Objective To provide a current language for clinical and pathological discription of gastric cancer. Methods The literature in recent years on the distribution of lymph nodes and staging of gastric cancer were reviewed. Results The lymph nodes of gastric cancer are distributed near the blood vessel and organs of gastric milieu. To ensure radical gastrectomy rational and scientific, the anatomic structure of gastric milieu should be familiarized. Conclusion The excellent outcome of surgery will be achieved by the effective dissection and removel of lymph nodes in gastric cancer.
ObjectiveTo investigate the expression of keratinocyte growth factor (KGF) and cyclooxygen-ase-2 (COX-2) protein and microvessel density (MVD), and to explore their function and mechanism in the multistep process of gastric cancer. MethodsThe expressions of KGF and COX-2 protein in 64 samples of gastric cancer and 30 cases of normal gastric mucosa tissues were detected by immunohistochemistry. The MVD was detected by staining the endothelial cells in microvessles using anti-CD34 antibody. ResultsThe positive rate of KGF and COX-2 protein expression in gastric cancer were 65.6% (42/64) and 79.7% (51/64), respectively, which was significantly higher than that in normal gastric mucosa tissues 〔(23.3%, 7/30), P=0.046; (13.3%, 4/30), P=0.008〕. The MVD of gastric cancer was 31.8±8.0, which was significantly higher than that of normal gastric mucosa tissues (14.3±6.1), P=0.000. The MVD in gastric cancer with coexpressive KGF and COX-2 protein was 35.9±5.7, which was significant higher than that with non-coexpressive KGF and COX-2 protein (25.7±7.0), P=0.000. Both the expression of KGF and COX-2 protein were related to the invasion of serosa, lymph node metastasis and TNM staging (Plt;0.05, Plt;0.01). The MVD of gastric cancer tissues was related to lymph node metastasis and TNM staging (Plt;0.05), but unrelated to patient’s age, gender, and differentiation of tumor (Pgt;0.05). The co-expression of KGF and COX-2 protein was frequently found in patients with deeper invasion of serosa, lymph node metastasis, and higher TNM staging (Plt;0.05), but which was not associated withpatient’sage, gender, and differentiation of tumor (Pgt;0.05). The expression of KGF protein was positively correlated to the expression of COX-2 protein (r=0.610, P=0.000). There was positive correlation between MVD and the expression of KGF (r=0.675, P=0.000) and COX-2 protein (r=0.657, P=0.000) in gastric cancer, respectively. ConclusionKGF and COX-2 highly expressed by gastric cancer, which may be involved in the invasion and metastasis of gastric cancer by synergisticly promoting the angiogenesis.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
To investigate the relationship between clinicopathological features and lymph node metastasis in the primary gastric cancer and affer the basis for deciding appropriate extent of lymph node dissection, a total of 192 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively. Result: The total rate of lymph node metastasis was 60.4%, with 28.9% of the resected lymph nodes involved. The lymph node metastasis of C, M, A region and the whole stomach were 64.6%, 57.7%, 59.1% and 90.9% respectively. The rates of the lymph node metastasis increased successively in carcinoma of early, middle and late stages (Ｐ＜0.05), the rate of the infiltrative tumor (Borr Ⅲ，Ⅳ) being 76.5% which was significantly higher than that of the circumscribed tumor (Borr Ⅰ，Ⅱ) (43.2%)。 Relating with the tumor size ＜4cm in diameter showed lesser rate, while 4-8 cm and ＞8cm in diameter showed increasingly higher metastaticrate (Ｐ＜0.01). As a result, we should decide the appropriate extent of lymph node dissection during the operation on the basis of clinicopathological stages, type of Borrmann’s, site and maximum diameter of gastric cancer along with the state of lymph node metastasis in carcinoma of different region of the stomach.
ObjectiveTo study and analyse the correlation between biologic behavior and clinical factors in gastric cancer.MethodsClinical and pathological study of carcinoma of stomach were retrospectively made in 1034 patients. ResultsIn this series,148 of 1034 patients (14.3%) were early gastric cancer.The frequency of lymph nodes metastasis was higher in proximal gastric cancer than distal (P＜0.0001).Similar frequency can also be seen in the tumor of larger diameter (P＜0.01),deeper invasion (P＜0.0001) and poor differentiation (P=0.004).Some difference in ages and sex of patients may be found on the invasion (P=0.003),differentiation (P＜0.0001),site (P＜0.001) and frequency of lymph nodes metastasis of the tumor (P=0.01).In multifactorial multivariate linear regression analysis,the site of tumor (P=0.003),diameter of tumor (P＜0.0001),depth of tumor infiltration (P＜0.0001) and the cell differentiation showed significant association with lymph node metastasis,in which the female patient had more lymph node metastasis than male (P＜0.001).Depth of tumor infiltration was the most important factor in lymph node metastasis.Numbers of lymph nodes resected were much more in total and distal gastrectomies than that in proximal gastrectomy (P＜0.0001). ConclusionThe results of this study suggest that radical gastrectomy with lymphadenectomy is necessary even in all stages of gastric cancer.
Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used in clinical setting, and is one of the optional treatment for peritoneal surface tumors. It can be used as adjuvant therapy to prevent peritoneal recurrence after gastric or colorectal cancer resection, or to treat those diseases with peritoneal metastasis alone through cytoreductive surgery +HIPEC or HIPEC alone, based on a multidisciplinary model. The updates of European HIPEC-related clinical trials, GASTRIPEC, GASTRICHIP, PRODIGE 7, PROPHYLOCHIP, COLOPEC, COMBATAC, were reported at the 11th International Workshop on Peritoneal Surface Malignancy. In those trials, there was no definitive result surporting that HIPEC treatment might bring survival benefits to patients with gastric or colorectal cancer. However, long-term follow-up results remain to be seen, and some studies are still recruiting. Although several studies were designed as phase Ⅲ trials, the overall sample size was small-scaled. In addition, in the trials, diagnostic laparoscopy were widely used in gastric or colorectal cancer patients, which was helpful to improve staging accuracy and optimizing treatment strategies. The indications for HIPEC therapy (peritoneal cancer index) and technical issues (duration, temperature, approach, and agents) need further investigate.
Objective To evaluate the rational of peritoneal warm perfusion chemotherapy after the operation. MethodsOne hundred and two patients with gastric cancer were included in this study. One hundred milliliter of peritoneal fluid were collected respectively after opening the abdomen,before closing the peritoneal cavity,and after hyperthermic peritoneal perfusion chemotherapy for free cancer cells examination. ResultsAfter opening the abdomen, the positive rate of free cancer cells was 36.3%(37/102), and the positive rate before closure of peritoneal cavity was 52.9%(54/102), 31 cases of free cancer cells were found killed after the warm perfusion chemotherapy,the effect rate was 57.4%(31/54).The free cancer cells positive rate related to the tumor infiltration depth, serous membrane invasion area and the type of histopathology. Conclusion In the peritoneal cavity of patients with gastric cancer, free cancer cells are able to survive and have a high degree of activity. Hyperthermic peritoneal perfusion chemotherapy is an effective method to kill free cancer cells.
【Abstract】 Objective To investigate the relationship between methylation of tumor suppressor gene and gastric cancer. Methods The literatures in recent years about the concept of methylation, its biological significance and the relationship between DNA methylation/demethylation and gastric cancer were reviewed. The effects of methylation of different tumor suppressor genes on gastric cancer were also analyzed. Results The effect of aberrant methylation on the development and the progression of gastric cancer was still unclear but it was supposed that the inactivation of genes related with cell cycle regulation, mitotic checkpoint, apoptosis, DNA mismatch repair, metastasis suppression and so on might be attributable to the aberrant methylation in gastric cancer. Conclusion Aberrant methylation of tumor suppressor genes plays an important role in the development and progression of gastric cancer. The status of methylation of tumor suppressor genes may be used as a useful molecule marker for diagnosis, assessing metastasis and evaluating prognosis, and demethylation could possibly be a new therapy for gastric cancer.