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.
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.
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.
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 summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
Objective To analyze risk factors of lymphatic metastasis in early gastric cancer in order to discuss reasonable therapeutic regimen. Methods The clinical data of 148 patients with early gastric cancer surgically treated in the Anhui Tumor Hospital from February 2013 to November 2017 were retrospectively analyzed. The relationship between the lymphatic metastasis with the clinicopathologic characteristics of the patient with the early gastric cancer was analyzed by the univariate and multiple regression analyses. Results The lymphatic metastasis were observed in 15 of 148 patients (10.14%), 1 in the 70 (1.43%) mucosal lesions and 14 in the 78 (17.95%) submucosal lesions. The results of the univariate analysis showed that the patients’ age, size of tumor, macroscopic type, invasion depth, and vascular invasion were related to the lymphatic metastasis in the early gastric cancer (P<0.050), the results of the multiple regression analysis showed that the invasion depth and vascular invasion were the independent risk factors of the lymphatic metastasis in the early gastric cancer (P<0.050). Conclusions Invasion depth and vascular invasion are closely related to lymphatic metastasis in early gastric cancer. Precise evaluation of lymphatic metastasis before treatment is very important to patient with early gastric cancer.
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.