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Chen Y, Jiang J, Yan C, Jiang J, Shi B, Xu Z, Yuan F, Zhang H, Zhang J. Prediction of tumor regression grade in far-advanced gastric cancer after preoperative immuno-chemotherapy using dual-energy CT-derived extracellular volume fraction. Eur Radiol 2025; 35:93-104. [PMID: 38981889 DOI: 10.1007/s00330-024-10737-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES This study examines the effectiveness of dual-energy CT (DECT) delayed-phase extracellular volume (ECV) fraction in predicting tumor regression grade (TRG) in far-advanced gastric cancer (FAGC) patients receiving preoperative immuno-chemotherapy. MATERIALS AND METHODS A retrospective analysis was performed on far-advanced gastric adenocarcinoma patients treated with preoperative immuno-chemotherapy at our institution from August 2019 to March 2023. Patients were categorized based on their TRG into pathological complete response (pCR) and non-pCR groups. ECV was determined using the delayed-phase iodine maps. In addition, tumor iodine densities and standardized iodine ratios were meticulously analyzed using the triple-phase enhanced iodine maps. Univariate analysis with five-fold cross-validation and Spearman correlation determined DECT parameters and clinical indicators association with pCR. The predictive accuracy of these parameters for pCR was evaluated using a weighted logistic regression model with five-fold cross-validation. RESULTS Of the 88 patients enrolled (mean age 60.8 ± 11.1 years, 63 males), 21 (23.9%) achieved pCR. Univariate analysis indicated ECV's significant role in differentiating between pCR and non-pCR groups (average p value = 0.021). In the logistic regression model, ECV independently predicted pCR with an average odds ratio of 0.911 (95% confidence interval, 0.798-0.994). The model, incorporating ECV, tumor area, and IDAV (the relative change rate of iodine density from venous phase to arterial phase), showed an average area under curves (AUCs) of 0.780 (0.770-0.791) and 0.766 (0.731-0.800) for the training and validation sets, respectively, in predicting pCR. CONCLUSION DECT-derived ECV fraction is a valuable predictor of TRG in FAGC patients undergoing preoperative immuno-chemotherapy. CLINICAL RELEVANCE STATEMENT This study demonstrates that DECT-derived extracellular volume fraction is a reliable predictor for pathological complete response in far-advanced gastric cancer patients receiving preoperative immuno-chemotherapy, offering a noninvasive tool for identifying potential treatment beneficiaries.
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Affiliation(s)
- Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinling Jiang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Yan
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Jiang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bowen Shi
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihan Xu
- Siemens Healthineers Ltd, Shanghai, China
| | - Fei Yuan
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Ji J, Ali M, Wang W, Ren J, Wang L, Tang D, Wang D. Tumor size impact on TNM staging which define post-operative complications in rectal cancer. J Robot Surg 2024; 18:161. [PMID: 38578471 DOI: 10.1007/s11701-024-01920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
The purpose of this study was to see how accurate tumor size was at predicting T and N stages in rectal malignancies. Tumor sizes of 40 mm and greater than 40 mm were used to assess post-operative challenges in related to T1-T2 and T3-T4 stages, as well as between node N0 and node N1 and N2 patients. A total of 131 patients were treated for colorectal cancer, with 54 patients < 40 mm and 77 patients > 40 mm receiving Da Vinci colorectal surgery. Conferring to the Clavien-Dindo classification grade III, there's an increase in the percentage of tumors > 40 mm, which also impacts the percentage of intestinal obstruction, anastomotic leakage, GERD, and sepsis with a P < 0.05. A tumor size of more than 40 mm is strongly associated with advanced pT stages. Tumor size may serve in addition to clinical staging and improve the management of rectal cancer.
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Affiliation(s)
- Jin Ji
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Muhammad Ali
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Jun Ren
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Liuhua Wang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Dong Tang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China.
- Medical College of Yangzhou University, Yangzhou, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Jin T, Li ZD, Chen ZH, He FJ, Chen ZW, Liang PP, Hu JK, Yang K. Development and validation of a nomogram for Siewert II esophagogastric junction adenocarcinoma: a retrospective analysis. Ther Adv Med Oncol 2024; 16:17588359241229425. [PMID: 38322753 PMCID: PMC10846006 DOI: 10.1177/17588359241229425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
Background Due to the complex histological type and anatomical structures, there has been considerable debate on the classification of adenocarcinoma of the esophagogastric junction (AEG), especially Siewert II AEG. Furthermore, neither the American Joint Committee on Cancer (AJCC) 7th tumor-node-metastasis (TNM) [esophageal adenocarcinoma (E) or gastric cancer (G)] nor the AJCC 8th TNM (E or G) accurately predicted the prognosis of patients with Siewert II AEG. Objective This study aimed to investigate the factors influencing the survival and prognosis of patients with Siewert II AEG and establish a new and better prognostic predictive model. Design A retrospective study. Methods Patients with Siewert II AEG, retrieved from the Surveillance, Epidemiology, and End Results (SEER) databases, were assigned to the training set. Patients retrieved from a single tertiary medical center were assigned to the external validation set. Significant variables were selected using univariate and multivariate Cox regression analyses to construct the nomogram. Nomogram models were assessed using the concordance index (C-index), a calibration plot, decision curve analysis (DCA), and external validation. Results Age, tumor grade, and size, as well as the T, N, and M stages, were included in the nomograms. For the SEER training set, the C-index of the nomogram was 0.683 (0.665-0.701). The C-index of the nomogram for the external validation set was 0.690 (0.653-0.727). The calibration curve showed good agreement between the nomogram estimations and actual observations in both the training and external validation sets. The DCA showed that the nomogram was clinically useful. Conclusion The new predictive model showed significant accuracy in predicting the prognosis of Siewert II AEG.
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Affiliation(s)
- Tao Jin
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ze-Dong Li
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ze-Hua Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng-Jun He
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng-Wen Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pan-Ping Liang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Kun Hu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kun Yang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Ma X, Pierce E, Anand H, Aviles N, Kunk P, Alemazkoor N. Early prediction of response to palliative chemotherapy in patients with stage-IV gastric and esophageal cancer. BMC Cancer 2023; 23:910. [PMID: 37759332 PMCID: PMC10536729 DOI: 10.1186/s12885-023-11422-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The goal of therapy for many patients with advanced stage malignancies, including those with metastatic gastric and esophageal cancers, is to extend overall survival while also maintaining quality of life. After weighing the risks and benefits of treatment with palliative chemotherapy (PC) with non-curative intent, many patients decide to pursue treatment. It is known that a subset of patients who are treated with PC experience significant side effects without clinically significant survival benefits from PC. METHODS We use data from 150 patients with stage-IV gastric and esophageal cancers to train machine learning models that predict whether a patient with stage-IV gastric or esophageal cancers would benefit from PC, in terms of increased survival duration, at very early stages of the treatment. RESULTS Our findings show that machine learning can predict with high accuracy whether a patient will benefit from PC at the time of diagnosis. More accurate predictions can be obtained after only two cycles of PC (i.e., about 4 weeks after diagnosis). The results from this study are promising with regard to potential improvements in quality of life for patients near the end of life and a potential overall survival benefit by optimizing systemic therapy earlier in the treatment course of patients.
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Affiliation(s)
- Xiaoyuan Ma
- Department of Statistics, University of Virginia, Charlottesville, USA
| | - Eric Pierce
- School of Medicine, University of Virginia, Charlottesville, USA
| | - Harsh Anand
- System and Information Engineering, University of Virginia, Charlottesville, USA
| | - Natalie Aviles
- Department of Sociology, University of Virginia, Charlottesville, USA
| | - Paul Kunk
- School of Medicine, University of Virginia, Charlottesville, USA
| | - Negin Alemazkoor
- System and Information Engineering, University of Virginia, Charlottesville, USA.
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Chen Y, Chen Y, Wen L, Tou L, Wang H, Teng L. PN3b as an independent risk factor for poor prognosis and peritoneal recurrence in Borrmann type IV gastric cancer: A retrospective cohort study. Front Surg 2022; 9:986696. [PMID: 36439539 PMCID: PMC9684711 DOI: 10.3389/fsurg.2022.986696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The clinicopathological features and surgical treatment strategies of Borrmann type IV gastric cancer (GC) remain controversial. Peritoneal metastasis is the most common recurrence pattern in patients with Borrmann type IV GC. METHODS Among 2026 gastric cancer between January 2009 and August 2019, 159 cases of Borrmann type IV GC were included in this study (7.8%). We retrospectively analyzed the clinicopathological characteristics and prognosis of these patients. Univariate and multivariate Cox proportional hazards were applied to identify independent prognostic factors. Predictors related to peritoneal metastasis of type IV GC were analyzed by multivariate Cox regression analysis. RESULTS Borrmann type IV gastric cancer was associated with more advanced clinicopathological features at diagnosis than the other Borrmann type GC. Of the 159 patients with Borrmann type IV GC, the median OS was 23 months. The number of patients with peritoneal metastasis was 43, accounted for 27.0% of all the patients and 87.8% of the patients with distant metastasis. Multivariate analyses revealed lymph node metastasis to be independent prognostic factor for survival in Borrmann type IV GC patients. pN3b and tumor size > 50 mm showed to be risk factors for peritoneal metastasis. CONCLUSIONS Borrmann type IV GC is an important independent prognostic factor. pN3b is an independent prognostic factor and a predictor of peritoneal metastasis in patients with Borrmann type IV GC.
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Affiliation(s)
- Yiran Chen
- Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanyan Chen
- Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liping Wen
- Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Laizhen Tou
- Department of Gastrointestinal Surgery, Lishui Hospital, College of Medicine, Zhejiang University, Lishui, China
| | - Haiyong Wang
- Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lisong Teng
- Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Li Y, Xie F, Xiong Q, Lei H, Feng P. Machine learning for lymph node metastasis prediction of in patients with gastric cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:946038. [PMID: 36059703 PMCID: PMC9433672 DOI: 10.3389/fonc.2022.946038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 01/19/2023] Open
Abstract
Objective To evaluate the diagnostic performance of machine learning (ML) in predicting lymph node metastasis (LNM) in patients with gastric cancer (GC) and to identify predictors applicable to the models. Methods PubMed, EMBASE, Web of Science, and Cochrane Library were searched from inception to March 16, 2022. The pooled c-index and accuracy were used to assess the diagnostic accuracy. Subgroup analysis was performed based on ML types. Meta-analyses were performed using random-effect models. Risk of bias assessment was conducted using PROBAST tool. Results A total of 41 studies (56182 patients) were included, and 33 of the studies divided the participants into a training set and a test set, while the rest of the studies only had a training set. The c-index of ML for LNM prediction in training set and test set was 0.837 [95%CI (0.814, 0.859)] and 0.811 [95%CI (0.785-0.838)], respectively. The pooled accuracy was 0.781 [(95%CI (0.756-0.805)] in training set and 0.753 [95%CI (0.721-0.783)] in test set. Subgroup analysis for different ML algorithms and staging of GC showed no significant difference. In contrast, in the subgroup analysis for predictors, in the training set, the model that included radiomics had better accuracy than the model with only clinical predictors (F = 3.546, p = 0.037). Additionally, cancer size, depth of cancer invasion and histological differentiation were the three most commonly used features in models built for prediction. Conclusion ML has shown to be of excellent diagnostic performance in predicting the LNM of GC. One of the models covering radiomics and its ML algorithms showed good accuracy for the risk of LNM in GC. However, the results revealed some methodological limitations in the development process. Future studies should focus on refining and improving existing models to improve the accuracy of LNM prediction. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022320752
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Hajibandeh S, Barghash M, Khan RMA, Milgrom D, Ali S, Ali S, Ali B. Predictive Significance of Tumour Size in Patients Undergoing Curative Surgery for Colorectal Cancer: A Retrospective Cohort Study. Cureus 2022; 14:e26656. [PMID: 35949794 PMCID: PMC9357253 DOI: 10.7759/cureus.26656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To evaluate the predictive significance of tumour size in patients undergoing curative surgery for colorectal cancer (CRC). Methods All patients undergoing curative surgery for colon or rectum cancer performed by a single colorectal surgeon between January 2013 and January 2020 were considered eligible for inclusion. Linear and binary logistic regression analyses were modelled to assess whether colonic or rectal tumour size could predict R0 resection, specimen length, number of harvested and positive lymph nodes, lymphocytic infiltration, venous invasion, and overall survival. Results A total of 192 patients were eligible for inclusion. In patients with colon cancer, tumour size was the independent predictor of the number of harvested lymph nodes (P<0.001), the number of positive lymph nodes (P=0.001), and lymphocytic infiltration (P=0.009). However, it did not predict R0 resection (P=0.563), specimen length (P=0.111), specimen length >120 mm (P=0.186), >12 harvested lymph nodes (P=0.145), venous invasion (P=0.103), and five-year overall survival (P=0.543). In patients with rectal cancer, tumour size was the independent predictor of the number of harvested lymph nodes (P<0.001) and the number of positive lymph nodes (P<0.001). However, it did not predict R0 resection (P=0.108), specimen length (P=0.774), specimen length >120 mm (P=0.405), >12 harvested lymph nodes (P= 0.069), lymphocytic infiltration (P=0.912), venous invasion (P= 0.105), and five-year overall survival (P=0.413). Conclusions The results of the current study suggest that tumour size on its own may not have a significant predictive value in oncological or survival outcomes in patients undergoing curative surgery for colon or rectum cancer.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, GBR
| | - Mohammed Barghash
- Department of General Surgery, North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Rao Muhammad A Khan
- Department of General and Colorectal Surgery, The Royal Oldham Hospital, Northern Care Alliance, Oldham, GBR
| | - David Milgrom
- Department of Vascular Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, GBR
| | - Saira Ali
- Department of General Surgery, North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Sofia Ali
- Bowel Cancer Screening, Harrogate and District NHS Foundation Trust, Harrogate, GBR
| | - Baqar Ali
- Department of General and Colorectal Surgery, The Royal Oldham Hospital, Northern Care Alliance, Oldham, GBR
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KARADENİZ A, BİLİCİ M, ŞİMŞEK M. Mide kanserli hastaların demografik özelliklerinin sağ kalıma etkisi. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1125583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: This study aimed to investigate the relationship between some demographic and clinical factors and survival in patients with gastric cancer.
Materials and Methods: We retrospectively evaluated the records of 252 gastric cancer patients followed up in the medical oncology department between 01.01.2016 and 10.01.2020. Gastric lymphoma, gastrointestinal stromal tumor, and neuroendocrine tumor were excluded. Factors evaluated in the study included age, sex, urban/non-urban residence, admitting complaints, smoking history, Eastern Cooperative Oncology Group (ECOG) score, stage at diagnosis, histological subtype, surgical history, tumor location, grade, diameter and macroscopic view of tumor, metastatic lymph node ratio, chemotherapy regimens, febrile neutropenia, post-chemotherapy radiological reports, chemoradiotherapy (CRT) history and survival after diagnosis.
Results: Mean overall survival (OS) time was significantly shorter in patients with weight loss (p
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Mase J, Adachi T, Kiriyama S, Horaguchi T, Yawata K, Ikawa A, Sano B, Imai S, Okamoto K, Shiroko T. A case of superficial spreading type of poorly differentiated adenocarcinoma of the stomach with invasion to the esophagus. World J Surg Oncol 2022; 20:136. [PMID: 35484561 PMCID: PMC9052692 DOI: 10.1186/s12957-022-02605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Invasion is more likely to occur in gastric cancer affecting larger areas. Poorly differentiated adenocarcinoma tends to invade deep. The cardiac region prefers submucosal invasion because the submucosa is coarser than the other regions. CASE PRESENTATION A 75-year-old man presented with a chief complaint of abdominal discomfort and weight loss. Esophagogastroduodenoscopy revealed an irregular ulcerative lesion with partial redness of the upper body and lesser curve of the stomach. A continuous shallow depressed lesion invaded the abdominal esophagus by approximately 40 mm. Poorly differentiated adenocarcinomas (por, sig) were observed on biopsy. Grossly, the cancer appeared to extend into the muscle layer; however, we could not confirm invasion into the muscle layer in our biopsy tissue. We diagnosed the lesion as a superficial spreading type of advanced gastric cancer and performed a total gastrectomy, D2-lymph node dissection (spleen preservation), Roux-en-Y reconstruction, and cholecystectomy. Postoperative histopathological examination revealed extensive infiltration of poorly differentiated adenocarcinoma (90 mm × 55 mm), and all were intramucosal lesions. The final pathological diagnosis was T1a, N0, M0, and Stage IA. The postoperative course was uneventful and the patient was discharged on postoperative day (POD) 11. Five years have passed since the operation, and the patient is alive without recurrence. CONCLUSION We encountered a case of gastric carcinoma in which poorly differentiated adenocarcinomas expanded extensively. All lesions were intramucosal.
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Affiliation(s)
- Junichi Mase
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan.
| | - Takahito Adachi
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Shunya Kiriyama
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Takeshi Horaguchi
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Kazunori Yawata
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Aiko Ikawa
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Bun Sano
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Susumu Imai
- Department of Gastroenterology, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Kiyohisa Okamoto
- Department of Pathology, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
| | - Takashi Shiroko
- Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan
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Feng H, Zheng J, Zheng C, Deng Z, Liao Q, Wang J, Li Y. The probability of Lymph node metastasis with a tumor size larger than and smaller than 4 cm is different in stages T1-T3 of Siewert type II adenocarcinoma of esophagogastric junction: A Population-Based Study. J Cancer 2021; 12:6873-6882. [PMID: 34659575 PMCID: PMC8518009 DOI: 10.7150/jca.63392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: In adenocarcinoma of esophagogastric junction (AEG), the relationship between tumor size (TS) and lymph node metastasis (LNM) is unclear. This study aimed to explore the relationship between TS and LNM, and to construct a prediction model for LNM. Materials and Methods: Data from 4649 Siewert type II AEG patients were retrospectively acquired from the Surveillance, Epidemiology, and End Result (SEER) database. TS data was analyzed as a continuous variable, but also divided into 1-cm-interval categorical groups for further analysis. The logistic regression model and restricted cubic spline (RCS) model was used to explore the relationship between TS and LNM, after adjusting for covariates. Internal validations as well as external validation (Single-Center data) were used to check our LNM prediction model. Results: TS and LNM showed a significant relationship in the logistic regression analysis, regardless of the TS data being entered as a continuous or a categorical variable, after adjusting for covariates. The logistic regression model and RCS consistently showed that larger TS resulted in larger Odds Ratio (OR) values. When tumors were larger than 4 cm, the OR value remained relatively constant. The receiver operator characteristic curve evaluated the nomogram by the area under the curve (AUC) (AUC=0.737, in internal validation; AUC=0.626, in external validation), and the calibration curve of the nomogram showed an improved prediction system. Conclusions: In Siewert type II T1-T3 stage AEG patients, we reported that LNM increased with TS up to 4-cm, and our nomogram provided a simple tool to predict LNM.
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Affiliation(s)
- Huolun Feng
- Department of gastrointestinal surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, P. R. China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, P. R. China
| | - Jiabin Zheng
- Department of gastrointestinal surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, P. R. China
| | - Chengbin Zheng
- Department of gastrointestinal surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, P. R. China
| | - Zhenru Deng
- Department of gastrointestinal surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, P. R. China
| | - Qianchao Liao
- Department of gastrointestinal surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, P. R. China
| | - Junjiang Wang
- Department of gastrointestinal surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, P. R. China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, P. R. China
| | - Yong Li
- Department of gastrointestinal surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, P. R. China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, P. R. China
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11
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Tonello AS, Capelli G, Bao QR, Marchet A, Farinati F, Pawlik TM, Gregori D, Pucciarelli S, Spolverato G. A nomogram to predict overall survival and disease-free survival after curative-intent gastrectomy for gastric cancer. Updates Surg 2021; 73:1879-1890. [PMID: 34125428 PMCID: PMC8500903 DOI: 10.1007/s13304-021-01083-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
An individual prediction of DFS and OS may be useful after surgery for gastric cancer to inform patients and to guide the clinical management. Patients who underwent curative-intent resection for gastric cancer between January 2010 and May 2020 at a single Italian institution were identified. Variables associated with OS and DFS were recorded and analysed according to univariable and multivariable Cox models. Nomograms predicting OS and DFS were built according to variables resulting from multivariable Cox models. Discrimination ability was calculated using the Harrell's Concordance Index. Overall, 168 patients underwent curative-intent resection. Nomograms to predict OS were developed including age, tumor size, tumor location, T stage, N stage, M stage and post-operative complications, while nomogram to predict DFS includes Lauren classification, and lymph node ratio (LNR). On internal validation, both nomograms demonstrated a good discrimination with a Harrell's C-index of 0.77 for OS and 0.71 for DFS. The proposed nomogram to predict DFS and OS after curative-intent surgery for gastric cancer showed a good discrimination on internal validation, and may be useful to guide clinician decision-making, as well help identify patients with high-risk of recurrence or with a poor estimated survival.
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Affiliation(s)
- Alice Sabrina Tonello
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Giulia Capelli
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Quoc Riccardo Bao
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Alberto Marchet
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Fabio Farinati
- Gastroenterology Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Timothy M Pawlik
- Department of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Salvatore Pucciarelli
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy.
| | - Gaya Spolverato
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
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12
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Huang C, Hu C, Zhu J, Zhang W, Huang J, Zhu Z. Establishment of Decision Rules and Risk Assessment Model for Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer. Front Oncol 2020; 10:1638. [PMID: 32984033 PMCID: PMC7492596 DOI: 10.3389/fonc.2020.01638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Preoperative accurate prediction of lymph node status is especially important for the formulation of treatment plans for patients with gastric cancer (GC). The purpose of this study was to establish decision rules and a risk assessment model for lymph node metastasis (LNM) in GC using preoperative indicators. Methods: The clinical data of 554 patients who underwent gastrectomy with D2 lymphadenectomy were collected. A 1:1 propensity score matching (PSM) system was used, and the clinical data of the matched 466 patients were further analyzed. The important risk factors for LNM were extracted by the random forest algorithm, and decision rules and nomogram models for LNM were constructed with a classification tree and the "rms" package of R software, respectively. Results: Tumor size (OR: 2.058; P = 0.000), computed tomography (CT) findings (OR: 1.969; P = 0.001), grade (OR: 0.479; P = 0.000), hemoglobin (Hb) (OR: 1.211; P = 0.005), CEA (OR: 1.111; P = 0.017), and CA19-9 (OR: 1.040; P = 0.033) were independent risk factors for LNM in GC. Tumor size did rank first in the ranking of important factors for LNM in GC and was the first-level segmentation of the two initial branches of the classification tree. The accuracy, sensitivity, specificity, and positive predictive value of the decision rules in diagnosing preoperative LNM in GC were 75.6, 85.7, 73.9, 73.5, and 79.3%, respectively. The accuracy, sensitivity, and specificity of the risk assessment model in predicting preoperative LNM in GC were 79.3, 80.3, and 79.4%, respectively. Conclusion: Tumor size was the most important factor for evaluating LNM in GC. This decision rules and nomogram model constructed to take into account tumor size, CT findings, grade, hemoglobin, CEA, and CA19-9 effectively predicted the incidence of LNM in preoperative GC.
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Affiliation(s)
| | | | | | | | | | - Zhengming Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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13
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Bando E, Ji X, Kattan MW, Seo HS, Song KY, Park CH, Bencivenga M, de Manzoni G, Terashima M. Development and validation of a pretreatment nomogram to predict overall survival in gastric cancer. Cancer Med 2020; 9:5708-5718. [PMID: 32588982 PMCID: PMC7433838 DOI: 10.1002/cam4.3225] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/23/2022] Open
Abstract
Background Pretreatment clinical staging is essential to select therapy. However, there have been no published pretreatment gastric cancer nomograms constructed using pretreatment clinical prognostic factors, including in nonresection patients. We aimed to develop a new pretreatment gastric cancer nomogram for individualized prediction of overall survival (OS). Methods The nomogram was developed using data of 5231 Japanese gastric cancer patients, and it was created with a Cox regression model. Fifteen clinical variables, which were obtained at pretreatment, were collected and registered. Data of two independent cohorts of patients from Seoul St. Mary's Hospital (1001 patients), and the University of Verona (389 patients) formed the external validation cohorts. The model was validated internally and externally using measures of discrimination (Harrell's C‐index), calibration, and decision curve analysis. Results The developed nomogram showed good discrimination, with a C‐index of 0.855; that of the American Joint Committee on Cancer (AJCC) clinical stage was 0.819. In the external validation procedure, the C‐indexes were 0.856 (AJCC, 0.795) in the Seoul St. Mary's cohort and 0.714 (AJCC, 0.648) in the University of Verona cohort. The nomogram performed well in the calibration and decision curve analyses when applied to both the internal and external validation cohorts. A stage‐specific subset survival analysis of the three risk groups calculated using the nomogram also showed the superiority of nomogram‐prediction when compared to AJCC. Conclusion This new pretreatment model accurately predicts OS in gastric cancer and can be used for patient counseling in clinical practice and stratification in clinical trials.
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Affiliation(s)
- Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH, USA
| | - Xinge Ji
- Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH, USA
| | - Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cho-Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Maria Bencivenga
- Division of General and Upper Gastrointestinal Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Giovanni de Manzoni
- Division of General and Upper Gastrointestinal Surgery, Department of Surgery, University of Verona, Verona, Italy
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14
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PİRHAN Y. Analysis of Prognostic Factors Affecting Postoperative Survival in Stage III Gastric Cancer Patients. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.705908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Tan YE, Wang PL, Yin SC, Zhang C, Hou WB, Xu HM. Thirty-year trends in clinicopathologic characteristics and prognosis after gastrectomy for gastric cancer: A single institution in Northern China. J Cancer 2020; 11:1056-1062. [PMID: 31956352 PMCID: PMC6959066 DOI: 10.7150/jca.36927] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background: We integrated changes in the trends in clinicopathologic characteristics and postoperative prognosis in patients with gastric cancer Northern China over a 30-year period. Methods: A retrospective analysis of patients undergoing gastric cancer resection and complete follow-up information from January 1981 to December 2010 in the first affiliated Hospital of China Medical University was carried out. We divided the patients into three consecutive periods. Results: A total of 3,520 patients were included in this study. The proportion of lower tumors increased (from 58.8 to 66.9%), while that of upper tumors decreased (from 21.3 to 13.4%). The proportion of tumors > 5cm decreased (from 58.6 to 41.1 %), but the increasing trend of poorly differentiated gastric cancer was obvious (from 60.1 to 75.7%). The percentage of early gastric cancer increased from 10.0 to 15.5 during the study periods, and that of TNM stage Ⅳ cancer decreased from 38.6 to 28.1. In surgery treatment, the rate of radical resection increased to 92.1% in recent period, and the average number of retrieved lymph nodes increased. The 5-year survival rate gradually increased from 36.5% to 48.5% (p<0.001). The Multivariate analysis showed that age, tumor size, T stage, N stage, number of retrieved lymph nodes and resection type were independent prognostic factors for gastric cancer. Conclusion: The patterns of clinicopathologic features for gastric cancer changed during the 30-year period in North China. Overall survival (OS) could be increased by early detection of tumors and standard surgical treatment.
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Affiliation(s)
- Yu-En Tan
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Peng-Liang Wang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Song-Cheng Yin
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chao Zhang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wen-Bin Hou
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hui-Mian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
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16
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Zhou L, Li W, Cai S, Yang C, Liu Y, Lin Z. Large tumor size is a poor prognostic factor of gastric cancer with signet ring cell: Results from the surveillance, epidemiology, and end results database. Medicine (Baltimore) 2019; 98:e17367. [PMID: 31577736 PMCID: PMC6783183 DOI: 10.1097/md.0000000000017367] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There has been a steady increase in the incidence of signet ring cell (SRC) carcinoma, a distinct histological type with cells containing abundant intracytoplasmic mucin. We aimed to analyze the clinicopathological characteristics and prognostic value of patients with SRC gastric cancer (GC) who underwent gastrectomy.Clinical data of 10,312 GC patients who underwent D2 radical gastrectomy were obtained from the Surveillance, Epidemiology, and End Results database and were retrospectively analyzed. X-tile plots were constructed to illustrate the optimal cut-off points using the minimum P-value from the log-rank Chi-squared test. The Kaplan-Meier method was used for the analysis of the overall cumulative probability of survival. Their differences were evaluated using the log-rank test. The Cox multiple factors analysis was performed using the logistic regression method.In total, 946 (9.17%) SRC GC patients with pT1a-4bN0-3bM0 stage cancer were recruited. The optimal cut-off point for size was 49 mm. The 3-year overall survival (OS) rates of the SRC GC, large-size, and small-size groups were 35.89%, 30.63%, and 44.96%, respectively (P < .05). Cox multivariate analysis showed that tumor size (odds ratio [OR] = 2.032), T3 category (OR = 1.324), T4a category (OR = 1.945), and T4b category (OR = 2.163) were independent hazard prognostic factors.SRC GC has a distinct biological behavior, presents as a large-sized tumor (≥49 mm), and is associated with worse outcomes. SRC GC patients have 2.032 times risk of mortality. SRC patients with larger tumors are at higher risk for infiltrative growth, lymph node metastasis, and distant metastasis.
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Affiliation(s)
- Liyuan Zhou
- Department of Surgical Oncology, Fujian Provincial Hospital
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Weihua Li
- Department of Surgical Oncology, Fujian Provincial Hospital
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Shaoxin Cai
- Department of Surgical Oncology, Fujian Provincial Hospital
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Changshun Yang
- Department of Surgical Oncology, Fujian Provincial Hospital
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yi Liu
- Department of Surgical Oncology, Fujian Provincial Hospital
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Zhizun Lin
- Department of Surgical Oncology, Fujian Provincial Hospital
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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17
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Hu K, Wang S, Wang Z, Li L, Huang Z, Yu W, Chen Z, Wu QF. Clinicopathological risk factors for gastric cancer: a retrospective cohort study in China. BMJ Open 2019; 9:e030639. [PMID: 31542754 PMCID: PMC6756371 DOI: 10.1136/bmjopen-2019-030639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine the potential clinicopathological factors affecting the prognosis of patients with gastric cancer after surgical treatment in China. METHODS Between 1 January 2001 and 31 December 2012, a total of 716 patients aged 22-84 years with gastric cancer were enrolled in the study. Survival analysis techniques including log rank test and Cox proportional hazard regression model were applied to evaluate the prognostic significance of clinicopathological characteristics in terms of survival time. RESULTS Of the 24 demographic and pathological variables collected in the data, 16 prognostic factors of gastric cancer were found to have statistically significant influences on survival time from the unadjusted analyses. The adjusted analysis furtherly revealed that age, age square, lymph node metastasis rate group, tumour size group, surgical type II, number of cancer nodules, invasion depth group and the interaction between surgical type II and tumour size group were important prognosis and clinicopathological factors for gastric cancer in Chinese. CONCLUSION Our study with relatively large sample size and many potential risk factors enable us to identify independent risk factors associated with the prognosis of gastric cancer. Findings from the current study can be used to assist clinical decision-making, and serve as a benchmark for the planning of future prognosis and therapy for patients with gastric carcinoma.
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Affiliation(s)
- Kongwang Hu
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shuaili Wang
- School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Zikun Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Longlong Li
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhiguo Huang
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weiqiang Yu
- School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Zhongxue Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Qing-Fa Wu
- School of Life Sciences, University of Science and Technology of China, Hefei, China
- School of Data Science, University of Science and Technology of China, Hefei, Anhui, China
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18
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Taniguchi K, Ota M, Yamada T, Serizawa A, Noguchi T, Amano K, Kotake S, Ito S, Ikari N, Omori A, Yamamoto M. Staging of gastric cancer with the Clinical Stage Prediction score. World J Surg Oncol 2019; 17:47. [PMID: 30849974 PMCID: PMC6408856 DOI: 10.1186/s12957-019-1589-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/28/2019] [Indexed: 12/13/2022] Open
Abstract
Background Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. Accordingly, it is important to distinguish between stage III/IV and stage I/II gastric cancer, but clinical staging is less accurate than pathological staging. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer. Methods We reviewed 2722 patients who underwent gastrectomy at our hospital from January 1996 to December 2015. As pretreatment factors potentially related to tumor stage, we assessed age, sex, tumor markers, tumor diameter, tumor location, tumor histology, and macroscopic type. Factors showing significance on multivariate analysis were used to develop the Clinical Stage Prediction score (CSP score), and a cutoff value for the score was determined by receiver operating characteristics analysis. Results According to multivariate analysis, clinical factors associated with stage III/IV disease were elevation of the carcinoembryonic antigen level, tumor diameter ≥ 60 mm, circumferential gastric involvement, esophageal infiltration, mucinous adenocarcinoma, and macroscopic types 2–4. The CSP score was obtained by weighting these factors according to the non-standardized β-coefficient. Receiver operating characteristics analysis indicated that the optimum cutoff value of the CSP score was 17 points. Among 1042 patients with a CSP score ≥ 17 points, 820 patients (78.7%) had stage III/IV gastric cancer. Conversely, among 1680 patients with a CSP score < 17 points, 1547 patients (92.1%) had stage I/II gastric cancer. When discrimination of stage III/IV gastric cancer from stage I/II gastric cancer by the CSP score was assessed, the sensitivity was 78.7%, specificity was 92.1%, positive predictive value was 86.0%, and negative predictive value was 87.5%. Conclusions The CSP score can be helpful for differentiating stage III/IV gastric cancer from stage I/II gastric cancer based on pretreatment clinical factors.
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Affiliation(s)
- Kiyoaki Taniguchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Masaho Ota
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takuji Yamada
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akiko Serizawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takeharu Noguchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kunihiko Amano
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Sho Kotake
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shunichi Ito
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Naoki Ikari
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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19
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Shimura T, Ebi M, Yamada T, Yamada T, Katano T, Nojiri Y, Iwasaki H, Nomura S, Hayashi N, Mori Y, Kataoka H, Moses MA, Joh T. Urinary kallikrein 10 predicts the incurability of gastric cancer. Oncotarget 2018; 8:29247-29257. [PMID: 28418926 PMCID: PMC5438727 DOI: 10.18632/oncotarget.16453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/22/2017] [Indexed: 01/06/2023] Open
Abstract
The current imaging modalities are not sufficient to identify inoperable tumor factors, including distant metastasis and local invasion. Hence, we conducted this study using urine samples to discover non-invasive biomarkers for the incurability of gastric cancer (GC). Urine samples from 111 GC patients were analyzed in this study. The GC cohort was categorized and analyzed according to disease stage and operability. In the discovery phase, protease protein array analysis identified 3 potential candidate proteins that were elevated in the urine of advanced GC patients compared to early GC patients. Among them, urinary kallikrein 10 (KLK10) was positively associated with tumor stage progression. Moreover, the urinary level of KLK10 (uKLK10) was significantly elevated in the urine of patients with inoperable GC compared to operable GC patients (median, 118 vs. 229; P=0.014). The combination of uKLK10, tumor location and tumor size distinguished operability of GC with an area under the curve of 0.859, 82.4% sensitivity and 86.2% specificity. Disease-free survival (DFS) was significantly shorter in GC patients with high uKLK10 compared to those with low uKLK10 (hazard ratio: 3.30 [95% confidence interval, 1.58-6.90] P<0.001). Immunohistochemical analyses also demonstrated a positive correlation between tumor stage and KLK10 expression in GC tissues (r=0.426, P<0.001). In addition, GC patients with high expression of pathological KLK10 (pKLK10) showed a significantly shorter DFS compared to those with low pKLK10 (hazard ratio: 3.79 [95% confidence interval, 1.27-11.24] P=0.010). uKLK10 is a promising non-invasive biomarker for the inoperability and incurability of GC.
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Affiliation(s)
- Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahide Ebi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | | | - Takahito Katano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yu Nojiri
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroyasu Iwasaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Satoshi Nomura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriyuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshinori Mori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Marsha A Moses
- Vascular Biology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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20
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Mohsenzadeh M, Sadeghi RN, Vahedi M, Kamani F, Hashemi M, Asadzadeh H, Zali MR. Promoter hypermethylation of RAR-β tumor suppressor gene in gastric carcinoma: Association with histological type and clinical outcomes. Cancer Biomark 2018; 20:7-15. [PMID: 28759951 DOI: 10.3233/cbm-160331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND While gastric cancer is a common cancer in the world and Iran, its molecular mechanisms are not fully understood as yet. Epigenetic modifications can lead to alteration of gene expression and development of tumorigenesis mechanisms. METHODS To clarify the difference in DNA methylation pattern of histological types in gastric carcinoma, CpG islands in the promoters of retinoic acid receptor β gene (RAR-β) was studied using methylation-specific PCR. RESULTS In gastric cancer tissues, hypermethylation frequency of RAR-β gene was respectively 61 and 33% for diffuse and intestinal type. In diffuse type, hypermethylation of RAR-β has been significantly associated with invasion (P= 0.007), differentiation (P= 0.033) and location (P= 0.012) of the tumor. However, hypermethylation of RAR-β correlated only with tumor size (P= 0.029) in intestinal type. For adjacent non-tumor samples, hypermethylation of RAR-β was not detected and there was no significant association between age of diagnosis and hypermethylation of RAR-β in both types of gastric cancer. CONCLUSIONS These results support previous findings denoting a distinct profile of promoter hypermethylation status in the development of the intestinal and diffuse type of gastric carcinoma and the process of the tumorigenesis in these subtypes of gastric cancer is different from each other.
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Affiliation(s)
- Maedeh Mohsenzadeh
- Department of Cellular and Molecular Sciences, Faculty of Advanced Sciences and Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Rouhallah Najjar Sadeghi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Department of Clinical Biochemistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohsen Vahedi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereshteh Kamani
- Department of Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Hashemi
- Department of Genetics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Hamid Asadzadeh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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Chen J, Cai R, Ren G, Zhao J, Li H, Guo C, He W, Wu X, Zhang W. Differences in clinicopathological characteristics and computed tomography findings between signet ring cell carcinoma and nonsignet ring cell carcinoma in early and advanced gastric cancer. Cancer Med 2018. [PMID: 29533002 PMCID: PMC5911613 DOI: 10.1002/cam4.1417] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Signet ring cell carcinoma (SRC) of the stomach is a histological type based on microscopic characteristics. SRC's clinicopathological characteristics and prognosis are still controversial. Our study is to describe the clinicopathological features and multidetector computed tomography (MDCT) findings of patients with SRC of the stomach in comparison with nonsignet ring cell adenocarcinoma (NSRC). We retrospectively analyzed data from 241 patients who had undergone curative gastrectomy, including 62 SRC and 179 NSRC. Clinicopathological outcomes and MDCT findings were evaluated, and we investigated whether these variables were correlated with histopathological type. In early gastric carcinoma, patients with SRC were younger (50.2 vs. 60.2 years; P = 0.000) and more likely to be observed in the middle and lower third stomach (P = 0.010). Early SRC had a tendency to be confined to the mucosa (82.1%). There were significant differences in degree of enhancement between early SRC and NSRC on MDCT imaging (P < 0.001). In advanced gastric carcinoma, SRC was more likely to be stage T3‐4 (100%). SRC patients had thicker tumors (P = 0.001) and a higher frequency of diffusely infiltrative gross appearance (P < 0.001). SRC was more likely to have high‐degree contrast enhancement than were NSRC (P = 0.001). The maximal diameter of SRC tumor on MDCT imaging correlated with lymph node metastasis (sensitivity 93.9%, specificity 74.1%) and serosal invasion (sensitivity 89.5%, specificity 78.0%) of SRC. In conclusion, SRC differs significantly from NSRC in clinicopathological features at presentation. MDCT could help differentiate advanced gastric SRC from NSRC based on the thickened stomach wall, high‐degree contrast enhancement, and a higher frequency of diffusely infiltrative gross appearance, particularly in combination.
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Affiliation(s)
- Jian Chen
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Rong Cai
- Department of Radiotherapy, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Gang Ren
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Jianxi Zhao
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Huali Li
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Chen Guo
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Wenguang He
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xiangru Wu
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Wenjie Zhang
- Department of Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
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22
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Haraguchi N, Arigami T, Uenosono Y, Yanagita S, Uchikado Y, Mori S, Kurahara H, Kijima Y, Nakajo A, Maemura K, Ishigami S, Natsugoe S. Clinical significance of primary tumor score determined by tumor depth and size in patients with resectable gastric cancer. Oncotarget 2018; 9:8512-8520. [PMID: 29492212 PMCID: PMC5823562 DOI: 10.18632/oncotarget.23953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/16/2017] [Indexed: 12/29/2022] Open
Abstract
Although postoperative management of gastric cancer is determined by pathological stage based on the tumor-node-metastasis classification, predicting disease recurrence and prognosis in patients undergoing gastrectomy is clinically difficult. We investigated the depth of tumor invasion and tumor size in resected specimens from patients with gastric cancer and assessed the clinical utility of primary tumor score (PTS) calculated by tumor depth and size as a prognostic marker. We classified 247 patients with gastric cancer into three groups based on cut-off values for deeper tumor invasion (pT2-T4) and larger tumor size (≥ 45 mm) as a PTS of 2 (both abnormalities), 1 (one abnormality), or 0 (neither abnormality). PTS correlated significantly with lymph node metastasis, lymphovascular invasion, and stage (P < 0.0001 each). Survival differences among groups based on PTS were significant (P < 0.0001). Multivariate analysis identified PTS alone as an independent prognostic factor (P = 0.0363). PTS derived from primary tumor information alone is a potentially useful marker for predicting tumor progression and prognosis in postoperative patients with gastric cancer.
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Affiliation(s)
- Naoto Haraguchi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takaaki Arigami
- Onco-biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshikazu Uenosono
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shigehiro Yanagita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yasuto Uchikado
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shinichiro Mori
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuko Kijima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kosei Maemura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Onco-biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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23
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Liu Z, Gao P, Liu S, Zheng G, Yang J, Sun L, Hong L, Fan D, Zhang H, Feng F. Tumor volume increases the predictive accuracy of prognosis for gastric cancer: A retrospective cohort study of 3409 patients. Oncotarget 2017; 8:18968-18978. [PMID: 28145885 PMCID: PMC5386662 DOI: 10.18632/oncotarget.14859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/16/2017] [Indexed: 12/22/2022] Open
Abstract
Tumor diameter or T stage does not reflect the actual tumor burden and is not able to estimate accurate prognosis of gastric cancer. The current study aimed to evaluate the prognostic value of tumor volume (V) for gastric cancer. A total of 3409 enrolled gastric cancer patients were randomly divided into training set (n = 1705) and validation set (n = 1704). Tumor volume was calculated by the formula V = Tumor diameter × (T stage)2/2. The survival predictive accuracy and prognostic discriminatory ability between different variables and staging systems were analyzed. Four optimal cutoff points for V were obtained in training set (3.5, 8.6, 25.0, 45.0, all P < 0.001). V stage was significantly associated with tumor location, macroscopic type, differentiation degree, tumor diameter, T stage, N stage, vessel invasion, neural invasion and TNM stage (all P < 0.001). V stage was an independent prognostic factor both in training and validation set. V stage showed better predictive accuracy and prognostic discriminatory ability than tumor diameter and T stage. VNM staging system also have advantages in predictive accuracy and prognostic discriminatory ability than TNM staging system. The VNM multivariable model represent good agreement between the predicted survival and actual survival. In conclusion, tumor volume was significantly associated with clinicopathological features and prognosis of gastric cancer. In comparison with TNM staging system, VNM staging system could improve the predictive accuracy and prognostic discriminatory ability for gastric cancer.
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Affiliation(s)
- Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Peng Gao
- Department of Radiation Medicine, Faculty of Preventive Medicine, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Shushang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Jianjun Yang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Li Sun
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Liu Hong
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Daiming Fan
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
| | - Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 710032, Xi'an, Shaanxi Province, China
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24
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Clinical impact of small advanced gastric cancer (≤ 40 mm) in elderly patients: A retrospective cohort study. Int J Surg 2017; 45:131-137. [DOI: 10.1016/j.ijsu.2017.07.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/06/2017] [Accepted: 07/14/2017] [Indexed: 01/07/2023]
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Tumor Size Is a Critical Factor in Adjuvant Chemotherapy for T 3-4aN0M0 Gastric Cancer Patients after D2 Gastrectomy. Gastroenterol Res Pract 2017; 2017:4928736. [PMID: 28331491 PMCID: PMC5346364 DOI: 10.1155/2017/4928736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/10/2016] [Accepted: 09/05/2016] [Indexed: 12/21/2022] Open
Abstract
Aim. To investigate whether tumor size is a reasonable indication for adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy. Method. We performed a retrospective study of 269 patients with a histological diagnosis of T3-4aN0M0 stage gastric cancer who underwent D2 radical surgery at the Sun Yat-sen University Cancer Center or the Sixth Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2010. The follow-up lasted until June of 2015. Chi-square tests and Kaplan-Meier methods were employed to compare the clinicopathological variables and prognoses. Result. For this group of patients, univariate analyses revealed that tumor size (p < 0.001), pathological T stage (p < 0.001), and tumor location (p = 0.025) were significant prognostic factors. Adjuvant chemotherapy did not exhibit prognostic benefits. For patients with tumors larger than 5 cm, univariate analysis revealed that tumor location (p = 0.007), Borrmann type (p = 0.039), postoperative chemotherapy (p = 0.003), and pathological T stage (p < 0.001) were significant prognostic factors. Multivariate analysis revealed that postoperative chemotherapy and pathological T stage were independent prognostic factors. Conclusion. Our results imply that tumor size should be a critical factor in the decision to utilize adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy. Additional randomized controlled trials are required before this conclusion can be considered definitive.
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26
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Dawson H, Novotny A, Becker K, Reim D, Langer R, Gullo I, Svrcek M, Niess JH, Tutuian R, Truninger K, Diamantis I, Blank A, Zlobec I, Riddell RH, Carneiro F, Fléjou JF, Genta RM, Lugli A. Macroscopy predicts tumor progression in gastric cancer: A retrospective patho-historical analysis based on Napoleon Bonaparte's autopsy report. Dig Liver Dis 2016; 48:1378-1385. [PMID: 27522550 DOI: 10.1016/j.dld.2016.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/02/2016] [Accepted: 07/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The cause of Napoleon Bonaparte's death remains controversial. Originally suggested to be gastric cancer, whether this was truly neoplastic or a benign lesion has been recently debated. AIMS To interpret findings of original autopsy reports in light of the current knowledge of gastric cancer and to highlight the significance of accurate macroscopy in modern-day medicine. METHODS Using original autopsy documents, endoscopic images and data from current literature, Napoleon's gastric situation was reconstructed. In a multicenter collection of 2071 gastric cancer specimens, the relationship between tumor size and features of tumor progression was assessed. RESULTS Greater tumor size was associated with advanced pT, nodal metastases and Borrmann types 3-4 (p<0.001). The best cut-off for predicting pT3-4 tumors was 6.5cm (AUC 0.8; OR 1.397, 95% CI 1.35-1.446), and 6cm for lymph node metastases (AUC 0.775; OR 1.389, 95% CI 1.338-1.442). The 6cm cut-off of had a positive predictive value of 0.820 for nodal metastases and a negative predictive value of 0.880 for distant metastases. CONCLUSION This analysis combines Napoleon's autopsy with present-day knowledge to support gastric cancer as his terminal illness and emphasizes the role of macroscopy, which may provide valuable information on gastric cancer progression and aid patient management.
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Affiliation(s)
- Heather Dawson
- Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland.
| | - Alexander Novotny
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Germany
| | - Karen Becker
- Institute of Pathology, Klinikum Rechts der Isar, Technische Universität München, Germany
| | - Daniel Reim
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Germany
| | - Rupert Langer
- Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Irene Gullo
- Centro Hospitalar de São João/Medical Faculty of Porto, Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto/i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Magali Svrcek
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Anatomie Pathologique, Paris, France
| | - Jan H Niess
- University Clinic of Visceral Surgery and Medicine, Inselspital Bern, Switzerland
| | - Radu Tutuian
- University Clinic of Visceral Surgery and Medicine, Inselspital Bern, Switzerland
| | | | | | - Annika Blank
- Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Inti Zlobec
- Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Robert H Riddell
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Fatima Carneiro
- Centro Hospitalar de São João/Medical Faculty of Porto, Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto/i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Jean-François Fléjou
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Anatomie Pathologique, Paris, France
| | - Robert M Genta
- Miraca Life Sciences, Research Institute, Irving, TX, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Alessandro Lugli
- Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
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Lee EW, Lee WY, Koo HS. Prognostic Factors for Node-Negative Advanced Gastric Cancer after Curative Gastrectomy. J Gastric Cancer 2016; 16:161-166. [PMID: 27752393 PMCID: PMC5065945 DOI: 10.5230/jgc.2016.16.3.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/15/2016] [Accepted: 08/29/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Lymph node (LN) metastasis is the best prognostic indicator in non-distant metastatic advanced gastric cancer. This study aimed to assess the prognostic value of various clinicopathologic factors in node-negative advanced gastric cancer. MATERIALS AND METHODS We retrospectively analyzed the clinical records of 254 patients with primary node-negative stage T2~4 gastric cancer. These patients were selected from a pool of 1,890 patients who underwent radical resection at Memorial Jin-Pok Kim Korea Gastric Cancer Center, Inje University Seoul Paik Hospital between 1998 and 2008. RESULTS Of the 254 patients, 128 patients (50.4%), 88 patients (34.6%), 37 patients (14.6%), and 1 patient (0.4%) had T2, T3, T4a, and T4b tumors, respectively. In a univariate analysis, operation type, T-stage, venous invasion, tumor size, and less than 15 LNs significantly correlated with tumor recurrence and cumulative overall survival. In a multivariate logistic regression analysis, tumor size, venous invasion, and less than 15 LNs significantly and independently correlated with recurrence. In a multivariate Cox proportional hazards analysis, tumor size (hazard ratio [HR]: 2.926; 95% confidence interval [CI]: 1.173~7.300; P=0.021), venous invasion (HR: 3.985; 95% CI: 1.401~11.338; P=0.010), and less than 15 LNs (HR: 0.092; 95% CI: 0.029~0.290; P<0.001) significantly correlated with overall survival. CONCLUSIONS Node-negative gastric cancers recurred in 8.3% of the patients in our study. Tumor size, venous invasion, and less than 15 LNs reliably predicted recurrence as well as survival. Aggressive postoperative treatments and timely follow-ups should be considered in cases with these characteristics.
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Affiliation(s)
- Eun Woo Lee
- Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Woo Yong Lee
- Department of Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ho-Seok Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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28
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Yu X, Hu F, Yao Q, Li C, Zhang H, Xue Y. Serum fibrinogen levels are positively correlated with advanced tumor stage and poor survival in patients with gastric cancer undergoing gastrectomy: a large cohort retrospective study. BMC Cancer 2016; 16:480. [PMID: 27418164 PMCID: PMC4946212 DOI: 10.1186/s12885-016-2510-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 06/22/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Platelet and blood coagulation abnormalities frequently occur in cancer patients. Fibrinogen is an important hemostatic factor that regulates the hemostatic pathway. Hyperfibrinogenemia is increasing recognized as an important risk factor influencing cancer development and outcome. However, few reports have investigated the prognostic potential of fibrinogen for predicting the survival of gastric cancer (GC) patients. The primary aim of this study was to evaluate the usefulness of preoperative serum fibrinogen as a biomarker for predicating tumor progression and survival of patients with GC. PATIENTS AND METHODS This retrospective study was conducted in GC patients who underwent gastrectomy from 2005 to 2007. Patient demographics, clinicopathological characteristics, preoperative plasma fibrinogen levels and median survival time (MST) were analyzed. Univariate and multivariate proportional hazard analysis of risk factors were used. RESULTS This study included 1196 patients (885 males and 311 females) with GC, more than half of whom had advanced GCs. Radical lymph node dissection was performed in 71.6 % of these patients. MST was 41.9 ± 32.4 months. Patient survival was significantly affected by family GC history (p <0.05), lymph node dissection mode (p <0.001), tumor size (≥5 cm; p <0.001), tumor location (p < 0.001), poor tumor differentiation (p <0.001), tumor histologic classification (p <0.001), extent of tumor invasion (p <0.001), number of metastatic lymph nodes (p <0.001), advanced stage of disease (p <0.001), extended operation duration (>150 min; p <0.001), higher operative bleeding volume (>200 ml; p <0.001), postoperative transfusion, preoperative serum fibrinogen levels, CEA levels and CA 19-9 levels (p <0.001). Multivariate analysis indicated that the independent prognostic factors significantly associated with poor survival included non-radical lymph node dissection, palliative lymph node dissection, multi-organ involvement, advanced TNM stages, poor tumor differentiation, higher preoperative serum fibrinogen levelsand higher CA19-9 levels. CONCLUSIONS Serum fibrinogen levels are positively correlated with advanced tumor stages and poor survival in GC patients undergoing gastrectomy. Preoperative plasma fibrinogen levels are an independent risk factor for survival in these patients. Serum fibrinogen is a useful biomarker for patients with clinically advanced GC.
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Affiliation(s)
- Xuefeng Yu
- Harbin Medical University Cancer Hospital, Haping Rd. #150, Harbin, 150040, Helongjiang Province, People's Republic of China
| | - Fulan Hu
- Harbin Medical University Public Health College, Harbin, 150081, Helongjiang Province, People's Republic of China
| | - Qiang Yao
- Harbin Medical University Cancer Hospital, Haping Rd. #150, Harbin, 150040, Helongjiang Province, People's Republic of China
| | - Chunfeng Li
- Harbin Medical University Cancer Hospital, Haping Rd. #150, Harbin, 150040, Helongjiang Province, People's Republic of China
| | - Hongfeng Zhang
- Harbin Medical University Cancer Hospital, Haping Rd. #150, Harbin, 150040, Helongjiang Province, People's Republic of China
| | - Yingwei Xue
- Harbin Medical University Cancer Hospital, Haping Rd. #150, Harbin, 150040, Helongjiang Province, People's Republic of China.
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29
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Zhao LY, Zhang WH, Chen XZ, Yang K, Chen XL, Liu K, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Prognostic Significance of Tumor Size in 2405 Patients With Gastric Cancer: A Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e2288. [PMID: 26683961 PMCID: PMC5058933 DOI: 10.1097/md.0000000000002288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 02/05/2023] Open
Abstract
The clinical prognostic significance of tumor size (Ts) in gastric cancer remains under debate. This study aims to evaluate the prognostic value of Ts in gastric cancer patients undergoing gastrectomy. A total of 2405 patients with gastric cancer, all having received radical resection, were enrolled in this retrospective study from 2000 to 2011. Patients were categorized by minimum P value from log-rank χ2 statistics using X-tile. The relationships between Ts and other clinicopathologic characteristics were analyzed, and the survival prediction accuracy was also compared between Ts and T stage. Patients were divided into 5 groups, according to which Ts stage and TsNM stage system were proposed. Ts, an independent prognostic factor identified by univariate and multivariate survival analysis, was significantly associated with sex, age, tumor location, macroscopic type, tumor diffferentiation, vessel invasion, perineural invasion, T stage, N stage, and TNM stage. Compared with T stage system, Ts stage system was found no superiorities in survival prediction. However, for patients with lymph node metastasis and patients with age ≥60, Ts stage system revealed a significant improvement of predictive accuracy in subgroup survival analysis. Furthermore, TsNM stage (c-index = 0.783) system was found to be superior to TNM stage (c-index = 0.743) system in prognostic prediction accuracy (P < 0.05). Ts is significantly correlated with gastric cancer progression, which can be regarded as a reliable prognostic factor, and the TsNM stage system may improve the prognostic prediction accuracy in gastric cancer patients.
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Affiliation(s)
- Lin-Yong Zhao
- From the Department of Gastrointestinal Surgery (L-YZ, W-HZ, X-ZC, KY, X-LC, KL, BZ, Z-XC, J-PC, Z-GZ, J-KH); and the Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China (L-YZ, W-HZ, X-ZC, KY, X-LC, KL, J-KH)
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Using gastric juice lncRNA-ABHD11-AS1 as a novel type of biomarker in the screening of gastric cancer. Tumour Biol 2015; 37:1183-8. [PMID: 26280398 DOI: 10.1007/s13277-015-3903-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/05/2015] [Indexed: 12/12/2022] Open
Abstract
Long noncoding RNAs (lncRNAs) play vital roles in tumorigenesis. However, the diagnostic values of most lncRNAs are largely unknown. To investigate whether gastric juice lncRNA-ABHD11-AS1 can be a potential biomarker in the screening of gastric cancer, 173 tissue samples and 130 gastric juice from benign lesion, gastric dysplasia, gastric premalignant lesions, and gastric cancer were collected. ABHD11-AS1 levels were detected by reverse transcription-polymerase chain reaction. Then, the relationships between ABHD11-AS1 levels and clinicopathological factors of patients with gastric cancer were investigated. The results showed that ABHD11-AS1 levels in gastric cancer tissues were significantly higher than those in other tissues. Its levels in gastric juice from gastric cancer patients were not only significantly higher than those from cases of normal mucosa or minimal gastritis, atrophic gastritis, and gastric ulcers but also associated with gender, tumor size, tumor stage, Lauren type, and blood carcinoembryonic antigen (CEA) levels. More importantly, when using gastric juice ABHD11-AS1 as a marker, the positive detection rate of early gastric cancer patients was reached to 71.4 %. Thanks to the special origin of gastric juice, these results indicate that gastric juice ABHD11-AS1 may be a potential biomarker in the screening of gastric cancer.
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Niihara M, Takeuchi H, Nakahara T, Saikawa Y, Takahashi T, Wada N, Mukai M, Kitagawa Y. Sentinel lymph node mapping for 385 gastric cancer patients. J Surg Res 2015; 200:73-81. [PMID: 26233688 DOI: 10.1016/j.jss.2015.06.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND The objectives were to investigate the accuracy of sentinel lymph node (SLN) biopsy, detect the predictors for undetected or false-negative cases, evaluate the indications for SLN-navigated gastrectomy, and characterize the problems of SLN mapping in gastric cancer. The SLN concept may be applicable to early gastric cancer, particularly clinical T1N0M0 or T2N0M0 with tumor diameter ≤4 cm. METHODS A total of 385 consecutive patients diagnosed with cT1N0M0 or cT2aN0M0 operable gastric cancer from April 1999 to December 2007 underwent radical gastrectomy with SLN mapping. SLNs were identified using radio-guided and dye-guided methods. Predictors for undetected or false-negative cases on SLN mapping were examined by multivariate regression analysis. RESULTS The detection rate of hot and/or blue nodes was 96.6% (372 of 385). The accuracy of metastatic status based on SLNs was 98.9% (368 of 372) for all cases in whom SLNs could be detected. Furthermore, the accuracy of metastatic status based on SLNs was 99.1% (344 of 347) in cT1 gastric cancer and 96.0% (24 of 25) in cT2 gastric cancer. Pathologically, the tumors invaded to the muscularis propria or deeper in three of four false-negative cases. All but one case had metastatic lymph nodes within the sentinel basins. In terms of 5-y recurrence free survival, positive SLN cases (SLN(+)) had a worse prognosis than negative SLN cases (SLN(-); P = 0.008). Moreover, SLN(+) and non-SLN(-) cases (SLN(+)/non-SLN(-)) had a similar prognosis as SLN(+) and non-SLN(+) cases (SLN(+)/non-SLN(+)) (P = 0.511). On multivariate regression analysis, undetected or false-negative cases were significantly associated with the time period. CONCLUSIONS The present results appeared to validate the SLN concept for untreated cT1 gastric cancer with tumor diameter ≤4 cm. SLN mapping may provide an effective method of staging the lymph node status of patients undergoing minimized gastrectomy. Sentinel basin dissection guards against the possibility of leaving positive lymph nodes. Stabilization of the procedure and experience with SLN mapping in gastric cancer might decrease undetected or false-negative cases.
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Affiliation(s)
- Masahiro Niihara
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroya Takeuchi
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
| | - Tadaki Nakahara
- Department of Radiology, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshiro Saikawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | | | - Norihito Wada
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Makio Mukai
- Division of Diagnostic Pathology, School of Medicine, Keio University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
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Futsukaichi T, Etoh T, Nakajima K, Daa T, Shiroshita H, Shiraishi N, Kitano S, Inomata M. Decreased expression of Bauhinia purpurea lectin is a predictor of gastric cancer recurrence. Surg Today 2015; 45:1299-306. [PMID: 25753302 DOI: 10.1007/s00595-015-1127-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/21/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Molecular markers as indicators for gastric cancer recurrence are urgently required. The aim of this study was to identify lectins that can be used to predict gastric cancer recurrence after gastrectomy. METHODS We created lectin expression profiles by microarray analysis for 60 patients, who underwent surgery for gastric cancer at the Oita University Hospital between January, 2005 and December, 2007. Lectin expression and clinicopathological factors in patients who suffered gastric cancer recurrence and those who did not were compared by univariate and multivariate analyses. RESULTS Thirteen lectins showed a significant increase in binding to cancer tissues, whereas 11 lectins showed a significant decrease in binding to cancer tissues, when compared with binding to normal epithelia. Multivariate analysis revealed that lymph node metastasis and low Bauhinia purpurea lectin (BPL)-binding signals were independent predictive factors for recurrence. All patients with low BPL expression had significantly worse relapse-free survival than those with high BPL expression. CONCLUSIONS Our results using a novel lectin microarray system provide the first solid evidence that BPL expression is a predictor of gastric cancer recurrence.
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Affiliation(s)
- Takuro Futsukaichi
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Kentaro Nakajima
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan
| | - Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Norio Shiraishi
- Center for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
| | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Yufu, Oita, 879-5593, Japan
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Sentani K, Matsuda M, Oue N, Uraoka N, Naito Y, Sakamoto N, Yasui W. Clinicopathological significance of MMP-7, laminin γ2 and EGFR expression at the invasive front of gastric carcinoma. Gastric Cancer 2015; 17:412-22. [PMID: 24048760 DOI: 10.1007/s10120-013-0302-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/30/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND For several types of cancer, including gastric cancer (GC), tumor cells at the invasive front are considered to have a more aggressive behavior compared with those in the more central region. The aim of the present study was to analyze the expression of MMP-7, laminin γ2 and EGFR in a large number of GCs and to investigate how these expression patterns correlate with clinicopathologic parameters, infiltrative patterns, histology or mucin phenotype. METHODS We immunohistochemically examined the expression of MMP-7, laminin γ2 and EGFR using a tissue microarray analysis of 790 GCs, and evaluated their clinicopathological significance. RESULTS MMP-7, cytoplasmic laminin γ2, extracellular laminin γ2 and EGFR expression were observed in 25, 25, 8 and 21 % of the 790 GC cases, respectively. Expression of MMP-7, cytoplasmic laminin γ2 and EGFR was associated with advanced T grade, N grade and tumor stage. Extracellular laminin γ2 expression was not associated with any clinicopathologic parameters, infiltrative patterns, histology or mucin phenotype. Furthermore, we investigated the correlations of MMP-7, laminin γ2 and EGFR expression. MMP-7 expression was significantly more frequent in positive expression of cytoplasmic laminin γ2 than negative cases, and EGFR expression was significantly more frequent in positive expression of cytoplasmic laminin γ2 and MMP-7. CONCLUSIONS Molecular expression of MMP-7, laminin γ2 or EGFR, and their combinations, may be associated with GC tumor aggressiveness. Assessment of expression of these molecules at the invasive front of primary tumors is clinically significant in predicting the malignant behavior of GC.
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Affiliation(s)
- Kazuhiro Sentani
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Deng J, Zhang R, Pan Y, Ding X, Cai M, Liu Y, Liu H, Bao T, Jiao X, Hao X, Liang H. Tumor size as a recommendable variable for accuracy of the prognostic prediction of gastric cancer: a retrospective analysis of 1,521 patients. Ann Surg Oncol 2015; 22:565-572. [PMID: 25155400 DOI: 10.1245/s10434-014-4014-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND It is still controversial whether tumor size (Ts) should be considered an important indicator for evaluation the prognosis of gastric cancer (GC). The purpose of this study was to elucidate the prognostic prediction superiority of Ts in the large-scale cohort of GC patients. METHODS Data from 1,521 patients who underwent the curative resection were analyzed for demonstration the prognostic value of Ts. In addition, a tumor size-node-metastasis (TsNM) classification system was proposed to evaluate the comparative superiorities of the prognostic prediction of GC patients. RESULTS With the univariate and multivariate analyses, Ts was identified as an independently prognostic predictor of GC patients, as was T stage. Ts was demonstrated to have smaller Akaike information criterion and Bayesian Information Criterion values within the Cox regression analyses than shown by T stage, which represented the optimum prognostic stratification. TsNM classification was also found to be competent for accurately prognostic evaluation of GC patients. The matched case-control logistic regression showed that TsNM classification could provide very powerful discriminations of patients' overall survival, compared with TNM classification. Additionally, Ts stage was found to enhance the survival discriminations in patients with certain clinicopathological characteristics, including male gender, T4a stage, N0 stage, diffuse type of Lauren classification, or age ≤60 years. CONCLUSIONS Ts should be recommended as an important clinicopathologic variable to enhance the accuracy of the prognostic prediction of GC clinical patients.
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Affiliation(s)
- Jingyu Deng
- Department of Gastric Cancer Surgery, National Clinical Research Center for Cancer, City Key Laboratory of Tianjin Cancer Center, Tianjin Medical University Cancer Hospital, Tianjin, China
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Wang Y, Zhuo C, Shi D, Zheng H, Xu Y, Gu W, Cai S, Cai G. Unfavorable effect of small tumor size on cause-specific survival in stage IIA colon cancer, a SEER-based study. Int J Colorectal Dis 2015; 30:131-7. [PMID: 25392257 DOI: 10.1007/s00384-014-2056-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND We sought to determine the prognostic role of tumor size on cause-specific survival (CSS) of patients with stage IIA colon cancer. METHODS Surveillance, Epidemiology and End Results (SEER) database was utilized to identify patients with stage IIA colorectal cancer (examined lymph nodes ≥12) diagnosed from 1988 to 2003. The prognostic effect of tumor size on CSS was evaluated by univariate and multivariate analyses. RESULTS A total of 8775 patients were enrolled in the analysis. The median follow-up time was 109 months. As determined by minimal P value method, tumor sizes of 2.5 and 6.0 cm were used as optimal cutoff value to divide the cohort. The 8-year CSS of colon cancer with tumor sizes ≤2.5, 2.6-6.0, and >6.0 cm was 81.6, 86.2, and 86.7% respectively (P = 0.003). In the multivariate analysis of colon cancer, using ≤2.5-cm tumors as reference, decreased hazard ratio (HR) of CSS was observed in 2.6-6.0 cm (HR, 0.736; 95% confidence interval (CI), 0.599-0.905; P = 0.004) and >6.0 cm (HR, 0.770; 95% CI, 0.619-0.958; P = 0.019) tumors. CONCLUSIONS In stage IIA colon cancer, small tumor size represented a subset with decreased CSS. Further studies are merited to validate the unfavorable prognostic role of small tumor size in stage IIA colon cancer.
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Affiliation(s)
- Yuwei Wang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
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Lu J, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M. Prognostic value of tumor size in patients with remnant gastric cancer: is the seventh UICC stage sufficient for predicting prognosis? PLoS One 2014; 9:e115776. [PMID: 25549339 PMCID: PMC4280110 DOI: 10.1371/journal.pone.0115776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/26/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The 7th UICC N stage may be unsuitable for remnant gastric cancer (RGC) because the original disease and previous operation usually cause abnormal lymphatic drainage. However, the prognostic significance of the current TNM staging system in RGC has not been studied. METHODS Prospective data from 153 RGC patients who underwent curative gastrectomy from Jan 1995 to Aug 2009 were reviewed. All patients were classified according to tumor size (<3 cm as N0;>3&≤5 cm as N1;>5&≤7 cm as N2; and>7 cm as N3). The overall survival was estimated using the Kaplan-Meier method, and hazard ratios (HRs) were calculated using the Cox proportional hazard model. RESULTS Tumor sizes ranged from 1.0 to 15.0 cm (median 5.0 cm). Tumor size, depth of invasion and lymph node (LN) metastasis were significant prognostic factors based on both the univariate and multivariate analyses (P<0.05). In the survival analysis, the seventh edition UICC-TNM classification provided a detailed classification; however, some subgroups of the UICC-TNM classification did not have significantly different survival rates. The combination of the seventh edition T classification and the suggested N classification, with ideal relative risk (RR) results and P value, was distinctive for subgrouping the survival rates except for the IA versus IB and II A versus IIB. A modified staging system based on tumor size, predicted survival more accurately than the conventional TNM staging system. CONCLUSIONS In RGCs, tumor size is an independent prognostic factor and a modified TNM system based on tumor size accurately predicts survival.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Chang-ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Chao-hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Jian-wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Jia-bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Jian-xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Qi-yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Long-long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China
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Balta AZ, Özdemir Y, Sücüllü İ, Derici ST, Bağcı M, Demirel D, Akın ML. Can horizontal diameter of colorectal tumor help predict prognosis? Turk J Surg 2014; 30:115-119. [PMID: 25931910 PMCID: PMC4379853 DOI: 10.5152/ucd.2014.2701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/27/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aimed to investigate the relationship between the horizontal tumor diameter and prognosis. MATERIAL AND METHODS Patients' records were analyzed retrospectively. Patient data, including age, gender, vertical penetration, anatomic location, differentiation of the tumor, tumor node metastasis (TNM) stage, survival rate, and disease-free survival, were analyzed to find out if there was any correlation with horizontal tumor diameter. RESULTS A total of 439 colorectal cancer patients were enrolled. Patients were stratified into two groups according to the horizontal tumor diameter (≤4.5 cm vs. >4.5 cm). Poorly differentiated tumors were significantly larger than other differentiation groups (p=0.003). The horizontal diameter increased with increase in T-stage (p<0.001). Similarly, the number of positive lymph nodes increased significantly as the size of the horizontal tumor diameter increased (p<0.001). The relationship between TNM staging and the horizontal diameter of tumors in both groups was examined, and it was found that the progression of tumor stage was accompanied by increased horizontal diameter (p<0.001). It was also found that the horizontal tumor diameter was not correlated with local recurrence (p=0.063). However, distant metastasis was higher in patients with a tumor larger than 4.5 cm (p=0.02). Although the disease-free survival was shorter in patients with a horizontal tumor diameter more than 4.5 cm, the difference was not statistically significant. CONCLUSION There is a significant relation between horizontal diameter of the tumor and depth of the tumor, lymph node involvement, overall survival, and distant metastasis. Horizontal diameter of the tumor can possibly be used as a prognostic factor in colorectal cancer patients.
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Affiliation(s)
- Ahmet Ziya Balta
- Department of General Surgery, Gülhane Military Medical Academy Haydarpaşa Education and Research Hospital, İstanbul, Turkey
| | - Yavuz Özdemir
- Department of General Surgery, Gülhane Military Medical Academy Haydarpaşa Education and Research Hospital, İstanbul, Turkey
| | - İlker Sücüllü
- Department of General Surgery, Gülhane Military Medical Academy Haydarpaşa Education and Research Hospital, İstanbul, Turkey
| | - Serhat Tolga Derici
- Department of General Surgery, Gülhane Military Medical Academy Haydarpaşa Education and Research Hospital, İstanbul, Turkey
| | - Mahir Bağcı
- Department of General Surgery, Etimesgut Military Hospital, Ankara, Turkey
| | - Dilaver Demirel
- Department of Pathology, Gülhane Military Medical Academy Haydarpaşa Education and Research Hospital, İstanbul, Turkey
| | - Mehmet Levhi Akın
- Department of General Surgery, Gülhane Military Medical Academy Haydarpaşa Education and Research Hospital, İstanbul, Turkey
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lncRNA-AC130710 targeting by miR-129-5p is upregulated in gastric cancer and associates with poor prognosis. Tumour Biol 2014; 35:9701-6. [DOI: 10.1007/s13277-014-2274-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
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Huang CM, Xu M, Wang JB, Zheng CH, Li P, Xie JW, Lin JX, Lu J. Is tumor size a predictor of preoperative N staging in T2-T4a stage advanced gastric cancer? Surg Oncol 2014; 23:5-10. [PMID: 24508061 DOI: 10.1016/j.suronc.2014.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 01/07/2014] [Accepted: 01/12/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to assess the relationship between tumor size and preoperative N staging in patients with T2-T4a stage advanced gastric cancer. METHODS A total of 697 patients with gastric cancer were analyzed. The correlations between the number of metastatic lymph nodes (LNs) and other clinicopathologic factors were investigated. The Kappa consistency test was used to test the agreement between predicted and pathologic N staging. RESULTS Multivariate analysis showed that tumor size was independently (r = 0.987, P < 0.05) and linearly (R(2) = 0.940, P < 0.05) correlated with the number of metastatic LNs. The numbers of predicted metastatic LNs in patients with primary tumors <2.02 cm, 2.02-4.07 cm, 4.07-6.80 cm, and ≥ 6.80 cm in size were 0 (Stage N0), 1-2 (Stage N1), 3-6 (Stage N2), and ≥ 7 (Stage N3), respectively. There was good agreement between N staging predicted by tumor size and pathologic N staging (Kappa value = 0.531, P < 0.05). The overall accuracy of tumor size for preoperative N staging was 82.13%. The 5-year survival rates of patients with predicted Stages N0, N1, N2, and N3 were 80.0%, 71.1%, 56.8%, and 39.8%, respectively (P < 0.05). There were no significant differences in the survival rates of patients with predicted N staging and the corresponding pathologic N staging. CONCLUSIONS Tumor size is correlated with the number of LN metastases in patients with stage T2-T4a advanced gastric cancer. The measurements of tumor size can predict preoperative N staging.
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Affiliation(s)
- Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China.
| | - Mu Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
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Lu J, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX. Consideration of tumor size improves the accuracy of TNM predictions in patients with gastric cancer after curative gastrectomy. Surg Oncol 2013; 22:167-171. [PMID: 23787074 DOI: 10.1016/j.suronc.2013.05.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/19/2013] [Accepted: 05/20/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate whether addition of tumor size improves the prognostic accuracy of the UICC 7th TNM staging system in gastric cancer patients who underwent radical surgery (R0 resection). METHODS The clinical and pathological data and postoperative 5-year survival rate of 507 patients with gastric cancer who underwent radical surgery (R0 resection) in our department from January 2004 to June 2006 were evaluated retrospectively. The prognostic accuracy of conventional UICC 7th TNM staging was compared with that of UICC 7th TNM staging plus tumor size. The ability of tumor size to improve the 95% confidence interval (CI) of postoperative 5-year survival rate in gastric cancer patients was assessed. RESULTS Of the 507 patients, 470 (92.7%) were followed up. The five-year survival rate of these patients was 50.4%. The survival rates of patients with pT1, pT2, pT3, and pT4 stage tumors were 89.3%, 72.4%, 36.9%, and 23.7%, respectively (P < 0.05), and the survival rates of patients with pN0, pN1, pN2, and pN3 stage tumors were 75.2%, 68.8%, 46.7%, and 21.3% (P < 0.05). Depth of invasion, lymph node metastasis stage, metastatic lymph node ratio (MLR), lymphatic invasion and tumor size were independent predictors of patient prognosis. The accuracy of UICC 7th TNM staging in predicting 5-year survival was 75.4% and the accuracy of tumor size plus the UICC 7th TNM staging was 77.9% (P < 0.05). This combination improved the 95% CI of postoperative 5-year survival rate in gastric cancer patients. CONCLUSION Tumor size can improve the accuracy of UICC 7th TNM staging in predicting survival in gastric cancer patients following radical surgery (R0 resection). Tumor size is likely to be another important indicator in future UICC-TNM staging systems for gastric cancer patients.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, China
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Zu H, Wang F, Ma Y, Xue Y. Stage-stratified analysis of prognostic significance of tumor size in patients with gastric cancer. PLoS One 2013; 8:e54502. [PMID: 23382906 PMCID: PMC3559879 DOI: 10.1371/journal.pone.0054502] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/12/2012] [Indexed: 12/23/2022] Open
Abstract
Background The prognostic significance of tumor size in gastric cancer is not well defined. The objective of this study was to identify the prognostic value of tumor size in patients with gastric cancer. Methods We retrospectively reviewed a total of 1800 patients with gastric cancer admitted to our hospital between 1997 and 2007. These patients were divided into two groups according to tumor size: small size group (SSG, tumor ≤5 cm) and large size group (LSG, tumor >5 cm). We compared clinico-pathologic features of the two groups and investigated the prognostic factors by performing univariate, multivariate, and stage- stratified analyses according to tumor size. Results LSG had more aggressive clinico-pathologic features than SSG. Tumor size was an independent prognostic indicator in patients with gastric cancer. In a stratified-pT, pN, and pTNM analysis, survival of patients with LSG was significantly worse than that of patients with SSG and advanced stage. Tumor size was not a significant predictor of survival in patients with early stage tumors. Large tumor size was associated with shorter survival in patients with stages N0, N1, N2, and N3, and stages I, II, III, and IV. Conclusions Tumor size is a simple and practical prognostic factor in patients with gastric cancer. Tumor size could supplement clinical staging in the future.
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Affiliation(s)
- Hongliang Zu
- Department of Gastroenterologic Surgery, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feng Wang
- Department of Gastroenterologic Surgery, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yan Ma
- Department of Gastroenterologic Surgery, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingwei Xue
- Department of Gastroenterologic Surgery, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
- * E-mail:
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Guo P, Li Y, Zhu Z, Sun Z, Lu C, Wang Z, Xu H. Prognostic value of tumor size in gastric cancer: an analysis of 2,379 patients. Tumour Biol 2013; 34:1027-35. [PMID: 23319074 DOI: 10.1007/s13277-012-0642-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/26/2012] [Indexed: 12/24/2022] Open
Abstract
Tumor size has been included into the staging systems of many solid tumors, such as lung and breast. However, tumor size is not integrated in the staging of gastric cancer, and its prognostic value for gastric cancer needs to be reappraised. A total of 2,379 patients who received radical resection for histopathologically confirmed gastric adenocarcinoma were enrolled in the present study. Tumor size, originally presented as continuous variable, was categorized into small gastric cancer (SGC) group and large gastric cancer (LGC) group using an optimal cutoff point determined by Cox proportional hazards model. The associations between tumor size and other clinicopathological factors were checked using Chi-square test. Survival of gastric cancer patients was estimated by using univariate Kaplan-Meier method, and the survival difference was checked by using the log-rank test. The significant clinicopathological factors were included into the Cox proportional hazards model to determine the independent prognostic factors, and their hazard ratios were calculated. With the optimal cutoff point of 4 cm, tumor size was categorized into SGC group (≤ 4 cm) and LGC group (>4 cm). Tumor size closely correlated with age, tumor location, macroscopic type, Lauren classification, and lymphatic vessel invasion. Moreover, tumor size was also significantly associated with depth of tumor invasion and status of regional lymph nodes. The 5-year survival rate was 68.7 % for SGC group which was much higher than 40.2 % for LGC group. Univariate analysis showed that SGC had a better survival than LGC, mainly for patients with IIA, IIB, and IIIA stage. Multivariate analysis revealed that tumor size as well as age, tumor location, macroscopic type, Lauren classification, lymphatic vessel invasion, depth of tumor invasion, and status of regional lymph nodes were independent prognostic factors for gastric cancer. Tumor size is a reliable prognostic factor for patients with gastric cancer, and the measurement of tumor size would be helpful to the staging and management of gastric cancer.
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Affiliation(s)
- Pengtao Guo
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
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Kusano T, Shiraishi N, Shiroshita H, Etoh T, Inomata M, Kitano S. Poor prognosis of advanced gastric cancer with metastatic suprapancreatic lymph nodes. Ann Surg Oncol 2013; 20:2290-5. [PMID: 23299769 PMCID: PMC3675275 DOI: 10.1245/s10434-012-2839-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Indexed: 12/14/2022]
Abstract
Background Whether gastrectomy with D2 lymphadenectomy improves survival of patients with advanced gastric cancer (AGC) remains controversial. Few studies have described the pathological features of AGC with metastatic suprapancreatic lymph nodes (LN), which are the target of D2 lymphadenectomy. This study therefore aims to clarify the prognosis and clinical pathological features including the number and location of metastatic LN in AGC with metastatic suprapancreatic LN. Methods 406 patients with AGC, who underwent gastrectomy with D2 lymphadenectomy from 1982 to 2007 at Oita University, were reviewed retrospectively with regard to presence or absence of metastatic suprapancreatic LN. The pathological factors associated with AGC with metastatic suprapancreatic LN were examined by univariate and multivariate analysis. Results Of 362 patients with AGC, 78 had suprapancreatic LN metastasis (21.5 %), differing significantly in terms of presence of vascular invasion and having a larger number of metastatic perigastric LN in comparison with only metastatic perigastric LN on univariate analysis. According to multivariate analysis, they were associated with presence of vascular invasion and a large number of total metastatic LN (more than two; N2≤). The overall 5-year survival rate of the AGC with perigastric LN metastasis (station 1–7) group was 37.9 % and of the AGC with suprapancreatic LN metastasis group was 12.8 %. There were significant differences in each group (P < 0.05). Conclusions Patients with AGC with metastatic suprapancreatic LN had a large number of total metastatic LN and poor prognosis, suggesting that it may be a systemic disease.
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Affiliation(s)
- Toru Kusano
- Department of Gastroenterological Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan.
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Jeong JY, Kim MG, Ha TK, Kwon SJ. Prognostic factors on overall survival in lymph node negative gastric cancer patients who underwent curative resection. J Gastric Cancer 2012; 12:210-6. [PMID: 23346492 PMCID: PMC3543970 DOI: 10.5230/jgc.2012.12.4.210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/06/2012] [Accepted: 09/09/2012] [Indexed: 12/21/2022] Open
Abstract
Purpose To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. Materials and Methods Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. Results There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph node-positive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (≥59, hazard ratio, 2.882), and carcinoembryonic antigen level (≥5 ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. Conclusions Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.
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Affiliation(s)
- Ji Yun Jeong
- Department of Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Wang HM, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J. Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach. World J Gastroenterol 2012; 18:5470-5475. [PMID: 23082065 PMCID: PMC3471117 DOI: 10.3748/wjg.v18.i38.5470] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 05/07/2012] [Accepted: 05/13/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate Kaplan-Meier survival analysis and multivariate Cox's proportional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC = 0.795, 95%CI: 0.751-0.839, P = 0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size < 4.8 cm). Tumor size was significantly correlated with histological type (P = 0.039), Borrmann type (P = 0.000), depth of tumor invasion (P = 0.000), lymph node metastasis (P = 0.000), tumor-nodes metastasis stage (P = 0.000), mean number of metastatic lymph nodes (P = 0.000) and metastatic lymph node ratio (P = 0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P = 0.000). Univariate analysis showed that depth of tumor invasion (χ² = 69.581, P = 0.000), lymph node metastasis (χ² = 138.815, P = 0.000), tumor size (χ² = 78.184, P = 0.000) and metastatic lymph node ratio (χ² = 139.034, P = 0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P = 0.000), lymph node metastasis (P = 0.019) and tumor size (P = 0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P < 0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT2-3N0-2 stage tumors (P > 0.05). CONCLUSION Using a tumor size cutoff value of 4.8 cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.
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Im WJ, Kim MG, Ha TK, Kwon SJ. Tumor size as a prognostic factor in gastric cancer patient. J Gastric Cancer 2012; 12:164-72. [PMID: 23094228 PMCID: PMC3473223 DOI: 10.5230/jgc.2012.12.3.164] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 01/18/2023] Open
Abstract
PURPOSE The purpose of this study is to investigate the prognostic significance of tumor size for 5-year survival rate in patients with gastric cancer. MATERIALS AND METHODS A total of 1,697 patients with gastric cancer, who underwent potentially curative gastrectomy, were evaluated. Patients were divided into 4 groups as follows, according to the median size of early and advanced gastric cancer, respectively: small early gastric cancer (tumor size ≤3 cm), large early gastric cancer (tumor size >3 cm), small advanced gastric cancer (tumor size ≤6 cm), and large advanced gastric cancer (tumor size >6 cm). The prognostic value of tumor size for 5-year survival rate was investigated. RESULTS In a univariate analysis, tumor size is a significant prognostic factor in advanced gastric cancer, but not in early gastric cancer. Multivariate analysis showed that tumor size is an independent prognostic factor for 5-year survival rate in advanced gastric cancer (P=0.003, hazard ratio=1.372, 95% confidence interval=1.115~1.690). When advanced gastric cancer is subdivided into 2 groups, according to serosa invasion: Group 1; serosa negative (T2 and T3, 7th AJCC), and Group 2; serosa positive (T4a and T4b, 7th AJCC), tumor size is an independent prognostic factor in Group 1 (P=0.011, hazard ratio=1.810, 95% confidence interval=1.149~2.852) and in Group 2 (P=0.033, hazard ratio=1.288, 95% confidence interval=1.020~1.627), respectively. CONCLUSIONS Tumor size is an independent prognostic factor in advanced gastric cancer irrespective of the serosa invasion, but not in early gastric cancer.
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Affiliation(s)
- Won Jin Im
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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Shinohara S, Korenaga D, Edagawa A, Koushi K, Itoh S, Kawanaka H, Eguchi D, Kawasaki K, Okuyama T, Ikeda Y, Takenaka K. Significant prognostic factors in patients with Stage IV gastric cancer with special reference to the curability of surgery. Surg Today 2012; 43:40-7. [PMID: 22743702 DOI: 10.1007/s00595-012-0230-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 10/17/2011] [Indexed: 02/07/2023]
Abstract
PURPOSES The purpose of this study was to determine an effective treatment strategy for patients with Stage IV gastric cancer. METHODS We analyzed the significant prognostic factors in 74 patients who underwent surgery between 1989 and 2005, and were finally determined to have Stage IV gastric cancer. These patients were classified as curability A (n = 0), B (n = 29) and C (n = 45) according to the criteria outlined by Japanese Gastric cancer society. Anti-tumor drugs were used after surgery in some cases. There were 32 patients who received either no treatment or an oral anti-tumor drug, and 42 patients who received new chemotherapeutic regimens. RESULTS According to a univariate analysis, the postoperative mean survival times were significantly different; tumor size ≤ 12 cm, a tumor without lymphatic involvement, more than D2 lymphadenectomy, and classification as curability B were favorable prognostic factors. The multivariate analysis revealed that tumor size, lymphadenectomy and curability were independent prognostic factors. In curability B patients, venous involvement was an independent prognostic factor. In curability C patients, both the tumor size and postoperative chemotherapy affected their prognosis. CONCLUSIONS In patients with curable Stage IV gastric cancer, at least a D2 gastrectomy to reduce the absolute volume of tumor cells, followed by adjuvant chemotherapy, may be essential to improve their prognosis. In incurable cases, aggressive new chemotherapeutic regimens should be the treatment of choice for the prolongation of survival.
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Affiliation(s)
- Shinji Shinohara
- Department of Surgery, Fukuoka City Hospital, 13-1 Yoshizuka-honmachi, Hakata-ku, Fukuoka 812-0046, Japan.
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Sung CO, Lee SM, Choi JS, Kim KM, Choi MG, Noh JH, Sohn TS, Bae JM, Kim WH, Park CK, Kim S. Tumor size predicts survival in mucinous gastric carcinoma. J Surg Oncol 2012; 106:757-64. [PMID: 22535583 DOI: 10.1002/jso.23141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/09/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mucinous gastric carcinoma (MGC) is a distinct histologic subtype of gastric cancer. However, the prognostic significances of the current TNM staging system and histology in MGC have not been studied. METHODS 206 patients who underwent R0 resection for MGC were classified by tumor size (<3 cm as T1; ≥ 3-5 cm as T2; ≥ 5-9 cm as T3; and ≥ 9 cm as T4). Immunohistochemistry for EGFR and HER2 was also performed. RESULTS Tumor sizes ranged from 1.2 to 21.0 cm (median 6.2 cm). Large tumor size (≥ 5 cm) was significantly associated with older patient age, deeper invasion depth, and more frequent lymph node metastasis (P < 0.05). Tumor size was a significant prognostic factor in both univariate (P < 0.001) and multivariate (P < 0.04) analyses. However, depth of invasion was not significant in multivariate analyses. A modified staging system based on tumor size predicted survival more accurately than did the conventional TNM staging system. We verified our results in an independent validation cohort of 123 MGC patients. Overexpression of either EGFR or HER2 was rare. CONCLUSIONS In MGCs, tumor size is an independent prognostic factor and a modified TNM system based on tumor size predicted survival accurately.
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Affiliation(s)
- Chang Ohk Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chung Y, Law S, Kwong DLW, Luk JM. Serum soluble E-cadherin is a potential prognostic marker in esophageal squamous cell carcinoma. Dis Esophagus 2011; 24:49-55. [PMID: 20807231 DOI: 10.1111/j.1442-2050.2010.01093.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
E-cadherin is a well-documented tumor suppressor with downregulated expression in many cancer types. Upon proteolytic cleavage, a soluble form of 80-kDa degradation fragment, known as soluble E-cadherin (s-Ecad), is present in circulation; its level in sera of cancer patients is significantly associated with metastasis, recurrence, and prognosis in some malignancies. The present study investigated the association of s-Ecad with clinicopathological characteristics of patients with esophageal squamous cell carcinoma (ESCC) and its prognostic significance. A cohort of 97 patients who underwent surgery alone (n= 56) or neoadjuvant chemoradiation therapy and surgery (CRT) (n= 41) was recruited for this study. Serum samples were collected at operation (surgery group) and pre- and post-CRT treatment (CRT group) for measurement of s-Ecad protein by enzyme linked immunosorbent assay. Serum s-Ecad levels were correlated with clinicopathological parameters as well as survival. Univariate analysis showed no significant relationship between serum s-Ecad level and clinicopathological parameters for all sets of samples. Survival analysis showed that in patients who had surgical resection only, those with s-Ecad levels equal to or below the median value survived significantly longer than those with levels above the median (median survival 25.6 vs. 14.1 months, P= 0.012). Multivariate analysis showed that pathological N stage, M stage, R category, and serum s-Ecad level were significant independent prognostic factors for ESCC patients who underwent surgery only. The hazard ratio for s-Ecad was 1.104 (95% CI: 1.026-1.187) and P= 0.008. Serum s-Ecad was detected in ESCC patients and its potential as an independent prognostic marker requires further investigation.
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Affiliation(s)
- Y Chung
- Department of Surgery, Division of Esophageal and Upper Gastrointestinal Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Chiang Y, Song Y, Wang Z, Chen Y, Yue Z, Xu H, Xing C, Liu Z. Aberrant expression of miR-203 and its clinical significance in gastric and colorectal cancers. J Gastrointest Surg 2011; 15:63-70. [PMID: 21063914 DOI: 10.1007/s11605-010-1367-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 10/19/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND MicroRNAs (miRNAs) are small, non-coding RNAs of endogenous origin, they have been increasingly shown to have aberrant expression in many tumor types. miR-203 has not been comprehensively investigated in gastric and colorectal cancers. METHODS Total RNA was extracted from tissues of 212 patients with gastric or colorectal cancer as well as from seven gastric and colorectal cell lines. We determined the expression of miR-203 by real-time PCR and calculated using the 2-ΔΔCt method. Then, we assessed miR-203 expression and clinicopathologic characteristics. Finally, we studied the effect of miR-203 on cell proliferation in SGC-7901 cells by MTT. RESULTS miR-203 has significantly low expression in colorectal cancer tissues (p < 0.001, paired t test) and cancer cell lines compared to non-tumor counterparts. Moreover, low expression of miR-203 was correlated with tumor size (p = 0.015, non-parametric test) and pT stage (p = 0.005) in colorectal cancer. Although expression of miR-203 was not significant in gastric cancer tissues (p = 0.124), interestingly, miR-203 was correlated with tumor size (p = 0.023), macroscopic type (p = 0.045), and pT stage (p = 0.013). Furthermore, we found miR-203 can inhibit the cell proliferation in SGC-7901 cells. CONCLUSION miR-203 may be related to the proliferation and invasion of gastric and colorectal cancers.
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Affiliation(s)
- Yeunpo Chiang
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
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