Outcome of gastric carcinoma detected by gastric mass survey in Japan.

The outcome was studied of gastric carcinoma found in six selected mass survey groups. One-hundred-and-thirty-seven cases of gastric carcinoma were detected and followed-up postoperatively for 16 years at the longest. They consisted of 55 cases of early and 74 of advanced carcinoma with eight cases of unknown depth of involvement. Early carcinoma amounted to 42-6% of the cases with known depth of involvement. The relative five-year and 10-year survival rates calculated by the method of Ederer et al. (1961) in the 137 cases were 0-628 and 0-642, respectively, and those for early carcinoma were 0-959 and 1-016. These survival rates are remarkably high. The five-year survival rate in those who were followed-up after operation for more than five years (83 cases) was 0-554, which is much higher than that of the outpatient cases, who presented themselves for medical advice with some symptoms. The good prognosis is largely explained by a high incidence of early gastric carcinoma in the cases detected in the mass survey. Where methods of screening were concerned, the use of the gastrocamera markedly improved the detection rate of gastric carcinoma.     

Surgical outcome of 483 patients with early gastric cancer: prognosis, postoperative morbidity and mortality, and gastric remnant cancer

BACKGROUND/AIMS: The aim of this retrospective study was to evaluate the characteristics, treatment, postoperative morbidity, mortality, and prognosis of early gastric cancer patients as well as the incidence of gastric remnant cancer after curative surgery based on an analysis of the surgical results of Nippon Medical School Hospital over the past 10 years (1991-2000). METHODOLOGY: Out of 1057 patients with gastric cancer (all stages), 483 patients (301 males and 182 females; mean age 60.9 years) underwent surgery for early gastric cancer. Early gastric cancer, defined as that invading the m or sm layer regardless of lymph node metastasis, was classified according to the Japanese Classification of Gastric Carcinoma. The survival rate was calculated using the Kaplan-Meier method. RESULTS: The stages of the 483 patients were as follows: stage Ia patients, 443 cases; stage Ib, 29 cases; stage II, 7 cases; and stage IV, 4 cases. The overall 5- and 10-year survival rates were 95.9% and 95.9% for stage Ia, 82.9% and 80.2% for stage Ib, 73.2% and 68.6% for stage II and 0% for stage IV, respectively. No difference was observed in the 5- and 10-year survival rates between patients with D1 and D2 dissections in cases without lymph node metastasis. In patients with n1 positive sm cancer, however, the 5-year survival rate of the patients who underwent D2 dissection was 91.0% while that of those who underwent D1 dissection was 80.0% (P<0.05). The incidences of postoperative morbidity from various cancers included 4.2% from surgical site infections, 1.6% from anastomotic dehiscence, 1.6% from intestinal obstructions, and 3.9% from respiratory and/or heart dysfunction. Three patients (0.6%) died of multiple organ failure. Five patients who had undergone gastrectomy for early gastric cancer were diagnosed as having early cancer in the gastric remnant during a periodic follow-up endoscopy and underwent regastrectomy. CONCLUSIONS: The prognosis of early gastric cancer is usually excellent, and the morbidity and mortality rates are satisfactory. D2 lymph node dissection is necessary in patients with n1 positive sm cancer. Periodic follow-up endoscopies in gastrectomized patients may be useful for the early detection of gastric remnant cancer.     

胃癌序贯筛查实施现场胃癌患者术后生存分析—11年随访

探讨胃癌序贯筛查法实施后手术治疗对胃癌患者生存率的影响。方法：参加胃癌序贯筛查的人群及作为对照的非筛查人群中发现胃癌并进行手术治疗的67例患者为研究对象,其中筛查组27例,非筛查组40例,自1987年随访至1997年,详细记录其生存时间等资料并进行生存分析。结果：胃癌筛查组患者术后5年及10年生存率均明显高于非筛查组患者、存在显著统计学差异（5年生存率：73．0％比34．5％,P＜0．05;10年生存率：69．0％比0,P＜0．05）。筛查组早期胃癌患者的比例亦明显高于非筛查组（63％比5％,P＜0．05）。结论：实施胃癌序贯筛查可以探查出更多的早期胃癌,手术治疗可以明显延长患者的生存时间。     

Incidence and prognosis of gastric cancer in a population-based cohort survey: the Hisayama study

BACKGROUND: No population-based cohort studies have been undertaken to evaluate the incidence and prognosis of gastric cancer. The purpose of this investigation was to clarify the incidence and fatal prognosis of gastric cancer and to determine the factors that contribute to the prognosis in a general Japanese population in Hisayama using a prospective study design. METHODS: From 1988 to 1998 a total of 2605 subjects aged 40 years or older with no history of gastrectomy or gastric cancer were followed-up prospectively after a health examination. The diagnosis of gastric cancer was based on clinical records or autopsy findings. RESULTS: During the follow-up period, 76 subjects developed gastric cancer. The age-adjusted incidence of gastric cancer for men (4.9 per 1000 person-years) was 4-fold higher than that for women (1.2, P < 0.05). In men, the incidence of gastric cancer increased with advancing age, but this trend was not observed in women. The age- and sex-adjusted 5-year survival rate was significantly higher in cancers of the middle third of the stomach than in those of the upper third of the stomach. The survival rate was higher in cancers of well-differentiated adenocarcinoma than in those of the other histological types. There were no cases of cancer-related death among the early gastric cancers during the follow-up period. CONCLUSIONS: Our data suggest that men are at higher risk of gastric cancer than women in the general Japanese population. Clinical stage, histological type, and site of cancer in the stomach contribute to a fatal prognosis.     

Long-term prognosis of gastric cancer in the population of Côte-d'Or

AIMS: The aim of this study was to determine long term prognostic factors of gastric cancer in a population-based series. METHODS: Out of 1 462 gastric cancers diagnosed in the C?te-d'Or area (494 000 residents) over a 20-year period (1976-1995), 649 (44.4 %) were resected for cure. Prognostic factors were determined using the actuarial method and relative survival and a multidimensional relative survival model. RESULTS: The 10-year crude survival rate was 8.7 % and the corresponding relative survival rate was 14.9 %. Age, stage and period of diagnosis were independent prognostic factors. After surgery for cure, operative mortality decreased from 18.3 % (1976-1979) to 6.6 % (1988-1991) and 10-year relative survival increased from 30.8 % to 37.2 % (NS). After resection for cure (postoperative mortality excluded), the 10-year survival rate remained stable over time. Stage at diagnosis was the main prognostic factor: the relative risk of death was more than 10 times higher at stages IIIB and IV than at stage I. Age, site and macroscopic type of growth were prognostic factors independently of stage. Prognosis did not improve over time after resection for cure. CONCLUSION: Although improving, the overall prognosis of gastric cancer remains poor. Improvement in prognosis was mainly due to decrease in operative mortality. Earlier diagnosis and effective adjuvant treatment represent two ways to improve prognosis.     

Evaluation of intraoperative radiotherapy for gastric carcinoma with D2 and D3 surgical resection

INTRODUCTION The fate of patients after surgical removal of a gastric carcinoma is determined to a large degree by regional failure of the operation (e.g. tumor recurrence in the tumor bed or in an adjacent structure). This is true for palliative resectio…     

Survival of patients with stomach cancer in Changle city of China

AIM: The survival rate of patients with stomach cancer is used to evaluate the effects of treatments. The short- and mid-term survival of patients on the present level of treatments can be described by calculating 1- to 5-year survival rates. The aims of this study were to document patterns of survival after treatments for stomach cancer in Changle city and analyze whether the stage of cancer and the way of treatment impacted on survival of patients or not. METHODS: A total number of 745 patients with stomach cancer reported in the Changle Cancer Registry from 1993 to 1998 were investigated with respect to the disease condition, the way of treatment and survival time. 1- to 5-year survival rates were estimated by using life-table method. RESULTS: The 1- to 5-year survival rates in the patients with stomach cancer in Changle city were 54.23%, 41.77%, 37.95%, 33.98% and 30.47%, respectively. The 1- to 5-year survival rates in stage I or II group were 3, 6.1, 7.4, 8.9 and 9.8 times as high as those in stage III or IV group, respectively. The 1- to 5-year survival rates in operation group were 3.5, 8.7, 11.2, 11.7 and 19 times as high as those in no operation group, respectively. For the patients with stage III or IV stomach cancer the 1-year survival rate in operation group was 3 times as high as that in no operation group and 2-year survival rate in operation group was 11.9 times as high as that in no operation group. For the patients with stage III or IV stomach cancer, the differences of the survival rates average survival times between total gastrectomy and partial gastrectomy were not significant and the median survival times in these 2 groups were 8 mo and 9 mo, respectively. CONCLUSION: Mid-term survival rates of patients with stomach cancer in Changle city are low. Stage of cancer is an important factor influencing survival of patients with stomach cancer. Surgery is an effective treatment for the patients with stage IV cancer and can raise short- and mid-term survival rates. Total gastrectomy should not be encouraged for the patients with late stage of cancer.     

Prevalence and prognosis of gastric cancer detected by screening in a large Japanese population: data from a single institute over 30 years

BACKGROUND AND AIM: In Japan, screening examination with photofluorography is widely performed to reduce the mortality due to gastric cancer. The possibility of a future decline in gastric cancer cases and changes in its characteristics is suggested. The aim of this study was to examine the usefulness of direct radiology as a general health screening technique and the historical changes of gastric cancer in Japan. METHODS: This study involved 936 patients with gastric cancer whose carcinomas were detected by direct radiology as part of a general health screening at the Aichi Prefectural Center for Health Care from 1970 to 2000. We studied the prevalence of gastric carcinoma, its prognosis, differences between the two histological types of carcinoma and historical changes. RESULTS: The age-adjusted cancer detection rate slightly decreased. Comparing two histological types, diffuse-type carcinoma cases relatively increased. Intestinal-type carcinomas increased in the lower portion of the stomach, whereas diffuse-type increased in the upper portion. The 5-year survival rate was 92.7% for intestinal-type carcinoma and 84.8% for diffuse-type. Diffuse-type carcinomas were further progressed than intestinal-type when detected by direct radiology; however, detection of diffuse-type improved, so the percentage of early gastric cancer of diffuse type significantly increased, and the survival rate significantly improved, from 70.4% to 90.5%. CONCLUSION: The prevalence of gastric cancer has been decreasing, but the proportion of diffuse-type carcinoma localized in the upper portion of the stomach has been increasing in Japan.     

Early Gastric Cancer as a Possible Cause of Cauda Equina Syndrome and Disseminated Intravascular Coagulation

Abstract: Early gastric cancer is an important gastric malignancy which is defined as adenocarcinoma confined to the mucosa or submucosa of the stomach with or without simultaneous metastases involving regional lymph nodes. The prognosis of early gastric cancer is generally good with a 5-year survival rate of about 95%. Distant metastases and disseminated intravascular coagulation (DIC) usually occur in the advanced stage of gastric cancer but are relatively rare in early gastric cancer. Cauda equina syndrome has never before been reported as the initial presentation of gastric cancer, and to our knowledge, up to 1993, only 17 cases of early gastric cancer with synchronous liver metastases had been reported. Bone metastases with DIC and adrenal metastasis are both rare in early gastric cancer. Herein, we present a case of early gastric cancer with an initial presentation including cauda equina syndrome and DIC. Synchronous hepatic, adrenal gland, pulmonary, bone and bone marrow metastases were found two days after admission. The patient had a fulminant clinical course and died 45 days after the diagnosis. A small focus (0.8 × 0.5cm) of poorly differentiated adenocarcinoma located in the mucosa and submucosa at the gastric lower body with extensive lymphatic permeation around the primary focus and duodenum were noted at autopsy. Cancers with an unknown primary accounted for 4.9% of cancers presenting with disseminated intravascular coagulation. Our experience disclosed that early gastric cancer is a potential cause of cauda equina syndrome and disseminated intravascular coagulation.     

Diagnosis and tactical approach to surgery for early gastric carcinoma: A retrospective analysis of the past 16 years in an Austrian General Hospital

In principle, many authors advocate a radical surgical approach for early gastric cancer (gastrectomy on principle). Our own experience with subtotal gastrectomy (including N1 + N2 lymphadenectomy; limited resection even without groups 11, 12) shows that this method yields comparable results. With an operative mortality of 2%, the survival rate was 84.3% after 5 years and 70.5% after 10 years, instead of the predicted values of 82.8% and 63.4% respectively. Applied to the same age group without gastric carcinoma, this yields a 5-year survival rate of 101.8% and thus almost reaches Japanese standards.     

Diagnosis and tactical approach to surgery for early gastric carcinoma: a retrospective analysis of the past 16 years in an Austrian general hospital

In principle, many authors advocate a radical surgical approach for early gastric cancer (gastrectomy on principle). Our own experience with subtotal gastrectomy (including N1 + N2 lymphadenectomy; limited resection even without groups 11, 12) shows that this method yields comparable results. With an operative mortality of 2%, the survival rate was 84.3% after 5 years and 70.5% after 10 years, instead of the predicted values of 82.8% and 63.4%, respectively. Applied to the same age group without gastric carcinoma, this yields a 5-year survival rate of 101.8% and thus almost reaches Japanese standards.     

Clinicopathologic differences between early gastric remnant cancer and early primary gastric cancer in the upper third of the stomach

BACKGROUND/AIMS: This study was designed to clarify the clinicopathologic characteristics and survival in early gastric remnant cancer and compare with early primary cancer in the upper third of the stomach. METHODOLOGY: Twenty-five patients with early gastric remnant cancer, who underwent resection at Kanagawa Cancer Center and First Department of Surgery, Yokohama City University between 1974 and 1996 were evaluated in this study. Various clinicopathologic characteristics, such as age, sex, symptoms, size of tumor, depth of invasion, lymph node metastasis, cell differentiation, and survival were investigated and early gastric remnant cancer was compared with early primary cancer in the upper third of the stomach. RESULTS: According to the macroscopic type, protruded type such as I or II type accounted for a great majority in early gastric remnant cancer, while II c depressed type was common in early primary cancer in the upper third of the stomach, comprising 64.2% of all cases. Pathological examination disclosed that well-differentiated carcinoma and mucosal carcinoma were more frequently observed in early gastric remnant cancer than in early primary cancer in the upper-third of the stomach. The 5-year survival rate was 83.5% for early primary cancer in the upper-third of the stomach. In contrast, no patients experienced recurrence after operation for early gastric remnant cancer. CONCLUSIONS: From the view point of clinicopathological evaluation, gastric remnant cancer is a special from of gastric cancer. A follow-up program is important in order to detect early gastric remnant cancer. A low incidence of lymph node metastasis suggests that endoscopic mucosal resection of the tumor or limited operation could be performed under strict indication.     

Chronological changes of characteristics of early gastric cancer and therapy: Experience in the Cancer Institute Hospital of Tokyo, 1950–1994

Gastric cancer, the leading cause of death from cancer in Japan, has long been studied. We received our first patient with early gastric cancer in 1950 and have since treated 2382 patients with this cancer up to 1990. The percentage of early gastric cancers diagnosed has been on the increase following the improvement in diagnostic skills and the establishment of mass screening. At present, more than half of the gastric cancers presenting are in the early stages. Chronological changes in diagnoses of early gastric cancer are characterized by the increased findings of (a) small tumors less than 4 cm in diameter (b) depressed-type carcinoma (c) lesions of the upper part of the stomach, and (d) undifferentiated-type adenocarcinoma. The standard method of treatment for early gastric cancer was standard radical operation in the 1970s. In the 1980s endoscopic mucosal resection and limited operation were adopted and their use has been increasing annually. The prognosis for early gastric cancer is quite favorable (the 5-year survival rate is more than 90%), and it is regarded as a disease with good prognosis. To obtain still better therapeutic results, it is essential to increase the proportion of early gastric cancers where endoscopic mucosal resection or limited operation is indicated, and improve the techniques of those procedures.     

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。     

Platelet mass has prognostic value in patients with myelodysplastic syndromes

Platelet mass (mean platelet volume x platelet count) can be derived from data obtained from the routine full blood count and separates patients with myelodysplastic syndromes (MDS) at diagnosis into three distinct prognostic groups: low platelet mass group - median survival 5 months and 5-year survival 0%; intermediate platelet mass group - median survival 30 months and 5-year survival 34%; high platelet mass group median survival - not reached at 82 months follow-up with a 5-year survival of 82%. These data provide a simple rapid prognostic index at the time of diagnosis in MDS.     

胃镜普查及随访对老年人胃癌的诊断价值

目的 通过老年人进行胃镜普及及随访,提高老年人胃癌的防治水平。方法 结合每年查体对3048例60－93岁老年人进行胃镜普查,胃镜随访2034例,随访率为66．7％。结果 共检出胃癌92例,检出率为3．0％,其中早期胃癌58例,占63．0％;胃镜随访中检出早期胃癌39例,占随访检出胃癌49例的79．6％。胃癌、早期胃癌的手术切除率为88．9％及100．0％,5年生存率分别为91．9％和96．3％。胃镜检查并发症的发生率为0．097％。结论 开展胃镜普查及随访是提高老年人早期胃癌诊断率及胃癌术后5年生存率的安全可靠方法。     

Survival trends in gastric cancer patients of Northeast China

AIM： To describe survival trends in patients in Northeast China diagnosed as gastric cancer. METHODS： A review of all inpatient and outpatient records of gastric cancer patients was conducted in the First Affiliated Hospital of China Medical University. All the gastric cancer patients who satisfied the inclusion criteria from January 1, 1980 through December 31, 2003 were included in the study. The main outcomes were based on median survival and 3-year and 5-year survival rates, by decade of diagnosis. RESULTS： From 1980 through 2003, the median survival for patients with gastric cancer （n = 1604） increased from 33 mo to 49 mo. The decade of diagnosis was not significantly associated with patient survival for gastric cancer （P = 0.084 for overall survival, and P = 0.150 for 5-year survival）; however, the survival rate of the 2000s was remarkably higher than that of the 1980s （P = 0.019 for overall survival, and P = 0.027 for 5-year survival）.CONCLUSION： There was no significant difference of survival among each period; however, the survival rate of the 2000s was remarkably higher than that of the 1980s.     

Significance of a Gastric Mass Screening Survey

We analyzed the rate of occurrence of gastric cancer in a population of 39,250 by mass screening survey. In 0.123% of the total subjects gastric cancer was detected, 0.064% was at early stage and 0.059% at an advanced stage. The incidence of gastric cancer in the newly examined persons was 0.17%, 0.08% was at early stage and 0.09% at advanced stage. Of the frequently examined persons 0.07% was found to have gastric cancer, 0.043% at early stage and 0.027% at an advanced stage. The rate of occurrence of early gastric cancer was significantly higher than that of advanced gastric cancer within a 1 1/2 year interval of screening. From these results, gastric mass screening survey is considered to be effective in detecting asymptomatic gastric cancer in the "newly examined persons," and also to be beneficial in detecting "early" gastric cancer at intervals of 1 1/2 years of screening.     

Choice of the surgical treatment in early gastric cancer

BACKGROUND/AIMS: The authors report their experience in choosing the surgical treatment for early gastric cancer. METHODOLOGY: A retrospective study was conducted to examine the long-term outcome of 18 patients with early gastric cancer (10%) on a series of 180 patients treated for gastric carcinoma by the same surgical équipe from January 1986 to June 1997. Radical surgery with gastrectomy and extended lymphadenectomy ("regional" from 1986 to 1991; D2 from 1992 to 1997) was chosen as standard treatment for early gastric cancer except in elderly or high-risk patients and in cases of mucosal tumors diagnosed at definitive histology after surgery for benign diseases in which limited surgery was performed. RESULTS: All patients received curative (R0) surgery. One patient with mucosal-N1 tumor and another one with submucosal-N0 tumor died because of gastric cancer at 51 and 42 postoperative months respectively. The mean follow-up time was 99.8 (11-193) months. The overall 5-year and 10-year survival rates are 86.7% and 86.7% respectively. The 5- and 10-year survival rates for intramucosal tumors are 91% and 91% respectively and for submucosal cancer are 75% and 75% (P=0.39). CONCLUSIONS: According to the prognostic value of nodal involvement and the difficulty in achieving a preoperative accurate diagnosis of depth of invasion and of nodal involvement in early gastric cancer, a radical gastric resection with D2-lymphadenectomy should be performed.     

Gastric remnant cancer compared with primary proximal gastric cancer

BACKGROUND/AIMS: Recently, detections of early-stage gastric remnant cancer and small proximal gastric cancer are increasing. The aim of this study was to compare pathologic and prognostic data of gastric remnant cancer with those of primary proximal gastric cancer including upper gastric cancer based on a recent 15-year experience at a single institute in Japan. METHODOLOGY: Among 698 patients who underwent gastrectomy for cancer between 1984 and 1998, 15 (2.1%) were patients with gastric remnant cancer. During the same period, 139 patients underwent primary gastrectomy for proximal gastric cancer which included 71 with upper gastric cancer confined to the upper one-third of the stomach. Clinicopathologic findings of gastric remnant cancer were compared with those of proximal gastric cancer. RESULTS: Of 15 gastric remnant cancers, 8 (53%) were stage I tumors. Although gastric remnant cancer and proximal gastric cancer was not different in several clinicopathologic factors, gastric remnant cancer and upper gastric cancer confined to the upper one-third of the stomach was different with regard to the frequency of tumor size > or = 4 cm (60% vs. 32%, p < 0.05), poorly differentiated type (67% vs. 38%, p < 0.05), serosal invasion (40% vs. 11%, p < 0.01), lymph node metastasis (47% vs. 20%, p < 0.05), stage III or IV disease (47% vs. 10%, p < 0.01), and noncurative gastrectomy (20% vs. 1%, p < 0.01). The 5-year survival rate of gastric remnant cancer (69%) was higher than that of proximal gastric cancer (57%) and lower than that of upper gastric cancer (81%), although the differences were not statistically significant. CONCLUSIONS: In our recent series, a half of gastric remnant cancers are stage I tumors. Although gastric remnant cancers are similar to proximal gastric cancers, they are more advanced and their surgical results are less satisfactory when compared with upper gastric cancers confined to the upper one-third of the stomach.