (TAVI) and compare study results of patients ≤ 80 years and patients > 80 years old. Methods A total of 240 patients treated with TAVI were divided into two groups according to age ≤ 80 years (n = 105; 43.8%) and > 80 years (n = 135; 56.2%). The baseline characteristics and the procedural outcomes were compared between these two groups of patients. Results With the exception of peripheral artery disease and hypercholesterolemia, which were more frequently observed in the older age group, baseline characteristics were comparable between groups. Complication rates did not differ significantly between patients ≤ 80 years and patients > 80 years. There were no differences in 30-day mortality rates between patients aged ≤ 80 years and patients > 80 years old (9.5% vs. 7.4%, respectively; P = 0.557). After a median follow-up of 28 months (interquartile range: 16–42 months), 50 (47.6%) patients aged ≤ 80 years died compared to 57 (42%) deaths in the group of patients > 80 years old (P = 0.404). Conclusion The results of the present single center study showed that age didn't significantly impact the outcomes of TAVI.     

Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer

AIM:To investigate the impact of prognostic nutritional index(PNI)on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.METHODS:The data for 386 patients with gastric cancer were extracted and analyzed between January2003 and December 2008 in our center.The patients were divided into two groups according to the cutoff value of the PNI:those with a PNI≥46 and those with a PNI<46.Clinicopathological features were compared between the two groups and potential prognostic factors were analyzed.The relationship between postoperative complications and PNI was analyzed by logistic regression.The univariate and multivariate hazard ratios were calculated using the Cox proportional hazard model.RESULTS:The optimal cutoff value of the PNI was set at 46,and patients with a PNI≥46 and those with a PNI<46 were classified into PNI-high and PNI-low groups,respectively.Patients in the PNI-low group were more likely to have advanced tumor(T),node(N),and TNM stages than patients in the PNI-high group.The low PNI is an independent risk factor for the incidence of postoperative complications(OR=2.223).The 5-year overall survival(OS)rates were 54.1%and21.1%for patients with a PNI≥46 and those with a PNI<46,respectively.The OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stagesⅡ(P=0.001)andⅢ(P<0.001)disease.CONCLUSION:The PNI is a simple and useful marker not only to identify patients at increased risk for postoperative complications,but also to predict long-term survival after total gastrectomy.The PNI should be included in the routine assessment of advanced gastric cancer patients.     

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory.Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.METHODS A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric cancer.For each patient we calculated the Kattan’s score.We arbitrarily divided the study population of patients into two groups based on the nomogram score(<100 points or≥100 points).Prespecified subgroups in these analyses were defined according to age(≤65 years or>65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity.RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy.Perioperative mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer patients.The removal of more than 35 lymph nodes does not lead to an increase in mortality.     

Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years

AIM:To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.METHODS:We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003and December 2007 in our center.Patients were categorized into three groups:younger group(age<50years),middle-aged group(50-69 years),and elderly group(≥70 years).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The log-rank test was used to assess statistical differences between curves.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of age on survival at each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.We analyzed the potential prognostic factors for patients aged≥70years.Finally,the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.RESULTS:In the elderly group,there was a male predominance.At the same time,cancers of the upper third of the stomach,differentiated type,and less-invasive surgery were more common than in the younger or middle-aged groups.Elderly patients were more likely to have advanced tumor-node-metastasis(TNM)stage and larger tumors,but less likely to have distant metastasis.Although 5-year overall survival(OS)rate specific to gastric cancer was not significantly different among the three groups,elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients(elderly vs middle-aged vs younger patients=22.0%vs 36.6%vs 38.0%,respectively).In the TNM-stratified analysis,the differences in OS were only observed in patients withⅡandⅢtumors.In multivariate analysis,only surgical margin status,pT4,lymph node metastasis,M1 and sex were independent prognostic factors for elderly patients.The5-year OS rate d     

Gastric adenocarcinoma in young adults: A comparative study with elderly patients

"Background: Gastric adenocarcinoma (GA) has been considered a disease of elderly age and has been rarely reported in patients younger than 35 years of age. The aim of this demographic, clinicopathological and prognosis of gastric cancer in young patients and to compare their features with the behavior in elder adults. Methods: Between 1993 and 2008, 1536 patients with GA were enrolled in a retrospective database. Clinical and pathologic features of thirty patients aged 35 years or less (young group) were compared with those of 458 aged 75 years or more (elder group). Results: Mean patient age was 31 and 80-years old in the young and elder groups, respectively, with a predominance of females in the last group (61%). Lauren diffuse type carcinoma was more frequent in people younger than 35 years (70%) than in older patients (17.4%). Main symptoms were dyspepsia (40%) and hemorrhage (20%). The most common T stage in young and elder patients was T3 (52.9% and 56.7% respectively). Surgical resection was performed in 68% of cases and the rest received only systemic chemotherapy. Conclusion: Gastric adenocarcinoma is rare in young patients and most cases presented at advanced clinical stage similar to elderly patients, so the prognosis in both age groups is poor. For this reason is important to be aware of alarm symptoms and risk factors in order to perform an early endoscopic diagnosis and a treatment with curative intent."     

Expression and clinical significance of CD73 and hypoxia-inducible factor-1α in gastric carcinoma

AIM: To investigate the expression of CD73 and hypoxia-inducible factor-1α (HIF-1α) in human gastric carcinoma, and explore their clinical significance and prognostic value. METHODS: CD73 and HIF-1α expressions were detected by immunohistochemistry in consecutive sections of tissue samples from 68 gastric carcinoma patients. The peritumor tissues 2 cm away from the tumor were obtained and served as controls. The presence of CD73 and HIF-1α was analyzed by immunohis-tochemistry using the Envision technique. RESULTS: CD73 and HIF-1α expressions in gastric carcinoma were significantly higher than those in gastric mucosal tissues as control (P < 0.001) and showed a close correlation (Spearman r = 0.390, P = 0.001). Overexpression of CD73 was positively correlated with differentiation of tumor (P = 0.000), histopathology (P = 0.041), depth of invasion (P < 0.001), nodal status (P = 0.003), metastasis (P = 0.013), and the American Joint Committee on Cancer (AJCC) stage (P < 0.001). High expression of HIF-1α was positively correlated with tumor diameter (P = 0.031), depth of invasion (P = 0.022), and AJCC stage (P = 0.035). The overall survival rate was low in the patients with high expression of CD73 (P < 0.001). Moreover, CD73+/HIF-1α+ patients had the worst prognosis (P < 0.001). CD73 expression was proven to be an independent predictor for patients with gastric carcinoma by both multivariate Cox regression analysis (P = 0.021) and receiver operating characteristic curves (P = 0.001).CONCLUSION: CD73 expression correlates closely with HIF-1α expression in gastric carcinoma. CD73 could be an independent prognostic indicator for gastric carcinoma.     

青年人与老年人胃癌临床病理及预后对比分析

目的探讨青年与老年胃癌的临床、内镜、术后病理特点及预后。方法回顾性总结我院2003年12月～2012年12月经胃镜检查,手术确诊的青年人(≤35岁)胃癌51例及老年人(≥65岁)胃癌284例,进行临床表现、内镜表现、术后病理分型及预后等对比分析。结果近年来,胃癌患病总人数下降,同期内老年人胃癌总人数多于青年人;青年组胃癌以女性多,老年组以男性多;青年组多在胃下1/3,老年组多在胃上1/3;内镜下青年组多表现为Borrmann Ⅲ、Borrmann Ⅳ,术后病理以低分化腺癌、黏液腺癌、印戒细胞癌为主;老年组以Borrmann Ⅰ、Borrmann Ⅲ为主,术后以高-中分化腺癌居多;两组胃癌手术方式无差异性;老年组1年、3年生存率高于青年组。结论青年人胃癌临床症状隐匿,病理分化差,预后差。早期胃镜检查、定期复查、幽门螺杆菌根除、手术是青年人胃癌治疗的关键。     

Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus

AIM: To investigate the clinicopathologic features which predict surgical overall survival in patients with proximal gastric carcinoma involving the esophagus (PGCE).METHODS: Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009. Each retrieved pathology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were selected as PGCE. Each tumor was re-staged, following the guidelines on esophageal adenocarcinoma, according to the 7th edition of the American Joint Commission on Cancer Staging Manual. All histology slides were studied along with the pathology report for a retrospective analysis of 13 clinicopathologic features, i.e., age, gender, Helicobacter pylori (H. pylori) infection, surgical modality, Siewert type, tumor Bormann’s type, size, differentiation, histology type, surgical margin, lymphovascular and perineural invasion, and pathologic stage in relation to survival after surgical resection. Prognostic factors for overall survival were assessed with uni- and multi-variate analyses.RESULTS: Patients’ mean age was 65 years (range: 47-90 years). The male: female ratio was 3.3. The 1-, 3- and 5-year overall survival rates were 87%, 61% and 32%, respectively. By univariate analysis, age, male gender, H. pylori, tumor Bormann’s type, size, histology type, surgical modality, positive surgical margin, lymphovascular invasion, and pT stage were not predictive for overall survival; in contrast, perineural invasion (P = 0.003), poor differentiation (P = 0.0003), > 15 total lymph nodes retrieved (P = 0.008), positive lymph nodes (P = 0.001), and distant metastasis (P = 0.005) predicted poor post-operative overall survival. Celiac axis nodal metastasis was associated with significantly worse overall survival (P = 0.007). By multivariate analysis, ≥ 16 positive nodes (P = 0.018), lymph node ratio > 0.2 (P = 0.003), and overall pathologic stage (P = 0.002) were independent predictors for poor overall survival after resection.CONCLUSION: Patients with PGCE showed worse overall survival in elderly, high nodal burden and advanced pathologic stage. This cancer may be more accurately staged as gastric, than esophageal, cancer.     

Impact of intraoperative blood loss on survival after curative resection for gastric cancer

AIM:To elucidate the potential impact of intraoperative blood loss(IBL)on long-term survival of gastric cancer patients after curative surgery.METHODS:A total of 845 stageⅠ-Ⅲgastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study.Patients were divided into 3groups according to the amount of IBL:group 1(<200mL),group 2(200-400 mL)and group 3(>400 mL).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The Log-rank test was used to assess statistical differences between the groups.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of IBL on survival in each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.Finally,we explored the possible factors associated with IBL and identified the independent risk factors for IBL≥200 mL.RESULTS:Overall survival was significantly influenced by the amount of IBL.The 5-year overall survival rates were 51.2%,39.4%and 23.4%for IBL less than 200mL,200 to 400 mL and more than 400 mL,respectively(<200 mL vs 200-400 mL,P<0.001;200-400 mL vs>400 mL,P=0.003).Age,tumor size,Borrmann type,extranodal metastasis,tumour-node-metastasis(TNM)stage,chemotherapy,extent of lymphadenectomy,IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis.Following stratified analysis,patients staged TNMⅠ-Ⅱand those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200mL,while patients staged TNMⅢ,whose IBL was less than 400 mL had better survival.Tumor location,tumor size,TNM stage,type of gastrectomy,combined organ resection,extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL,while tumor location,type of gastrecto