Objective To investigate pattern of lymph node metastasis (LNM) in patient with early gastric cancer (EGC) and it’s relation to clinicopathologic features so as to providing evidence for proper clinical management for EGC. Method The clinical and pathologic data of 101 EGC patients who were diagnosed and treated in the West China Hospital of Sichuan University from January 2011 to December 2012 were retrospectively analyzed. Results The LNM was found in the 28 patients, the rate of the LNM was 27.7% (28/101). In the univariate analysis, the LNM was associated with the macroscopic type (P=0.013), depth of invasion (P<0.001), differentiation type (P=0.044), and lymphovascular invasion (P=0.020); In the multivariate logistic regression analysis, the factors including of the macroscopic type (RR=4.742, P=0.009), differentiation type (RR=6.369, P=0.011), and depth of invasion (RR=15.218, P<0.001) were the independent risk factors for the LNM. Twenty-eight patients with LNM had only 1 positive lymph node, 4 patients had more than 7 positive lymph nodes. The No.6 lymph node was the most frequently involved station (35.7%, 10/28). The LNMs in the 69.7% (19/28) patients were restricted in the extent of the D1 lymphadenectomy, 3 (10.7%) patients without the perigastric lymph node involvement had the No.8a or No.9 LNM. Conclusion LNM in patient with EGC is correlated with clinicopathologic features such as macroscopic type, depth of invasion, differentiation type, and lymphovascular, further investigation is warranted to clarify risk factors of LNM in patient with EGC.
Objective To investigate the expression of cell division regulators p16, Rb and cyclin D1 in human early gasric carcinoma tissues and their role in tumor transformation and the correlation among p16, Rb and cyclin D1. MethodsA comparative study was carried out by using immuno-histochemical techniques between the paracarcinomatous intestinal metaplasia of 39 cases of early gatric carcinoma and the non-carcinomatous gastric mucosal intestinal metaplasia tissues of 34 cases.ResultsOver expression of cyclin D1 was determined in 33/39 carcinomatous samples(84.6%) and also in para-carcinomatous intestinal metaplasia tissues. p16 was undetectable in 12 of 39 samples. Interestingly, 15 of 26 Rb positive cancers had no or low p16,while 9 Rb negative cancers showed high levels of p16.Conclusion The over expression of cyclin D1 may be a common molecular abnormality and an early molecular event in early gastric carcinoma. Cyclin D1 over expression and Rb inactivation can co-exist in early gastric carcinoma. However, there is a reciprocity between Rb inactivation and p16 expression in early gastric carcinoma. Thus, abnormality in the negative feedback regulatory pathway of cyclin D1,Rb and p16 may be related to the tumorigenesis in early gastric carcinoma.
With the promotion of health awareness and the improvement of gastroscopy examination technology, the detection rate of early gastric cancer in our country had gradually increased. The early gastric cancer had a favorable prognosis and long-term survival. Improving the postoperative quality of life of patients with early gastric cancer had become one of the important directions in gastric cancer research. Under the premise of ensuring tumor radical resection, preserving partial gastric remnant function had become a hot topic in the treatment of early gastric cancer. Function preserving gastrectomy for early gastric cancer mainly included segmental gastrectomy, proximal gastrectomy, and local gastrectomy, among others. The author summarized the important research progress in function preserving gastrectomy at home and abroad in recent years, as well as the practical experiences of this center, aiming to provide reference for clinical surgeons to better carry out this type of surgery.
ObjectiveTo explore the risk factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC), and try to establish a risk prediction model for LNM of EGC.MethodsThe clinicopathologic data of EGC patients who underwent radical gastrectomy and lymph node dissection from January 1, 2015 to December 31, 2019 in this hospital were retrospectively analyzed. Univariate analysis and logistic regression analysis were used to determine the risk factors for LNM of EGC, and the risk prediction model for LNM of EGC was established based on the multivariate results.ResultsA total of 311 cases of EGC were included in this study, and 60 (19.3%) cases had LNM. Univariate and multivariate analysis showed that age (younger), depth of tumor invasion (submucosa), vascular invasion, and undifferentiated carcinoma were the risk factors for LNM of EGC (P<0.05). The optimal threshold for predicting LNM of EGC was 0.158 (area under the receiver operating characteristic curve was 0.864), the sensitivity was 80.0%, and the specificity was 79.3%.ConclusionsFrom results of this study, risk factors for LNM of EGC have age, depth of invasion, vascular invasion, and differentiation degree. Risk prediction model for LNM of EGC established on this results has high sensitivity and specificity, which could provide some references for treatment strategy of EGC.
ObjectiveTo explore the feasibility and clinical efficacy of laparoscopic sentinel lymph node biopsy combined with endoscopic submucosal dissection(ESD) for patients with early gastric cancer(EGC). MethodsThe clinical data of 26 cases who received ESD combined with laparoscopic sentinel lymph node biopsy for EGC between March 2009 to August 2013 in Affiliated Hospital of Jiangnan University were analyzed retrospectively. These patients first underwent laparoscopic sentinel lymph node(SLN) biopsy. If frozen sectioning examination suggested there was lymph node metastasis, laparoscopic D2 radical gastrectomy would be operated. However, the ESD would be operated if the frozen sectioning examination was negative. ResultsThe total numbers of SLN were 95, and mean numbers of SLN were 3.7±1.4(range from 1 to 6). Two patients with positive SLN underwent laparoscopic-assisted distal gastrectomy and 24 patients with negative SLN underwent ESD. The disease free survival(DFS) and local recurrence rate after ESD for EGC was 91.7%(22/24) and 4.2%(1/24), respectively. And the total DFS for all patients was 96.2% (25/26). ConclusionESD for EGC is a safe and feasible procedure, combined with laparoscopic sentinel lymph node biopsy conforms more to the concept of principle of radical operation.
ObjectiveTo investigate the risk factors of lymph node metastasis for early distal gastric signet ring cell cancer and indications of radical surgery.MethodsFrom Mar. 2013 to Nov. 2018, a total of 91 early gastric cancer patients who accepted radical gestrectomy and regional lymph node dissection, and proved postoperatively for early distal gastric signet ring cell cancer in the First Affiliated Hospital of Soochow University were enrolled in this study. We collected clinicpathologic characteristics, such as gender, age, maximum diameter of tumor, number of lesions, depth of invasion, macroscopic type, and lymphovascular invasion, to explore the risk factors of lymph node metastasis and further analyze the indication of radical surgery.ResultsAll 91 patients accepted radical gestrectomy and regional lymph node dissection, 10 patients suffered from lymph node metastasis. Univariate analysis showed a positive relationship between maximum diameter of tumor (χ2=5.631, P=0.025), depth of invasion (χ2=4.389, P=0.016), number of lesions (χ2=5.615, P=0.023), and lymphovascular invasion (χ2=22.500, P=0.001) and lymph node metastasis of early distal gastric signet ring cell cancer. The multivariate analysis revealed that maximum diameter of tumor (OR=3.675, P=0.012), depth of invasion (OR=3.886, P=0.015), and lymphovascular invasion (OR=8.711, P<0.001) were independent risk factors of lymph node metastasis.ConclusionsThe risk of lymph node metastasis of early distal gastric signet ring cell cancer was high in those with tumor diameter≥2 cm, submucosal cancer, and lymphovascular invasion. Radical surgery might be necessary in cases of early distal gastric signet ring cell cancer that satisfying one of the following criteria: tumor diameter≥2 cm and lymphovascular invasion.
ObjectiveTo investigate the relationship between clinicopathological characteristics and invasion depth of early gastric cancer (EGC), in order to put forward suitable regimens for EGC with different clinicopathological characteristics. MethodsThe clinicopathological data of 18 patients with EGC diagnosed from January 2008 to January 2013 were retrospectively analyzed. Clinicopathologic variables such as age, gender, tumor size and location, Helicobacter pylori infection, melaena, macroscopic type, and histopathological type were investigated by using chi-square test for their possible relationship with the depth of invasion. ResultsLymph node metastasis was more common in patients with submucous cancer (3/9, 33.3%) than in those with mucous cancer (0/9, 0%). Submucosal invasion was found in 77.8% (7/9) of undifferentiated adenocarcinoma cases, whereas only 22.2% (2/9) of differentiated adenocarcinoma had submucosal invasion. TypeⅢ EGC had a significant association with submucosal invasion (P<0.05). ConclusionEndoscopic treatment is unsuitable for patients with Type Ⅲ EGC.
Objective To study the relationship between early gastric cancer and MiB-1 expression. Methods Resected early gastric cancer from 99 cases were studied by immunohistochemical method. Results MiB-1 proliferation index (MiB-1 PI) was related to patient ’s age, tumor size, location and depth of invasion. MiB-1 PI was higher in differentiated adenocarcinomas than in undifferentiated adenocarcinomas(P＜0.01). Cancers with lymphatic vessel invasion or lymph node metastasis had higher MiB-1 PI (P＜0.05). The postoperative survival was related to MiB-1 proliferation grade (MiB-1 PG), being higher in MiB-1 PG 1,2 grade than that in MiB-1 PG 3,4 grade. Conclusion Even in the early stage of gastric cancer, tumor proliferation activity was related to patients’ prognosis.