Correlation between serum immunosuppressive substance and clinico-pathological findings in patients with gastric carcinoma

Serum levels of immunosuppressive substance (IS) were determined in 99 patients with gastric cancer and in 32 healthy individuals. The serum IS levels in the patients (769.6 +/- 314.8 micrograms/ml) were significantly higher than those in the healthy individuals (549.7 +/- 104.7 micrograms/ml). A multivariate analysis on the correlation between serum IS levels and clinicopathological findings in the patients disclosed that there was a close correlation between the serum IS levels and the depth of invasion, in particular, the prognostic serosal invasion, metastasis to the distal lymph nodes and peritoneal dissemination. There was, however, no correlation between the serum IS level and hepatic metastasis. Serum IS levels were higher in patients with well-differentiated adenocarcinoma than in those with poorly differentiated adenocarcinoma or signet ring cell carcinoma. A serum IS level higher than 1000 micrograms/ml indicates the possibility that the tumor is only palliatively resectable because of involvement of the distal lymph nodes or peritoneal dissemination.     

Natural killer activity and serum immunosuppressive acidic protein levels in esophageal and gastric cancers

The natural killer (NK) activity of peripheral blood mononuclear cells and serum immunosuppressive acidic protein (IAP) levels were examined in patients with esophageal or gastric cancer, before and after surgery. Patients with stage IV esophageal or stage IV gastric cancer had significantly lower NK activity (39.5±14.8% and 37±11.6%, respectively), and also higher serum IAP levels (778±264 g/mL and 633±156 g/mL, respectively), than the corresponding control values (50±5.6% and 375±26 g/mL, respectively). Patients with esophageal or gastric cancer who underwent curative resection had high NK activity (54.8±11.6% and 54.8±8.0%, respectively), and low IAP levels (471±116 g/mL and 490±42 g/mL, respectively), compared with those who underwent non-curative resection. Patients who underwent non-curative resection had lower NK activity and higher serum IAP levels than those who underwent curative resection, even 1 month after surgery. Mononuclear cells in the regional lymph nodes and tumor specimens showed significantly lower NK activity than those in the peripheral blood and spleen. Thus, NK activity and the IAP level reflected the immunocompetence, clinical course, and surgical curability of those patients. NK cells appeared not to have any significant antitumor activity in the regional lymph nodes or in the tumor itself, although they were still active in the peripheral blood.     

A correlation between serum immunosuppressive acidic protein and altered immunocompetence in patients with brain tumours

Summary The present investigation was conducted to document a correlation between the serum levels of immunosuppressive acidic protein (IAP) and depressed lymphocyte responsiveness to mitogens in vitro in patients with intracranial tumours, and to delineate the possible roles of IAP upon immunocompetence in these patients. It was thought that high concentrations of IAP present in the serum of brain-tumour patients may play a significant role in the immunosuppression seen in this patient population. The effect of IAP upon mitogen-stimulated lymphocyte function was evaluated by tritiated (³H)-thymidine incorporation. Lymphocytes from both 30 patients with intracranial tumours and 30 normal individuals were incubated for 90 hours in culture medium in the presence of three mitogens: phytohaemagglutinin (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM). Lymphocytes obtained from patients with brain tumours and cultured in autologous serum displayed a significant depression of³H-thymidine incorporation, as was observed in previous studies. In addition, a significant suppression of mitogen-induced activation of the normal lymphocytes was demonstrated in the presence of allogeneic patients' serum and the percentage of inhibition was found significantly proportional to the IAP concentrations. Furthermore it was also demonstrated that increased levels of serum IAP could significantly correlate with two in vivo aspects of impaired cellular immunity: the decreased lymphocyte counts in the peripheral blood and diminished cutaneous delayed hypersensitivity reactions measured by purified protein derivative (PPD) skin test reactivity. On the other hand, an attempt was also made to investigate changes in humoral immunity and immunoglobulin concentrations were observed not to correspond to the serum IAP levels. These studies suggest a possible connection between serum IAP levels and altered cellular immune competence in brain-tumour patients.     

Impact of splenectomy and immunochemotherapy on survival following gastrectomy for carcinoma: Covariate interaction with immunosuppressive acidic protein, a serum marker for the host immune system

(Received for publication on Jan. 14, 1998; accepted on Nov. 6, 1998)     

Circulating immune complexes in gastric cancer patients and their effect on lymphocyte mitogenesis (the first report)

Immune complexes (IC) were measured in 66 gastric cancer patients, using the 3.5 percent polyethylene glycol (PEG) precipitation method. Preoperatively, the IC values in patients with advanced gastric cancer (stages III and IV) were significantly higher than in normal subjects (p<0.01). In the presence of 3.5 percent PEG-precipitated IC from sera of gastric cancer patients, the mitogen respones of normal peripheral blood lymphocytes was inhibited; the PHA response revealed a significant negative correlation with the concentration of IC (p<0.01). Our data suggest that IC may be a major serum factor exerting immunosuppressive effect in cancer hosts.     

血清抵抗素与胃癌恶病质的关系

目的 观察血清抵抗素与胃癌及胃癌恶病质的关系,并初步探讨胃癌恶病质中抵抗素与白介素-6相关性。方法 选取胃癌并恶病质患者23例为胃癌恶病质组,胃癌患者23例为胃癌组、健康成人23例为对照组。记录患者性别、年龄、BMI及肿瘤分期。采用ELISA法测定血清抵抗素和白介素-6水平（IL-6）。结果 Ⅲ、Ⅳ期胃癌较Ⅰ、Ⅱ期胃癌更易发生恶病质（P<0.05）,与健康成人相比血清抵抗素、白介素-6在胃癌及胃癌恶病质中升高（P<0.05）。血清抵抗素水平随着胃癌病理分期的增加有逐渐升高趋势（P<0.05）。胃癌恶病质组血清白介素-6水平与血清抵抗素水平显著正相关（r=0.512,P=0.012）。结论 血清抵抗素水平随着胃癌病理分期的增加逐渐升高,胃癌恶病质患者血清抵抗素的升高与白介素-6呈正相关关系。     

Immunosuppressive activity of sera from gastric cancer patients

Sera from 60 gastric cancer patients and 20 patients with benign gastric diseases and 8 healthy controls were tested for inhibitory effects on the humoral response to sheep erythrocytes (SRBC) by the plaque forming cell assay (PFC R.I.) using mouse spleen cells and on the phytohemagglutinin (PHA)-induced blastogenesis of normal mouse spleen cells (PHA S.R.). Gastric cancer patient sera showed a significantly lower PFC R.I. than did sera from benign gastric disease patients and from the healthy controls. However, there was no appreciable interstage difference in the degree of depression. The PHA-induced blastogenesis of normal spleen cells was also decreased in the presence of sera from cancer patients, as compared to that in the presence of sera from benign disease patients and from the healthy controls. The depression progressed with advancing stage of cancer. The PHA S.R. showed significant negative correlations with serum levels of IAP, IS, α₁-acid glycoprotein and α₁-antitrypsin, but there were no such correlations between PFC R.I. and these glycoproteins in serum. There was also no correlation between the values of the PHA S.R. and the PFC R.I. These results suggest that these two assays may depict immunosuppressive activities operating through entirely different mechanisms.     

早期胃癌临床病理学特征与预后的关系

目的:探讨和总结早期胃癌的临床病理学特征及其与病人预后间的关系,分析早期胃癌的淋巴结转移规律,为微创治疗、缩小手术提供依据。方法:采用单因素及多因素的分析法,回顾分析2003年1月至2008年9月仁济医院普外科接受手术治疗的231例早期胃癌病人的临床及病理学资料。结果:单因素分析显示,肿瘤大小、浸润深度及淋巴结转移程度与早期胃癌的预后相关;多因素分析提示,淋巴结转移是早期胃癌预后的独立性危险因素。单发早期胃癌的淋巴结转移率为15.6%(36/231),黏膜内癌淋巴结转移率为5.7%(4/70),黏膜下癌淋巴结转移率为19.9%(32/161)。Logistic回归分析提示,肿瘤直径>2 cm(P=0.038,OR=1.351)和肿瘤浸润至黏膜下层(P=0.027,OR=3.635)是淋巴结转移的独立危险因子。本研究中,无淋巴结转移的早期胃癌病人,其术后3年生存率为98.6%,显著优于有淋巴结转移者(P2 cm、肿瘤浸润至黏膜下层是早期胃癌淋巴结转移的独立危险因子;术前应用影像学技术评估早期胃癌淋巴结转移情况有助于选择合理的治疗方案。     

胃黄色瘤与根治幽门螺旋杆菌后早期胃癌的相关性分析

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

Serum CEA levels in patients with gastric carcinoma correlate with the tumorigenicity of their xenografts in nude mice

We examined the correlation among preoperative serum carcinoembryonic antigen (CEA) levels, staining properties of the tumors by CEA immunohistochemistry and the tumorigenicity of their xenografts in nude mice, in 28 patients with gastric cancer. Eleven (40 per cent) of them were positive for serum CEA (≧2.5 ng/ml) and seven (25 per cent) of the xenografts were tumorigenic in nude mice. All the tumorigenic cases were positive for serum CEA (p<0.001) and the mean value of the serum CEA level in the patients with tumorigenic neoplasms was 20.8 ng/ml, being significantly higher than that (1.4 ng/ml) in the patients with nontumorigenic neoplasms (p<0.001). Twenty-five of the 28 carcinomas (89 per cent) were positive for CEA staining in their cancer cells by the ABC method and CEA localization correlated with tumorigencity (p<0.05). These results suggest that the serum CEA level in patients is correlated with the tumorigenicity of their gastric carcinoma xenografts in nude mice and may account for the poor prognosis of patients with high serum CEA.     

Immunoreactive carcinoembryonic antigen in gastric juice in patients with gastric cancer

To clarify the significance of immunoreactive carcinoembryonic antigen in gastric juice (gastric CEA) from gastric cancer patients, we studied the gastric CEA in comparison with cancer progress, histologic types of tumors, staining, for CEA and extent of intestinal metaplasia. The gastric CEA levels from patients with other gastric diseases, i.e., gastric ulcer, duodenal ulcer and chronic gastritis were also investigated. The mean gastric CEA level from gastric cancer patients was significantly higher than from gastric or duodenal ulcer patients, but there was no significant difference between levels in patients with gastric cancer and in those with chronic gastritis. The gastric CEA levels from cancer patients increased with progression of the cancer. The differentiated carcinomas showed significantly higher gastric CEA levels than the poorly differentiated carcinomas. Positive CEA tumors showed significantly higher gastric CEA levels than did the negative CEA tumors. The tumors with diffuse intestinal metaplasia revealed high gastric CEA levels. Determination of gastric CEA levels is considered to be useful for screening of gastric cancer.     

早期胃癌淋巴结转移和临床病理特征的关系(附467例报道)

目的:探讨早期胃癌病人各临床病理因素与淋巴结转移的关系,为制定合理的治疗方案提供帮助.方法:对467例早期胃癌病人进行回顾性分析,对其年龄、性别、肿瘤大小、大体类型、分化程度、浸润深度、淋巴管癌栓与淋巴结转移的关系进行单因素和多因素分析.结果:影响早期胃癌淋巴结转移的因素主要有:肿瘤大小(最大径,≤2 cm比>2 cm,P<0.01)、分化程度(分化良好比分化不佳,P<0.01)、浸润深度(黏膜层比黏膜下层,P<0.01)、淋巴管癌栓(无比有,P<0.01).Logistic回归多因素分析结果显示,肿瘤大小、分化程度、浸润深度、淋巴管癌浸润均是提示胃癌是否有淋巴结转移的独立因素.结论:早期胃癌淋巴结转移与肿瘤大小、肿瘤分化程度、浸润深度、淋巴管癌栓等因素有关.确定早期胃癌手术方案时,可参考上述因素判断淋巴结转移风险,决定是否行淋巴结清扫术.     

Correlation between endoscopic and angiographic findings in patients with esophageal and isolated gastric varices.

BACKGROUND/AIM: The correlation between angiographic vascular patterns and endoscopic findings in portal hypertension is not sufficiently known, and knowledge of the vascular anatomy may contribute to an improvement in endoscopic embolization and transjugular retrograde obliteration procedures. We propose a new vascular map that should prove useful for this purpose. METHODS: Between April 1985 and December 1997 we performed percutaneous transhepatic portography in a selected group of 75 patients (16 women and 59 men), aged 43-71 years, from whom informed consent was obtained. All patients had been diagnosed endoscopically as having either esophageal or isolated gastric varices. According to the Child-Pugh classification, class A, B, and C cirrhosis was seen in 19, 40, and 16 patients, respectively. We created a vascular map of esophageal and isolated gastric varices, based on the opacification of the portal venous collaterals on percutaneous transhepatic portography. We compared the patients in both variceal groups in terms of portal venous pressure, main blood supply, and drainage routes. RESULTS: We found that the portal collateral system was divided into two systems: the portoazygos venous system and the portophrenic venous system. The former contributed to the formation of esophageal and cardiac varices and the latter to the formation of isolated gastric varices located at the fundus or at both the cardia and fundus. The left gastric vein participated as blood supply in 70% of the isolated gastric varices and in 100% of the esophageal varices (p < 0.01). The posterior gastric vein participated as blood supply in 70% of the isolated gastric varices and in 24% of the esophageal varices (p < 0.01). We classified the main blood drainage routes of isolated gastric varices functionally into three types: gastrorenal shunt (85%), gastrophrenic shunt (10%), and gastropericardiac shunt (5%). The portal venous pressure in patients with esophageal varices was 358 +/- 66 mm H(2)O, whereas in patients with isolated gastric varices it was 262 +/- 44 mm H(2)O (p < 0.01). CONCLUSION: We suggest that this new vascular map will be useful in endoscopic embolization and transjugular retrograde obliteration procedures for esophageal and isolated gastric varices.     

A cohort study on second malignancies in gastrectomized patients with gastric cancer II. Second maliganacies in the gastric remnant

In a retrospective cohort study, a total of 22 (0.22 per cent) carcinomas of the gastric remnant were clinically observed, as second malignancies, in 7,672 patients during the average of a 9.4-year follow-up period. All had undergone distal subtotal gastrectomy for gastric cancer from 1960–1975 in seven different institutions. Of 22 carcinomas of the gastric remnant, 5 were at the anastomotic site, 14 distant from the anastomosis; the location was unknown in three. All five carcinomas of the anastomotic site occurred after Billroth II operation. Time intervals between the first operation and the occurrence of second cancer varied from two to 21 years. With regard to the administration of adjuvant chemotherapeutic agents such as mitomycin-C (MMC), 5-fluorouracil (5FU) or its derivative Tegafur, no significant differences in the rate of second malignancies were obtained between the chemotherapy and non-chemotherapy groups. The occurrence rate of cancer of the gastric remnant between Billroth I and Billroth II groups showed no statistically significant difference, although it did tend to be slightly higher in the latter.     

胃癌128例临床病理分析

目的 探讨胃癌的临床及病理特点。方法回顾性分析我院2002年1月～2004年12月行手术治疗，并经病理确诊的128例胃癌患者的临床资料。结果 本组患者男性多于女性（3．4：1），40岁以上中老年占86．7％。临床症状主要为：中上腹疼痛86例（67．2％），消瘦66例（51．6％）和贫血58例（45．3％）。128例中胃体及胃底部癌71例（55．5％）；Bor-rmannⅡ型和Ⅲ型分别为41例（32．O％）和52例（40．6％）。56．3％（72例）组织病理学为腺癌；76．6％（98例）TNM分期为Ⅲ期和Ⅳ期；120例肿瘤可切除，属根治性切除101例（78．9％）。结论 本组资料显示中老年胃癌发病率高，且中晚期病变多．根治性切除率仅为60％。因此，必须进一步提高对胃癌的认识，尽可能做到早诊断、早治疗，这是提高疗效及患者生存率的关键。     

Treatment and prognosis of gastric stump carcinoma in comparison with primary proximal gastric cancer

BACKGROUND: The intention of this study was to evaluate the outcome of patients with gastric stump cancer (GSC) in comparison with patients treated for primary proximal gastric cancer (PPGC). METHODS: Nineteen patients with GSC undergoing surgery between January 1989 and August 2005 were compared with 194 PPGC patients treated during the same time period. Various factors such as epidemiologic data, type of treatment, and histopathologic data were evaluated in the analysis. RESULTS: The overall 5-year disease-specific survival was 42% for resected GSC patients in comparison with 37% for resected PPGC patients. There was no statistically significant difference in the survival rate detected between these 2 groups. On multivariate analysis the infiltration of the gastrojejunal anastomosis by the carcinoma was shown to be a significant predictor for the outcome of patients with GSC. CONCLUSIONS: In summary, no significant difference in the outcome between GSC and PPGC has been detected.     

Lymphocyte responsiveness to phytohemagglutinin (PHA) and serum inhibitory effect in patients with gastric cancer

The in vitro lymphocyte response to PHA was determined in patients with gastric cancer in various stages prior to the sugical treatment. The lymphocyte responsiveness in the presence of homologous pooled AB serum in patients of stages II, III and IV were markedly reduced as compared with that in healthy controls (stages II, III; p<0.05, stage IV; p<0.01). Inhibition of normal lymphocyte responsiveness to PHA by serum from patients in stages III and IV were statistically significant as compared with that in stage I (stage III; p<0.05, stage IV; p<0.01). Serum inhibitory effect on the normal lymphocyte responsiveness was significant only in the advanced stage. It was concluded that the suppression of the immune response in the early stage of gastric cancer was mainly due to the impairment of lymphocyte itself, which advanced with the progress of the stage and was modified by the serum inhibitory effect in advanced stages. In patients with advanced cancer, the higher was the lymphocyte responsiveness to PHA and PWM prior to the initial treatment, the more effective was the immunotherapy. This shows that the indication of the immunotherapy in patients with advanced cancer could be initiated. Furthermore, the correlation between the lymphocyte responsiveness to PHA and the clinical results of immunotherapy was discussed. Supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Education, Science and Culture.     

318例老年胃癌病人的临床分析

目的 分析和总结老年胃癌的临床特点。方法 对我院318例老年胃癌患者的共存病以及术后并发症进行分析和总结。结果318例老年胃癌患者,238例（74.84％）患有高血压、心脏病、糖尿病等一些老年人常见病。术后发生并发症共71例,死亡13例。手术前有并存病者,术后并发症的发生率为25.63％;而手术前无并存病者,术后并发症的发生率为12.50％,两者有非常显著性的差异（P<0.01）。结论 老年胃癌患者常患有高血压、心脏病、糖尿病等疾病。加强围手术期处理,可提高手术的安全性,减少并发症的发生。     

Increased serum concentrations of soluble tumor necrosis factor receptor I in noncachectic and cachectic patients with advanced gastric and colorectal cancer

(Received for publication on May 22, 1997; accepted on Jan. 6, 1998)     

胃癌腹腔灌注化疗的应用

术后腹腔转移是胃癌治疗失败的主要原因之一,而且一旦发生转移就很难进行有效治疗.腹腔灌注是有望最大程度的减少术后胃癌腹腔转移的有效手段之一.因此本文就针对灌注化疗的应用背景、临床疗效和药物选择等问题进行文献回顾.