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Preoperative predictors of beyond endoscopic submucosal dissection indication or lymphovascular invasion in endoscopic resection for early gastric cancer. Surg Endosc 2017; 32:2948-2957. [PMID: 29280013 DOI: 10.1007/s00464-017-6009-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/06/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND To successfully resect early gastric cancer (EGC), prediction of lymph node metastasis is essential. Beyond endoscopic submucosal dissection (ESD) indication or lymphovascular invasion (LVI) are known risk factors associated with lymph node metastasis. However, accurate prediction of tumor invasion depth or LVI is impossible before endoscopic resection even when endoscopic ultrasound is used. The aim of this study was to identify the predictive factors associated with beyond ESD indication or LVI after ESD for EGC. METHODS Between Jan 2011 and Feb 2015, 532 lesions from 506 patients who received ESD for EGCs were included. We reviewed the data of patients diagnosed as EGCs without ulceration or those smaller than 3 cm with ulceration. RESULTS The incidence of EGCs found to be beyond expanded ESD indications or present of LVI after ESD was 11.1% (59/532). On multivariable analysis, endoscopic features of SM invasion, surface color changes, and elevated lesions were associated with beyond ESD indication or LVI. In particular, submucosal (SM) invasive features such as SM tumor-like marginal elevation [odds ratio (OR) 17.2; 95% confidence interval (CI) 2.0-146.7], fusion of convergent folds (OR 12.9; 95% CI 3.9-42.1), irregular surface (OR 17.8; 95% CI 5.6-56.8), and discoloration of the tumor surface (OR 16.1; 95% CI 2.4-105.9) were significant risk factors for beyond ESD indication or LVI. CONCLUSIONS The decision to proceed with endoscopic resection for EGCs with endoscopic features of SM invasion, surface color changes, or elevated forms must be made cautiously.
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Irino T, Takeuchi H, Terashima M, Wakai T, Kitagawa Y. Gastric Cancer in Asia: Unique Features and Management. Am Soc Clin Oncol Educ Book 2017; 37:279-291. [PMID: 28561675 DOI: 10.1200/edbk_175228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gastric cancer (GC) poses a burden to patients across the globe as the third leading cause of cancer deaths worldwide. Incidence of GC is particularly high in Asian countries, which is attributed to the prevalence of Helicobacter pylori (H. pylori) infection and has prompted the establishment of unique treatment strategies. D2 gastrectomy, which was established in the 1950s in Japan, has served as a gold standard for locally advanced GC for over half a century. Since the beginning of the 21st century, endoscopic resection (ER) techniques and minimally invasive laparoscopic surgery have greatly changed the treatment of patients with early GC. S-1, which showed a striking survival benefit in a large randomized trial in Japan, has been used as adjuvant therapy for the last decade. Likewise, S-1-based chemotherapy regimens are currently the standard of care for the treatment of unresectable/metastatic GC in Asia. Along with the development of standardized therapy, novel techniques and new drugs have been rapidly brought into clinical practice. State-of-the-art sentinel node (SN) navigation surgery enables clinicians to perform truly minimally invasive surgery for early GC, and appropriate chemotherapy regimens are now determined by a tumor's molecular expression. New classifications based on gene signatures are proposed and may replace conventional clinical classifications. Such highly individualized treatment has the potential to alter our clinical practice in GC in the near future. The best practice in each geographic region should be shared and integrated, resulting in the best practice without borders.
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Affiliation(s)
- Tomoyuki Irino
- From the Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroya Takeuchi
- From the Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Terashima
- From the Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Toshifumi Wakai
- From the Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- From the Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan; Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Yoon HM, Kim CG, Lee JY, Cho SJ, Kook MC, Eom BW, Ryu KW, Kim YW, Choi IJ. Non-exposure simple suturing endoscopic full-thickness resection (NESS-EFTR) versus laparoscopic wedge resection: a randomized controlled trial in a porcine model. Surg Endosc 2017; 32:2274-2280. [PMID: 29101561 DOI: 10.1007/s00464-017-5921-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current endoscopic full-thickness resection (EFTR) methods produce transmural communication and expose the tumor to the peritoneum. An EFTR method with a simple suturing technique that does not expose the gastric mucosa to the peritoneum (non-exposure simple suturing, NESS) was recently developed. To date, there have been no prospective studies that compare EFTR with laparoscopic wedge resection in human or animal. The aim of this study was to compare outcomes between NESS-EFTR and laparoscopic wedge resection (LWR) using the linear staplers in a randomized animal study. METHODS NESS-EFTR includes steps of laparoscopic seromuscular suturing, EFTR of the inverted stomach wall, and endoscopic mucosal suturing with endoloops and clips. Sixteen pigs underwent NESS-EFTR (n = 8) or LWR (n = 8). The resected locations were the cardia, fundus, upper body anterior and greater curvature, antrum lesser and greater curvature side. The pigs were killed 3 weeks after surgery. Rates of successful complete resection (en-bloc resection with clear margins), successful closure, and complications were evaluated. RESULTS The complete resection rates in the NESS-EFTR and LWR groups were 100 and 75%, respectively (P = 0.467). All wounds were successfully closed in both groups. Resected tissues were significantly larger in the LWR group (mean ± SD: 8.0 ± 0.8 cm vs. 4.4 ± 0.5 cm, P < 0.001). Procedure time was significantly shorter in the LWR group (31.7 ± 10.0 min vs. 118.1 ± 23.4 min, P < 0.001). Early deaths due to complications only occurred in the LWR group (a leakage at cardia and a stenosis at the antrum lesser curvature side). CONCLUSIONS Incomplete resection and complications were occurred in only LWR group. NESS-EFTR was feasible and safe in animal.
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Affiliation(s)
- Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea.
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
| | - Soo-Jeong Cho
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea
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Kong SH, Kim TH, Huh YJ, Oh SY, Ahn HS, Park SY, Choi YS, Suh YS, Lee HJ, Yang HK. A Feasibility Study and Technical Tips for the Use of an Articulating Bipolar Vessel Sealer in da Vinci Robot-Assisted Gastrectomy. J Laparoendosc Adv Surg Tech A 2017. [DOI: 10.1089/lap.2017.0093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Han Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeon Ju Huh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - So Yong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yun Suk Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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105
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Serial intermediate-term quality of life comparison after endoscopic submucosal dissection versus surgery in early gastric cancer patients. Surg Endosc 2017; 32:2114-2122. [DOI: 10.1007/s00464-017-5909-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/03/2017] [Indexed: 12/14/2022]
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Choo JW, Ju Y, Lim H, Youn SH, Soh JS, Park JW, Kang HS, Kim SE, Moon SH, Kim JH, Park CK, Ha HI, Kim MJ, Kim KC, Cho JW. Is it beneficial to perform surgical resection in elderly patients more than 80 years old with advanced gastric cancer? Scand J Gastroenterol 2017. [PMID: 28639835 DOI: 10.1080/00365521.2017.1339828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES With the aging population, the number of elderly patients diagnosed with gastric cancer is increasing. However, determining treatment strategies for elderly patients with gastric cancer is controversial. The aim of this study is to evaluate the usefulness of surgical treatment on elderly patients aged ≥80 years with advanced gastric cancer. METHODS A total of 147 elderly patients who were diagnosed with advanced gastric cancer from August 2001 to December 2015 were retrospectively analyzed. We compared the clinicopathological features and prognoses of 94 elderly patients (80-85 years) and 53 extreme-elderly patients (≥86 years) according to treatment modalities. RESULTS In the elderly group, the 3-year overall survival (OS) rates of the surgical resection group and supportive care group were 42.1% and 4.0%, respectively (p < .001). In the extreme-elderly group, the 3-year OS rates of the surgical resection group and supportive care group were 36.4% and 8.0%, respectively (p = .028). The post-operative mortality rate of the elderly group and extreme-elderly group was 5.6% and 9.1%, respectively. In the analysis of risk factors associated with survival, surgical resection was a significantly good prognostic factor in the elderly group (hazard ratio [HR] = 0.277; p = .003) compared with supportive care. In the extreme-elderly group, surgical resection was associated with good prognosis but did not reach statistical significance (HR = 0.491; p = .099). CONCLUSIONS These results suggest that elderly patients aged 80-85 years with advanced gastric cancer could expect a better prognosis with surgical resection. However, extreme-elderly patients aged ≥86 years should consider the risks and benefits of surgical treatment.
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Affiliation(s)
- Jin Woo Choo
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Yeonmi Ju
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Hyun Lim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Hee Youn
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Jae Seung Soh
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ji Won Park
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ho Suk Kang
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Eun Kim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Hoon Moon
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Jong Hyeok Kim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Choong Kee Park
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Hong Il Ha
- b Department of Radiology , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Min-Jeong Kim
- b Department of Radiology , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Kab-Choong Kim
- c Department of Surgery , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ji Woong Cho
- c Department of Surgery , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea.,d Department of Surgery , University of Hallym College of Medicine, Kangnam Sacred Heart Hospital , Seoul , Republic of Korea
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107
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Ryu DG, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ, Nam HS. Predictive factors to diagnosis undifferentiated early gastric cancer after endoscopic submucosal dissection. Medicine (Baltimore) 2017; 96:e8044. [PMID: 28885374 PMCID: PMC6392593 DOI: 10.1097/md.0000000000008044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
It is difficult to predict precisely whether the lesion corresponds to endoscopic resection indication. Furthermore, discrepancy may occur between endoscopic forceps biopsy (EFB) and finally resected specimen, which may be diagnosed as undifferentiated cancer and additional surgery may be required. Our study aimed to evaluate predictive factors to diagnose undifferentiated cancer after endoscopic submucosal dissection (ESD).Among the 532 patients diagnosed by ESD between January 2009 and December 2015, 557 early gastric cancer (EGC) cases were studied. Factors predicting diagnosis of undifferentiated cancer and clinical outcomes of the lesions were retrospectively analyzed.Among the 557 cases with EGC, 535 (96.1%) were diagnosed as differentiated cancer and 22 (3.9%) as the undifferentiated type with ESD. Tumor size was larger (mean size 20.67 vs 13.59 mm, P < .001) and age was lower (60.24 vs 64.50 years, P < .001) in the group with undifferentiated cancer. En bloc resection rate was similar (95.5% vs 95.9%, P = .886), but the complete resection rate was lower (72.7% vs 92.4%, P < .001) in the group with undifferentiated cancer. On multivariate analysis, tumor size ≥10 mm (OR = 11.340, P = .032), age <55 years (OR = 5.972, P = .004), surface redness (OR = 11.562, P = .024), and whitish discoloration (OR = 35.368, P < .001) were predominantly associated with undifferentiated cancer.Young age (<55 years), large tumor size (≥10 mm), surface redness, and whitish discoloration are predictors of undifferentiated cancer, and lesions with these features detected need to be treated cautiously.
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108
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Clinical application of early gastric carcinoma with lymphoid stroma based on lymph node metastasis status. Gastric Cancer 2017; 20:793-801. [PMID: 28205059 DOI: 10.1007/s10120-017-0703-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastric carcinoma with lymphoid stroma (GCLS) is characterized by undifferentiated carcinoma mixed with prominent lymphoid infiltration. GCLS has unique clinicopathological features and a better prognosis compared to other types of gastric cancer. We analyzed the clinicopathological features of early GCLS in relation to lymph node metastasis (LNM). METHODS We performed a retrospective analysis of 241 patients diagnosed with GCLS confined to the mucosa or the submucosa between March 1998 and December 2015. Their data were compared with those from 1219 patients who underwent resection for differentiated early gastric cancer (EGC). RESULTS Of the 241 patients analyzed, 33 (13.7%) had intramucosal cancers and 208 (86.3%) had cancers that penetrated the submucosa. Compared to differentiated EGC, early GCLS was more prevalent in younger individuals and in men, tended to be proximally located, was highly associated with Epstein-Barr virus (EBV) infection (89.2%), and had a lower risk of LNM. The 5-year disease-specific survival rate of patients with early GCLS was 98.3% but depended significantly on LNM status (p < 0.001) and EBV infection status (p = 0.039). The risk of LNM from mucosal GCLS and submucosal GCLS was 0% [95% confidence interval (CI) 0-9.1] and 10% (95% CI 6.8-15.2), respectively. On multivariate analysis, LNM was found to be associated with tumor size (p = 0.022) and lymphovascular invasion (p = 0.002) in addition to tumor depth. CONCLUSIONS Early GCLS has distinct clinicopathological features depending on age, sex, tumor location, EBV infection status, and LNM status. Tailored therapies, including endoscopic treatment, are needed based on the distinct clinicopathological features of early GCLS.
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Zhu SX, Tong XZ, Zhang S. Expression of miR-711 and mechanism of proliferation and apoptosis in human gastric carcinoma. Oncol Lett 2017; 14:4505-4510. [PMID: 29085447 PMCID: PMC5649520 DOI: 10.3892/ol.2017.6777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/10/2017] [Indexed: 12/11/2022] Open
Abstract
MicroRNAs (miRs) are involved in many aspects of cell biology, including cell proliferation and apoptosis, two critical aspects of tumor biology. We investigated the effect of miR-711 on Bcl-2 expression in human MGC803 gastric cancer cells and the mechanism of cell proliferation, apoptosis, and invasion. Expression of miR-711 and Bcl-2 was significantly increased in gastric adenocarcinoma compared to adjacent normal tissue. Inhibition of miR-711 in MGC803 gastric cancer cells decreased the expression of Bcl-2, decreased cell proliferation, decreased the invasion ability, and increased apoptosis. The expression of Bcl-2 protein correlated with clinical staging, lymph node metastasis, and tumor differentiation in patients with gastric cancer. The expression of miR-711 positively correlated with the expression of Bcl-2, suggesting that miR-711 and Bcl-2 are co-regulated and involved in the development of gastric cancer.
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Affiliation(s)
- Sheng-Xing Zhu
- Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China.,Department of The Second General Surgery, People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Xian-Zhou Tong
- Department of The Second General Surgery, People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Shuijun Zhang
- Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
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Bang CS, Park JM, Baik GH, Park JJ, Joo MK, Jang JY, Jeon SW, Choi SC, Sung JK, Cho KB. Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis. Clin Endosc 2017; 50:569-577. [PMID: 28743132 PMCID: PMC5719916 DOI: 10.5946/ce.2017.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023] Open
Abstract
Background/Aims To assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology.
Methods Cases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed.
Results From 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years).
Conclusions ER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Myung Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jong Jae Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Moon Kyung Joo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Suck Chei Choi
- Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Shin HJ, Han SU. The first step, but extra effort for better nationwide database. Transl Gastroenterol Hepatol 2017; 2:37. [PMID: 28529991 DOI: 10.21037/tgh.2017.04.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ho-Jung Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Zhu ML, Lu JX, Pan GP, Ping S, Zhao FR, Qi HT, Yu HY, Jian X, Wan GR, Li P. Traditional Chinese medicine Ka-Sai-Ping suppresses the growths of gastric cancers via induction of autophagy. Oncotarget 2017; 8:95075-95082. [PMID: 29221112 PMCID: PMC5707006 DOI: 10.18632/oncotarget.18041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022] Open
Abstract
Traditional Chinese medication is increasingly used to treat a wide range of human chronic diseases like cardiovascular diseases and cancers. This study was designed to explore whether ka-sai-ping (KSP), a novel traditional Chinese medicine developed by us, prevents gastric cancer growths and to investigate the underlying mechanism. The xenograft model of mouse gastric cancer was established by injecting MFCs into nude mouse subcutaneously. Cell autophagy was assessed by MDC staining. Lysosome and mitochondria were detected by Lyso-Tracker Red and Mito-Traker Green staining. Incubation of cultured mouse gastric cancer cell line MFCs with KSP for 48 hours, concentration-dependently reduced cell survivals and activated autophagy, which were accompanied with damaged lysosomes and mitochondria. In vivo studies indicated that KSP therapy (20 ml/kg/day) for two weeks suppressed the growth of gastric cancer, increased the protein levels of LC3-II, beclin-1, cathepsin L, bcl-2, p53, and capase-3 in tumor tissues from the xenograft model of mouse gastric cancer. Importantly, all these effects induced by KSP were abolished by co-administration of autophagy inhibitor 3-MA. In conclusion, KSP activates cell autophagy to suppress gastric cancer growths. Clinically, KSP is potentially considered as a medicine to treat patients with gastric cancer.
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Affiliation(s)
- Mo-Li Zhu
- College of Pharmacy, Xinxiang Medical University, Xinxiang, China
| | - Jun-Xiu Lu
- Department of Histology and Embryology, Xinxiang Medical University, Xinxiang, China
| | - Guo-Pin Pan
- College of Pharmacy, Xinxiang Medical University, Xinxiang, China
| | - Song Ping
- College of Pharmacy, Xinxiang Medical University, Xinxiang, China
| | - Fan-Rong Zhao
- San-Quan College of Xinxiang Medical University, Xinxiang, China
| | - Heng-Tian Qi
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital, Xinxiang Medical University, Xinxiang, China
| | - Hai-Ya Yu
- Department of Neurology, The People's Hospital of Xishui County, Huangang, Hubei, China
| | - Xu Jian
- College of Pharmacy, Xinxiang Medical University, Xinxiang, China
| | - Guang-Rui Wan
- College of Pharmacy, Xinxiang Medical University, Xinxiang, China
| | - Peng Li
- College of Pharmacy, Xinxiang Medical University, Xinxiang, China
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Gu JB, Bao XB, Ma Z. Effects of miR-21 on proliferation and apoptosis in human gastric adenocarcinoma cells. Oncol Lett 2017; 15:618-622. [PMID: 29403555 PMCID: PMC5780787 DOI: 10.3892/ol.2017.6171] [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: 10/17/2016] [Accepted: 03/14/2017] [Indexed: 11/05/2022] Open
Abstract
The present study investigated the expression of miR-21 in MGC803 gastric cancer cells and its effects on Bcl-2 expression and cell proliferation, apoptosis, and invasion. In total 50 patients were recruited with gastric cancer who were admitted to the Henan Province People's Hospital. The samples of gastric cancer and the adjacent normal tissues were collected after surgery. We found that mRNA levels of miR-21 and Bcl-2 were significantly elevated in tumor tissues compared to control tissue. The expression of Bcl-2 protein was also elevated in cancerous tissue. This high expression of Bcl-2 was associated with clinical stage, lymph node metastasis, and tumor differentiation degree. Inhibition of miR-21 reduced the levels of miR-21 and Bcl-2 in MGC803 cells, and lowered cell proliferation and invasiveness. These results indicate that miR-21 and Bcl-2 may participate in the occurrence and development of gastric adenocarcinoma, suggesting their potential role as biomarkers and therapeutic targets.
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Affiliation(s)
- Jun-Bao Gu
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Xue-Bin Bao
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Zhao Ma
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
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Marrelli D, Ferrara F, Giacopuzzi S, Morgagni P, Di Leo A, De Franco L, Pedrazzani C, Saragoni L, De Manzoni G, Roviello F. Incidence and Prognostic Value of Metastases to "Posterior" and Para-aortic Lymph Nodes in Resectable Gastric Cancer. Ann Surg Oncol 2017; 24:2273-2280. [PMID: 28405772 DOI: 10.1245/s10434-017-5857-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this retrospective study was to evaluate the incidence and prognostic value of metastases to "posterior" (8p, 12b/p, 13) and para-aortic lymph nodes in a large cohort of Western patients submitted to D2 plus lymphadenectomy. METHODS Removal of "posterior" nodes was performed in 743 patients, and para-aortic lymphadenectomy in a subgroup of 390 patients. After lymph node mapping and retrieval on the fresh specimen, a median number of 41 total lymph nodes were analyzed. The median follow-up period was 37 months for the entire series and 68 months for survivors. RESULTS Of 743 included patients, 23 (3.1%) had metastases in station 8p, 12 (1.6%) in station 12b/p, and 19 (2.6%) in station 13. On the whole, 47 of 743 patients (6.3%) had positive "posterior" nodes. Para-aortic metastases were present in 42 of 390 patients (10.8%). Metastases to "posterior" stations were significantly related to depth of invasion, number of positive nodes, and surgical radicality. Distal tumors showed higher trend to metastasize to "posterior" nodes than upper third, whereas for para-aortic metastases it was the reverse. 5-year survival in patients with positivity to "posterior" nodes was 17%, with no significant difference according to 8p, 12b/p, and 13 stations; long-term outcome was overlapping to pN3b stage. 5-year survival in para-aortic positive cases was 11%, and a trend to better outcome was observed in proximal tumors. CONCLUSIONS Although metastases to "posterior" and para-aortic nodes are expression of an advanced nodal stage, not negligible survival rates are observed in subgroups of patients.
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Affiliation(s)
- Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - Francesco Ferrara
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Simone Giacopuzzi
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Alberto Di Leo
- Unit of General Surgery, Rovereto Hospital, Trento, Italy
| | - Lorenzo De Franco
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Luca Saragoni
- Department of Pathology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giovanni De Manzoni
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Kang DH, Choi CW, Kim HW, Park SB, Kim SJ, Nam HS, Ryu DG. Location characteristics of early gastric cancer treated with endoscopic submucosal dissection. Surg Endosc 2017; 31:4673-4679. [PMID: 28389793 DOI: 10.1007/s00464-017-5534-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/20/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND STUDY AIMS The timely detection of early gastric cancer (EGC) is important in performing endoscopic submucosal dissection (ESD). We attempted to determine the location characteristics of regions where EGC is frequently detected and analyzed the EGC characteristics associated with that location. METHODS We retrospectively reviewed the medical records of patients with EGC treated by ESD between November 2008 and August 2016. We retrospectively investigated and analyzed 647 EGC lesions. RESULTS The patients' mean age was 66.7 ± 10.8 years. The patient population was predominantly male (77.1%, 499/647). A well-to-moderately differentiated carcinoma was observed in 97.2% of patients. The common site of carcinoma occurrence was the lower part of the stomach (the antrum and lower third of body, 89.6%). Among the stomach hemispheres, the lesser curvature side was the most frequent site of EGC (43.9%). The posterior side of EGC was more frequent than anterior side of EGC (20.4 vs. 15.6%, respectively). Submucosal invasive EGC was more frequent in the mid-to-upper parts of stomach than lower part of stomach (odds ratio 1.919; confidence interval 1.014-3.623; p = 0.045). CONCLUSIONS Most EGCs that are resectable with ESD were found in the lower part and in the lesser curvature of the stomach. The submucosal invasive EGC was more frequent in the mid-to-upper part of stomach.
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Affiliation(s)
- Dae Hwan Kang
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea.
| | - Hyung Wook Kim
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea
| | - Su Bum Park
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea
| | - Hyeong Seok Nam
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea
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Cheng J, Wu J, Ye Y, Zhang C, Zhang Y, Wang Y. Extramural venous invasion detected by MDCT as an adverse imaging feature for predicting synchronous metastases in T4 gastric cancer. Acta Radiol 2017; 58:387-393. [PMID: 27439402 DOI: 10.1177/0284185116658323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Extramural venous invasion (EMVI) is defined histologically as the active invasion of tumor cells to the lumens of mesenteric vessels beyond the muscularis propria in advanced gastrointestinal cancer, resulting in distant metastases. Purpose To determine the association between synchronous metastatic disease in patients with T4 gastric cancer and EMVI detected on contrast-enhanced multiple-row detector computed tomography (MDCT). Material and Methods A total of 152 patients with T4 gastric carcinoma were retrospectively reviewed and divided into EMVI-positive and EMVI-negative groups where EMVI, as detected on MDCT, was defined as a tubular or nodular soft tissue thickening extending from the tumor along the vessels of the mesentery. Synchronous metastases were detected by MDCT and/or confirmed by postoperative diagnosis. Logistic regression analyses were performed to analyze the predictive factors of synchronous metastases in gastric cancer. Results Synchronous metastases were found in 47 of 152 (30.9%) patients with T4 gastric cancer. Thirty-one of 77 (40.3%) patients in the EMVI-positive group had evidence of metastases compared to 16 (21.3%) of 75 patients in the EMVI-negative group ( P = 0.019). Synchronous metastases were significantly associated with EMVI with an odds ratio (OR) of 2.250 (95% CI, 1.072-4.724). Conclusion EMVI-positive tumors, as an adverse imaging feature, were significantly associated with synchronous metastases in patients with T4 gastric cancer.
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Affiliation(s)
- Jin Cheng
- Department of Radiology, People’s Hospital, Peking University, Beijing, PR China
| | - Jing Wu
- Department of Radiology, People’s Hospital, Peking University, Beijing, PR China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, People’s Hospital, Peking University, Beijing, PR China
| | - Chunfang Zhang
- Clinical Epidemiology and Medical Statistics, People’s Hospital, Peking University, Beijing, PR China
| | - Yinli Zhang
- Department of Pathology, People’s Hospital, Peking University, Beijing, PR China
| | - Yi Wang
- Department of Radiology, People’s Hospital, Peking University, Beijing, PR China
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Yang SY, Roh KH, Kim YN, Cho M, Lim SH, Son T, Hyung WJ, Kim HI. Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer. Ann Surg Oncol 2017; 24:1770-1777. [PMID: 28357674 DOI: 10.1245/s10434-017-5851-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND In contrast to the significant advantages of laparoscopic versus open gastrectomy, robotic gastrectomy has shown little benefit over laparoscopic gastrectomy. This study aimed to compare multi-dimensional aspects of surgical outcomes after open, laparoscopic, and robotic gastrectomy. METHODS Data from 915 gastric cancer patients who underwent gastrectomy by one surgeon between March 2009 and May 2015 were retrospectively reviewed. Perioperative parameters were analyzed for short-term outcomes. Surgical success was defined as the absence of conversion to open surgery, major complications, readmission, positive resection margin, or fewer than 16 retrieved lymph nodes. RESULTS This study investigated 241 patients undergoing open gastrectomy, 511 patients undergoing laparoscopic gastrectomy, and 173 patients undergoing robotic gastrectomy. For each approach, the respective incidences were as follows: conversion to open surgery (not applicable, 0.4%, and 0%; p = 0.444), in-hospital major complications (5.8, 2.7, and 1.2%; p = 0.020), delayed complications requiring readmission (2.9, 2.0, and 1.2%; p = 0.453), positive resection margin (1.7, 0, and 0%; p = 0.003), and inadequate number of retrieved lymph nodes (0.4, 4.1, and 1.7%; p = 0.010). Compared with open and laparoscopic surgery, robotic gastrectomy had the highest surgical success rate (90, 90.8, and 96.0%). Learning-curve analysis of success using cumulative sum plots showed success with the robotic approach from the start. Multivariate analyses identified age, sex, and gastrectomy extent as significant independent parameters affecting surgical success. Surgical approach was not a contributing factor. CONCLUSIONS Open, laparoscopic, and robotic gastrectomy exhibited different incidences and causes of surgical failure. Robotic gastrectomy produced the best surgical outcomes, although the approach method itself was not an independent factor for success.
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Affiliation(s)
- Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Kun Ho Roh
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - You-Na Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Seung Hyun Lim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. .,Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea. .,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea.
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Lee EG, Ryu KW, Eom BW, Yoon HM, Kim YI, Cho SJ, Lee JY, Kim CG, Choi IJ, Kim YW. The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer. J Gastric Cancer 2017; 17:33-42. [PMID: 28337361 PMCID: PMC5362832 DOI: 10.5230/jgc.2017.17.e4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/30/2016] [Accepted: 11/10/2016] [Indexed: 12/14/2022] Open
Abstract
Purpose Endoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors. Materials and Methods From January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD. Results Several characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications. Conclusions ESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.
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Affiliation(s)
- Eun-Gyeong Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Keun-Won Ryu
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Bang-Wool Eom
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Hong-Man Yoon
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Yong-Il Kim
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Soo-Jeong Cho
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Jong-Yeul Lee
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Chan-Gyoo Kim
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Il-Ju Choi
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Gastric Cancer Branch, Division of Translational & Clinical Research I, Research Institute, National Cancer Center, Goyang, Korea
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119
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Marrelli D, De Franco L, Iudici L, Polom K, Roviello F. Lymphadenectomy: state of the art. Transl Gastroenterol Hepatol 2017; 2:3. [PMID: 28217753 PMCID: PMC5313293 DOI: 10.21037/tgh.2017.01.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/12/2022] Open
Abstract
The extent of lymphadenectomy in gastric cancer (GC) surgery has been for long time a matter of debate. Randomized trials performed in the West reported worse results of D2 dissection, in terms of postoperative complications and long-term survival benefit, than Eastern series and observational studies from specialized Western centers. However, long-term re-evaluation of such trials and in depth-analysis of other experiences demonstrated the potential benefit of D2 in reducing the probability of cancer-related death and the safety of this procedure when avoiding unnecessary spleno-pancreatectomy and in centers with ad adequate surgical volume. Nowadays, the D2 is considered the standard treatment in most guidelines all over the world. More limited procedures (D1, D1 plus) may be adequate in selected cases, and more extended dissections (D2 plus) could be indicated in advanced forms with high risk of metastases to distant nodes, but in specialized centers or in the setting of clinical studies. The integration with neoadjuvant therapies and multimodality approach could offer a chance of cure in groups of patients with poor results when approached with standard treatment.
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Affiliation(s)
- Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Lorenzo De Franco
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Livio Iudici
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Karol Polom
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
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Therapeutic outcomes of endoscopic submucosal dissection for early gastric cancer: single-center study. Eur J Gastroenterol Hepatol 2017; 29:61-67. [PMID: 27508325 DOI: 10.1097/meg.0000000000000718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Endoscopic submucosal dissection (ESD) has been widely accepted for selected patients with early gastric cancer (EGC). The aim of this study was to assess the therapeutic outcomes after ESD according to the pathological extent. PATIENTS AND METHODS From January 2005 to December 2014, a total of 599 patients with 611 lesions were enrolled in this study. The tumors were categorized according to pathological results on the basis of absolute criteria (AC), expanded criteria (EC), EC with undifferentiated histology [(EC-U), mucosal cancer, ulcer (-), ≤20 mm], or beyond EC (BEC). The therapeutic outcomes among the four groups were analyzed retrospectively. RESULTS The number of patients in the AC, EC, EC-U, and BEC groups was 447, 91, 19, and 54. The complete resection rates of EGC were 97.8, 84.6, 94.4, and 45.5% (P=0.001) and en bloc resection rates in the AC, EC, EC-U, and BEC groups were 99.1, 98.9, 100, and 98.1% (P=0.833), respectively. The 5-year disease-free survival rate in the AC, EC, EC-U, and BEC groups was 90.6, 88.7, 75.0, and 83.3% (P=0.394). In multivariate analysis, undifferentiated histology (P=0.001) and tumor size (>30 mm, P=0.017) were risk factors related to local recurrence. CONCLUSION The efficacy of ESD for EGCs in EC is almost equal to that in AC when complete resection was achieved. However, the indication for ESD should be decided conservatively because the complete resection rate of EGC in the EC group was significantly lower than that in the AC group. Undifferentiated histology and tumor size over 30 mm were risk factors related to local recurrence.
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Sun ZQ, Yan G, Ge YX, Li J, Jin LF, Xie ZH, Zhao P. Can low-dose CT perfusion imaging accurately assess response of advanced gastric cancer with neoadjuvant chemotherapy? JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:981-991. [PMID: 28697579 DOI: 10.3233/xst-17271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To explore the value of low-dose CT perfusion imaging (LDCTPI) technology and its perfusion parameters in assessing response of neoadjuvant chemotherapy (NAC) in patients with advanced gastric cancer (AGC). METHODS Thirty patients with AGC were studied prospectively by LDCTPI to measure two parameters including blood flow (BF) and blood volume (BV) of tumor area before and after chemotherapy, respectively. All of the patients received two courses of NAC and surgical resection of gastric tumor within one week after chemotherapy, and then obtained the result of postoperative pathology response for chemotherapy. The comparisons of BF and BV values of AGC before and after chemotherapy were analyzed by paired-samples t-test, respectively; and the correlations between BF as well as BV decrease rates after NAC and the pathology response grade were analyzed by Spearman statistical test. Thirty patients were divided into effective and ineffective groups according to different pathology response grade. Comparisons of BF as well as BV decrease rates between effective and ineffective groups were analyzed by independent-samples t-test, respectively. Receiver operating characteristic (ROC) curves were used to determine the cutoff values of BF and BV decrease rates as evaluation indicators of AGC after NAC and calculate area under the curve (AUC). RESULTS There were significant differences in BF and BV values of AGC between before and after NAC (p < 0.001), respectively, and there were obvious correlations between BF as well as BV decrease rates and pathology response grade (r = 0.660, p < 0.001; r = 0.706, p < 0.001), respectively. There were also significant differences in BF and BV decrease rates of AGC between effective and ineffective groups (P = 0.001), respectively. If BF decrease rate of 12.1% (AUC was 0.816, P = 0.005) was used as the cutoff value for chemotherapy effectiveness of AGC, the sensitivity of 82% and specificity of 84% were achieved, and if BV decrease rate of 32.8% (AUC was 0.844, P = 0.002) was used as the cutoff value for chemotherapy effectiveness of AGC, the sensitivity of 82% and specificity of 89% were achieved. CONCLUSIONS BF and BV decrease rates have potential to be used as effective indicators to assess chemotherapy efficacy of AGC from the hemodynamics.
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Affiliation(s)
- Zong-Qiong Sun
- Department of Radiology, Affiliated Hospital of Jiangnan University, The Forth People's Hospital of Wuxi City, Wuxi, Jiangsu, China
| | - Gen Yan
- Department of Radiology, Affiliated Hospital of Jiangnan University, The Forth People's Hospital of Wuxi City, Wuxi, Jiangsu, China
| | - Yu-Xi Ge
- Department of Radiology, Affiliated Hospital of Jiangnan University, The Forth People's Hospital of Wuxi City, Wuxi, Jiangsu, China
| | - Jie Li
- Department of Intervention, Affiliated Hospital of Jiangnan University, The Forth People's Hospital of Wuxi City, Wuxi, Jiangsu, China
| | - Lin-Fang Jin
- Department of Pathology, Affiliated Hospital of Jiangnan University, The Forth People's Hospital of Wuxi City, Wuxi, Jiangsu, China
| | - Zhi-Hui Xie
- Department of Surgical Gastroenterology, Affiliated Hospital of Jiangnan University, The Forth People's Hospital of Wuxi City, Wuxi, Jiangsu, China
| | - Peng Zhao
- Departments of Neuroscience, Anatomy, Histology, and Embryology, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
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Hu X, Chen L, Du Y, Fan B, Bu Z, Wang X, Ye Y, Zhang Z, Xiao G, Li F, He Q, Li G, Shen X, Xiong B, Zhu L, Liu J, Liu L, Wu T, Zhou J, Zhang J, Zhao G, Wang X, Liang P, Wang X, Zhang Y, Wu X, Zhang J, Ji X, Zong X, Fu T, Jia Z, Ji J. Postoperative chemotherapy with S-1 plus oxaliplatin versus S-1 alone in locally advanced gastric cancer (RESCUE-GC study): a protocol for a phase III randomized controlled trial. Chin J Cancer Res 2017; 29:144-148. [PMID: 28536493 PMCID: PMC5422416 DOI: 10.21147/j.issn.1000-9604.2017.02.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The ACTS-GC study had shown postoperative adjuvant therapy with S-1 improved survival of patients with locally advanced gastric cancer. Addition of oxaliplatin to S-1 is considered to be acceptable as one of the treatment options for gastric cancer patients after radical gastrectomy with D2 lymph node excision. METHODS We have commenced a randomized phase III trial in December 2016 to evaluate S-1 plus oxaliplatin compared with S-1 alone in the adjuvant setting for locally advanced gastric cancer. A total of 564 patients will be accrued from 13 Chinese institutions in two years. The primary endpoint is 3-year relapse-free survival. The secondary endpoints are 5-year overall survival, proportion of patients who complete the postoperative chemotherapy and incidence of adverse events. ETHIC AND DISSEMINATION The trial has been approved by the institutional review board of each participating institution and it was activated on December, 2016. The enrollment will be finished in December, 2018. Patient's follow-up will be ended until December, 2023. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02867839. Registered on August 4, 2016.
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Affiliation(s)
- Xiang Hu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Lin Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Yian Du
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Biao Fan
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Zhaode Bu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xin Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Zhongtao Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Gang Xiao
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Fei Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Qingsi He
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Guoli Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Bin Xiong
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Liming Zhu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Jiwei Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Lian Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Tao Wu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Jing Zhou
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Jun Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Gang Zhao
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xulin Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Pin Liang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xinxin Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Yan Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xiaojiang Wu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Ji Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xin Ji
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xianglong Zong
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Tao Fu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Ziyu Jia
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
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Clinical outcomes of endoscopic submucosa dissection for high-grade dysplasia from endoscopic forceps biopsy. Gastric Cancer 2017; 20:671-678. [PMID: 27822683 PMCID: PMC5486495 DOI: 10.1007/s10120-016-0665-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Although the Vienna Classification recommends endoscopic resection for gastric high-grade dysplasia (HGD), many resected lesions are diagnosed as gastric cancer after endoscopic resection. This study aims to evaluate the clinical outcomes of gastric HGD identified by endoscopic forceps biopsy (EFB) after endoscopic submucosal dissection (ESD) and factors associated with discrepant results. PATIENTS AND METHODS From December 2008 to July 2015, a total of 427 lesions diagnosed as initial HGD by EFB were enrolled. The rate of early gastric cancer (EGC) and factors predicting diagnosis upgrade were analyzed retrospectively. RESULTS Tumors ranged between 2 and 65 mm in size (median 12.59). En bloc and complete resection rates were 97.4 and 95.3%, respectively. The diagnostic discrepancy rate was 76.3%. Upgrade and downgrade rates of pathological diagnoses were 66.5 and 9.8%, respectively. Central depression (OR 4.151), nodular surface (OR 5.582), surface redness (OR 2.926), lesion location (upper third of the stomach) (OR 3.894), and tumor size ≥10 mm (OR 2.287) were significantly associated with EGC. Nodular surface (OR 2.746), submucosal fibrosis (OR 3.958), lesion location (upper third of the stomach) (OR 6.652), and tumor size ≥10 mm (OR 4.935) significantly predicted invasive submucosal cancer. CONCLUSIONS Central depression, nodular surface, surface redness, lesion location, large tumor size, and submucosal fibrosis were associated with EGC or submucosal cancer. Caution must be used in treating lesions with these features with ESD.
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Wang X, Chen Q, Huang X, Zou F, Fu Z, Chen Y, Li Y, Wang Z, Liu L. Effects of 17β-estradiol and tamoxifen on gastric cancer cell proliferation and apoptosis and ER-α36 expression. Oncol Lett 2016; 13:57-62. [PMID: 28123522 PMCID: PMC5244966 DOI: 10.3892/ol.2016.5424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/15/2016] [Indexed: 12/15/2022] Open
Abstract
The present study aimed to investigate the effects of 17β-estradiol and tamoxifen, an agonist and inhibitor of the estrogen receptor (ER), respectively, on the proliferation and apoptosis of gastric cancer cells, as well as the messenger (m)RNA expression levels of ER-α36. Nested reverse transcription-polymerase chain reaction (RT-PCR) confirmed that ER-α36 was expressed in the BGC823, MKN45 and SGC7901 human gastric cancer cell lines. Subsequently, the BGC823 cell line was stimulated with various concentrations of 17β-estradiol or tamoxifen for 24 or 48 h, and the proliferation, apoptosis and mRNA expression levels of ER-α36 were determined by water-soluble tetrazolium (WST)-1 assay, flow cytometry and RT-quantitative PCR, respectively. The activity of BGC823 cells was significantly increased following treatment with 10−12 mol/l 17β-estradiol for 24 h (P=0.013), as compared with the control, and reached a peak at 48 h (P=0.002). Notably, the activity of BGC823 cells was decreased with increasing concentrations of 17β-estradiol, although it remained higher compared with that of the control. In the tamoxifen-treated groups, the cell activity decreased as the drug concentration increased. The apoptosis rate was markedly reduced in the 17β-estradiol group after 24 h (10−12 mol/l, P=0.013; 10−11 mol/l, P=0.023; and 10−10 mol/l, P=0.017) and after 48 h (10−12 mol/l, P=0.002; 10−11 mol/l, P=0.011; and 10−10 mol/l, P=0.033), whereas the rate of apoptosis increased as the tamoxifen concentration increased (24 h: 5×10−6 mol/l, P=0.002; and 10−5 mol/l, P=0.001; and 48 h: 5×10−6 mol/l, P=0.014 and 10−5 mol/l, P=0.0021), as compared with the control group. The mRNA expression levels of ER-α36 were significantly increased after 24 h of treatment with 10−12 mol/l (P=0.024), 10−11 mol/l (P=0.0113) and 10−10 mol/l (P=0.0037) 17β-estradiol compared with the control group when the concentration of 17β-estradiol was low, and the same was observed after 48 h of treatment 10−12 mol/l (P=0.0164), 10−11 mol/l (P=0.0342) and 10−10 mol/l (P=0.0198) 17β-estradiol. The mRNA expression levels of ER-α36 were significantly decreased with increasing concentrations of tamoxifen after 24 h (5×10−6 mol/l, P=0.0233; and 10−5 mol/l, P=0.007) and after 48 h (5×10−6 mol/l, P=0.001; and 10−5 mol/l, P=0.0153). In addition, the ability of tamoxifen to inhibit the growth of gastric cancer cells was concentration-dependent. The results of the present study suggested that gastric cancer cells were sensitive to the effects of 17β-estradiol and tamoxifen, and that tamoxifen is able to induce gastric cancer cell apoptosis. The expression levels of ER-α36 were upregulated, and the growth of gastric cancer cells was increased, following treatment with 17β-estradiol, thus suggesting that gastric cancer tumors are stimulated by estrogen.
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Affiliation(s)
- Xuming Wang
- Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China; Department of Pathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Qiuyue Chen
- Department of Pathology, Guilin Medical University, Guilin, Guangxi 541004, P.R. China
| | - Xuan Huang
- Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China; Department of Pathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Feng Zou
- Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China; Department of Pathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Zhengqi Fu
- Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China; Department of Pathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Ying Chen
- Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Yan Li
- Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China; Department of Pathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Zhaoyi Wang
- Department of Medical Microbiology and Immunology, Creighton University Medical School, Omaha, NE 68178, USA
| | - Lijiang Liu
- Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China; Department of Pathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China
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Eom BW, Kim YW, Nam BH, Ryu KW, Jeong HY, Park YK, Lee YJ, Yang HK, Yu W, Yook JH, Song GA, Youn SJ, Kim HU, Noh SH, Park SB, Yang DH, Kim S. The Korean Gastric Cancer Cohort Study: Study Protocol and Brief Results of a Large-Scale Prospective Cohort Study. J Gastric Cancer 2016; 16:182-190. [PMID: 27752396 PMCID: PMC5065948 DOI: 10.5230/jgc.2016.16.3.182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to establish a large-scale database of patients with gastric cancer to facilitate the development of a national-cancer management system and a comprehensive cancer control policy. Materials and Methods An observational prospective cohort study on gastric cancer was initiated in 2010. A total of 14 cancer centers throughout the country and 152 researchers were involved in this study. Patient enrollment began in January 2011, and data regarding clinicopathological characteristics, life style-related factors, quality of life, as well as diet diaries were collected. Results In total, 4,963 patients were enrolled until December 2014, and approximately 5% of all Korean patients with gastric cancer annually were included. The mean age was 58.2±11.5 years, and 68.2% were men. The number of patients in each stage was as follows: 3,394 patients (68.4%) were in stage IA/B; 514 patients (10.4%), in stage IIA/B; 469 patients (9.5%), in stage IIIA/B/C; and 127 patients (2.6%), in stage IV. Surgical treatment was performed in 3,958 patients (79.8%), endoscopic resection was performed in 700 patients (14.1%), and 167 patients (3.4%) received palliative chemotherapy. The response rate for the questionnaire on the quality of life was 95%; however, diet diaries were only collected for 27% of patients. Conclusions To provide comprehensive information on gastric cancer for patients, physicians, and government officials, a large-scale database of Korean patients with gastric cancer was established. Based on the findings of this cohort study, an effective cancer management system and national cancer control policy could be developed.
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Affiliation(s)
- Bang Wool Eom
- Gastric Cancer Branch, Division of Translational & Clinical Research I, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Gastric Cancer Branch, Division of Translational & Clinical Research I, National Cancer Center, Goyang, Korea
| | - Byung-Ho Nam
- Biometric Research Branch, Division of Cancer Epidemiology and Prevention, Research Institute, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Gastric Cancer Branch, Division of Translational & Clinical Research I, National Cancer Center, Goyang, Korea
| | - Hyun-Yong Jeong
- Department of Internal Medicine, Daejeon Regional Cancer Center, Chungnam National University Hospital, Daejeon, Korea
| | - Young-Kyu Park
- Department of Surgery, Jeonnam Regional Cancer Center, Chonnam National University Hospital, Hwasun, Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongnam Regional Cancer Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Wansik Yu
- Department of Surgery, Daegu-Gyeongbuk Regional Cancer Center, Kyungpook National University Medical Center, Chilgok, Korea
| | - Jeong-Hwan Yook
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geun Am Song
- Department of Internal Medicine, Busan Cancer Center, Pusan National University Hospital, Busan, Korea
| | - Sei-Jin Youn
- Department of Internal Medicine, Chungbuk Regional Cancer Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju Regional Cancer Center, Jeju National University Hospital, Jeju, Korea
| | - Sung-Hoon Noh
- Department of Surgery, Severance Hospital, Seoul, Korea
| | - Sung Bae Park
- Department of Surgery, Gangwon Regional Cancer Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Doo-Hyun Yang
- Department of Surgery, Jeonbuk Regional Cancer Center, Chonbuk National University Hospital, Jeonju, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Seoul, Korea
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Abstract
Based upon studies from randomized clinical trials, the extended (D2) lymph node dissection is now recommended as a standard procedure for local advanced gastric cancer worldwide. However, the rational extent lymphadenectomy for local advanced gastric cancer has remained a topic of debate in the past decades. Due to the limitation of low metastatic rate in para-aortic nodes (PAN) in JCOG9501, the clinical benefit of D2+ para-aortic nodal dissection (PAND) for patients with stage T4 and/or stage N3 disease, which is very common in China and other countries except Japan and Korea, cannot be determined. Furthermore, the role of splenectomy for complete resection of No.10 and No.11 nodes has been controversial, and however, the final results from the randomized trial of JCOG0110 have yet to be completed. Gastric cancer with the No.14 and No.13 lymph node metastasis is defined as M1 stage in the current version of the Japanese classification. We propose that D2+No.14v and +No.13 lymphadenectomy may be an option in a potentially curative gastrectomy for tumors with apparent metastasis to the No.6 nodes or infiltrate to duodenum. The examined lymph node and extranodal metastasis are significantly associated with the survival of gastric cancer patients.
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Affiliation(s)
- Han Liang
- Gastric Cancer Surgical Department, Tianjin Medical University Cancer Institute & Hospital, National Clinic Research Center for Cancer, Tianjin 300060, China
| | - Jingyu Deng
- Gastric Cancer Surgical Department, Tianjin Medical University Cancer Institute & Hospital, National Clinic Research Center for Cancer, Tianjin 300060, China
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Carter GC, Kaltenboeck A, Ivanova J, Liepa AM, San Roman A, Koh M, Rajan N, Cheng R, Birnbaum HG, Kim JS, Bang YJ. Real-World Treatment Patterns among Patients with Advanced Gastric Cancer in South Korea. Cancer Res Treat 2016; 49:578-587. [PMID: 27618820 PMCID: PMC5512370 DOI: 10.4143/crt.2016.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 08/26/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose The purpose of this study was to understand patient treatment patterns, outcomes, and healthcare resource use in cases of metastatic and/or locally recurrent, unresectable gastric cancer (MGC) in South Korea. Materials and Methods Thirty physicians reviewed charts of eligible patients to collect de-identified data. Patients must have received platinum/fluoropyrimidine first-line therapy followed by second-line therapy or best supportive care, had no other primary cancer, and not participated in a clinical trial following MGC diagnosis. Data were summarized using descriptive statistics. Kaplan-Meier analysis was used to describe survival. Results Of 198 patients, 73.7% were male, 78.3% were diagnosed with MGC after age 55 (mean, 61.3 years), and 47.0% were current or former smokers. The majority of tumorswere located in the antrum/pylorus (51.5%). Metastatic sites most often occurred in the peritoneum (53.5%), lymph nodes (47.5%), and liver (38.9%). At diagnosis, the mean Charlson comorbidity indexwas 0.4 (standard deviation, 0.6). The most common comorbidities were chronic gastritis (22.7%) and cardiovascular disease (18.7%). Most patients (80.3%) received second-line treatment. Single-agent fluoropyrimidine was reported for 22.0% of patients, while 19.5% were treated with irinotecan and a fluoropyrimidine or platinum agent. The most common physician-reported symptoms during second-line treatment were nausea/vomiting (44.7%) and pain (11.3%), with antiemetics (44.7%), analgesics (36.5%), and nutritional support (11.3%) most often used as supportive care. Two-thirds of inpatient hospitalizations were for chemotherapy infusion. Outpatient hospitalization (31.6%) and visits to the oncologist (58.8%) were common among second-line patients. Conclusion Most patients received second-line treatment, although regimens varied. Understanding MGC patient characteristics and treatment patterns in South Korea will help address unmet needs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Hugen S, Thomas RE, German AJ, Burgener IA, Mandigers PJJ. Gastric carcinoma in canines and humans, a review. Vet Comp Oncol 2016; 15:692-705. [PMID: 27549077 DOI: 10.1111/vco.12249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/06/2016] [Accepted: 05/20/2016] [Indexed: 02/06/2023]
Abstract
Gastric carcinoma (GC) is the most common neoplasm in the stomach of dogs. Although incidence in the general population is reported to be low, breed-specific GC has a high incidence. Median age at presentation ranges from 8 to approximately 10 years. The disease is mostly located in the lesser curvature and antropyloric region of the stomach. Unfortunately, diagnosis is usually made when the disease is at an advanced stage and, therefore, prognosis is poor. Due to similarities in clinical presentation, diagnosis, histology and prognosis, canine GC may serve as a valuable model for human GC. Extensive pedigrees of canine gastric carcinoma cases could reveal insights for human gastric carcinoma. Putative species differences include the role of Helicobacter in pathogenesis, the wide array of genetic data and screening available for humans, and treatment protocols that are available for human GC.
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Affiliation(s)
- S Hugen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - R E Thomas
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - A J German
- School of Veterinary Science, University of Liverpool, Neston, UK
| | - I A Burgener
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P J J Mandigers
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Liang H. Intraperitoneal chemotherapy for locally advanced gastric cancer to prevent and treat peritoneal carcinomatosis. Transl Gastroenterol Hepatol 2016; 1:62. [PMID: 28138628 DOI: 10.21037/tgh.2016.07.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 12/22/2022] Open
Abstract
Gastric cancer (GC) is one of the leading causes of cancer death in both sexes in the world. The overall survival (OS) of GC patients is still unsatisfactory. The peritoneal dissemination is the most common type of recurrence in advanced GC. The rationale for administering chemotherapeutic drugs directly into peritoneal cavity is supported by the relative transport barrier that is formed by the tissue surrounding the peritoneal space. Intraperitoneal (IP) chemotherapy with taxanes is safe and feasible. Further randomized phase III clinical trials are needed to validate IP chemotherapy with taxanes for peritoneal carcinomatosis (PC) from GC. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) used as prophylaxis against peritoneal recurrence in patients with high risk GC is safe, significantly improves the survival and reduces the risk of peritoneal recurrence. A drug delivery system with anticancer drugs seem to be have a pharmacokinetic advantage but further randomized clinical trials are needed to validate its effect.
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Affiliation(s)
- Han Liang
- Department of Gastric Cancer, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Treatment, Cancer Hospital, Tianjin Medical University, Tianjin 300060, China
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Li H, Huo ZB, Chen SB, Li H, Wu DC, Zhai TS, Xiao QH, Wang SX, Zhang LL. Feasibility study on expanded indication for endoscopic submucosal dissection of intramucosal poorly differentiated early gastric cancer. World J Gastroenterol 2016; 22:6736-6741. [PMID: 27547016 PMCID: PMC4970474 DOI: 10.3748/wjg.v22.i29.6736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/20/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify clinicopathological factors predictive of lymph node metastasis (LNM) in intramucosal poorly differentiated early gastric cancer (EGC), and further to expand the possibility of using endoscopic submucosal dissection (ESD) for the treatment of intramucosal poorly differentiated EGC.
METHODS: Data for 81 surgically treated patients with intramucosal poorly differentiated EGC were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Several clinicopathologic factors were investigated to identify predictive factors for lymph nodes metastasis, including gender, age, family history of gastric cancer, number of tumors, tumor location, ulceration, tumor size, macroscopic type, lymphatic vessel involvement, and signet-ring-cell component.
RESULTS: Tumor size (OR = 7.273, 95%CI: 1.246-29.918, P = 0.042), lymphatic vessel involvement (OR = 42.219, 95%CI: 1.923-97.052, P = 0.018) and signet-ring-cell component (OR = 17.513, 95%CI: 1.647-77.469, P = 0.034) that were significantly associated with LNM by univariate analysis, were found to be significant and independent risk factors for LNM by multivariate analysis. However, gender, age, family history of gastric cancer, number, location, ulceration and macroscopic type of tumor were found not to be associated with LNM. Of these 81 patients diagnosed with intramucosal poorly differentiated EGC, 7 (8.6%) had LNM. The LNM rates were 9.1%, 22.2% and 57.1%, respectively, in cases with one, two and three of the risk factors. There was no LNM in 54 patients without the three risk clinicopathological factors.
CONCLUSION: Tumor size, lymphatic vessel involvement and signet-ring-cell component are independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Thus, these three risk factors may be used as a simple criterion to expand the possibility of using ESD for the treatment of intramucosal poorly differentiated EGC.
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Eom BW, Joo J, Park B, Jo MJ, Choi SH, Cho SJ, Ryu KW, Kim YW, Kook MC. Nomogram Incorporating CD44v6 and Clinicopathological Factors to Predict Lymph Node Metastasis for Early Gastric Cancer. PLoS One 2016; 11:e0159424. [PMID: 27482895 PMCID: PMC4970798 DOI: 10.1371/journal.pone.0159424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/01/2016] [Indexed: 12/25/2022] Open
Abstract
Background Treatment strategy for early gastric cancer depends on the probability of lymph node metastasis. The aim of this study is to develop a nomogram predicting lymph node metastasis in early gastric cancer using clinicopathological factors and biomarkers. Methods A literature review was performed to identify biomarkers related to lymph node metastasis in gastric cancer. Seven markers were selected and immunohistochemistry was performed in 336 early gastric cancer tissues. Based on the multivariable analysis, a prediction model including clinicopatholgical factors and biomarkers was developed, and benefit of adding biomarkers was evaluated using the area under the receiver operating curve and net reclassification improvement. Functional study in gastric cancer cell line was performed to evaluate mechanism of biomarker. Results Of the seven biomarkers studied, α1 catenin and CD44v6 were significantly associated with lymph node metastasis. A conventional prediction model, including tumor size, histological type, lymphatic blood vessel invasion, and depth of invasion, was developed. Then, a new prediction model including both clinicopathological factors and CD44v6 was developed. Net reclassification improvement analysis revealed a significant improvement of predictive performance by the addition of CD44v6, and a similar result was shown in the internal validation using bootstrapping. Prediction nomograms were then constructed based on these models. In the functional study, CD44v6 was revealed to affect cell proliferation, migration and invasion. Conclusions Overexpression of CD44v6 was a significant predictor of lymph node metastasis in early gastric cancer. The prediction nomograms incorporating CD44v6 can be useful to determine treatment plans in patients with early gastric cancer.
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Affiliation(s)
- Bang Wool Eom
- Department of Medicine, Yonsei University Graduate School of Medicine, Seoul, Republic of Korea
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Jungnam Joo
- Cancer Biostatistics Branch, Research Institute for National Cancer Control & evaluation, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Boram Park
- Cancer Biostatistics Branch, Research Institute for National Cancer Control & evaluation, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Min Jung Jo
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Seung Ho Choi
- Department of Medicine, Yonsei University Graduate School of Medicine, Seoul, Republic of Korea
| | - Soo-Jeong Cho
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Keun Won Ryu
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Young-Woo Kim
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Myeong-Cherl Kook
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
- * E-mail:
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Clinical features of negative pathologic results after gastric endoscopic submucosal dissection. Surg Endosc 2016; 31:1163-1171. [PMID: 27405480 DOI: 10.1007/s00464-016-5086-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/05/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is widely used for the treatment of gastric superficial neoplasms. Negative pathologic results after ESD can confuse the endoscopists and patients. The aim of this study was to evaluate the reasons for and the factors associated with negative pathologic results after ESD. PATIENTS AND METHODS From December 2008 to July 2015, a total of 1379 lesions diagnosed as definite dysplasia or adenocarcinoma by endoscopic forceps biopsy (EFB) were removed with an ESD procedure. The initial endoscopic and pathologic findings were analyzed. RESULTS The incidence of negative pathology after ESD was 2.0 % (28/1379). Compared with positive pathologic lesions, negative pathologic lesions were smaller and had less surface area (P < 0.001). The reasons for negative pathologic lesions after ESD were complete removal by EFB (n = 20), over-estimations of the EFB specimen (n = 5), and different ESD site (n = 3). CONCLUSION Small tumor size and surface area are associated with negative pathologic results after ESD. When negative pathologic results are reported after ESD, we should review the previous endoscopic biopsy tissue specimen and compare the previous EFB site to the ESD site. Thereafter, regular endoscopic examination of the lesion is needed.
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Okabe H, Tsunoda S, Obama K, Tanaka E, Hisamori S, Shinohara H, Sakai Y. Feasibility of Laparoscopic Radical Gastrectomy for Gastric Cancer of Clinical Stage II or Higher: Early Outcomes in a Phase II Study (KUGC04). Ann Surg Oncol 2016; 23:516-523. [PMID: 27401443 DOI: 10.1245/s10434-016-5383-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE A phase II study was performed to evaluate the safety and efficacy of laparoscopic gastrectomy (LG) for gastric cancer of clinical stage II or higher. METHODS The eligibility criteria were gastric cancer of clinical stage II or higher that was amenable to potentially curative resection. Patients with prior chemotherapy, tumors requiring total gastrectomy (TG), tumors that invaded adjacent organs, and patients with bulky lymph node metastasis were included. The primary endpoint was incidence of postoperative complications of grade II or higher in the Clavien-Dindo classification. The sample size was determined to be 73, based on an expected rate of complications of 19 % and a threshold of 30 %. Gastrectomy was performed by expert surgeons who were certified by the Japan Society for Endoscopic Surgery. RESULTS A total of 73 patients were enrolled; 54 patients (74 %) had clinical T stage T4a/T4b, and 47 patients (64 %) were administered preoperative chemotherapy. The type of surgery was distal gastrectomy in 41 patients and TG in 31 patients. Dissection of D2 or more was performed in 62 patients (85 %). Of the 25 patients who underwent D2/D2+ TG, 15 underwent splenectomy or pancreaticosplenectomy. R0 resection was performed in 64 patients (88 %). The median number of resected lymph nodes was 56, and postoperative complications occurred in 15 patients (20.5 %), which was significantly lower than the threshold value (p = 0.039). One in-hospital death occurred (1.4 %). CONCLUSION LG for gastric cancer of clinical stage II or higher can be safely performed by experienced surgeons.
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Affiliation(s)
- Hiroshi Okabe
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Department of Surgery, Otsu Municipal Hospital, Otsu, Japan.
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Eiji Tanaka
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Kobe City Medical Center, West Hospital, Kobe, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisashi Shinohara
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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134
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Park HK, Lee KY, Yoo MW, Hwang TS, Han HS. Mixed Carcinoma as an Independent Prognostic Factor in Submucosal Invasive Gastric Carcinoma. J Korean Med Sci 2016; 31:866-72. [PMID: 27247494 PMCID: PMC4853664 DOI: 10.3346/jkms.2016.31.6.866] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/09/2016] [Indexed: 12/12/2022] Open
Abstract
Mixed carcinoma shows a mixture of glandular and signet ring/poorly cohesive cellular histological components and the prognostic significance of each component is not fully understood. This study aimed to investigate the significance of the poorly cohesive cellular histological component as a risk factor for lymph node metastasis and to examine the diagnostic reliability of endoscopic biopsy. Clinicopathologic characteristics of 202 patients who underwent submucosal invasive gastric carcinoma resection with lymph node dissection in 2005-2012 were reviewed. Mixed carcinoma accounted for 27.2% (56/202) of cases. The overall prevalence of lymph node metastasis was 17.3% (35/202). Lymphatic invasion (P < 0.001), family history of carcinoma (P = 0.025), tumor size (P = 0.004), Lauren classification (P = 0.042), and presence of any poorly cohesive cellular histological component (P = 0.021) positively correlated with the lymph node metastasis rate on univariate analysis. Multivariate analyses revealed lymphatic invasion, family history of any carcinoma, and the presence of any poorly cohesive cellular histological component to be significant and independent factors related to lymph node metastasis. Review of preoperative biopsy slides showed that preoperative biopsy demonstrated a sensitivity of 63.6% and a specificity of 100% in detecting the presence of the poorly cohesive cellular histological component, compared with gastrectomy specimens. The presence of any poorly cohesive cellular histological component was an independent risk factor associated with lymph node metastasis in submucosal invasive gastric carcinoma. Endoscopic biopsy had limited value in predicting the presence and proportion of the poorly cohesive cellular histologic component due to the heterogeneity of mixed carcinoma.
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Affiliation(s)
- Hyung Kyu Park
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung-Yung Lee
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Moon-Won Yoo
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Sook Hwang
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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135
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Practical intraoperative pathologic evaluation of sentinel lymph nodes during sentinel node navigation surgery in gastric cancer patients - Proposal of the pathologic protocol for the upcoming SENORITA trial. Surg Oncol 2016; 25:139-46. [PMID: 27566014 DOI: 10.1016/j.suronc.2016.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/08/2016] [Indexed: 02/07/2023]
Abstract
Over the last decade, as the number of patients with early gastric cancer increased and the subsequent survival rate improved, there has been a consistent effort to verify the applicability of the sentinel node concept in gastric cancer in a bid to improve postoperative quality of life in these patients. During sentinel node navigation surgery in gastric cancer patients, intraoperative pathologic examination of the retrieved sentinel nodes plays a critical role in determining the extent of surgery, but the optimal method is still under debate. Currently, a multicenter, phase III clinical trial is underway to compare laparoscopic sentinel basin dissection with stomach preserving surgery and standard laparoscopic gastrectomy in terms of oncologic outcomes in patients with clinical stage T1N0 gastric cancer. Herein, the currently available intraoperative pathologic techniques are reviewed and their clinical significance and applicability are appraised based on the published literature. The proper pathologic examination of the sentinel lymph nodes in an upcoming clinical trial (SENORITA trial) is also proposed here based on this review.
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136
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Mihmanli M, Ilhan E, Idiz UO, Alemdar A, Demir U. Recent developments and innovations in gastric cancer. World J Gastroenterol 2016; 22:4307-20. [PMID: 27158199 PMCID: PMC4853688 DOI: 10.3748/wjg.v22.i17.4307] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/30/2016] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer has an important place in the worldwide incidence of cancer and cancer-related deaths. It can metastasize to the lymph nodes in the early stages, and lymph node metastasis is an important prognostic factor. Surgery is a very important part of gastric cancer treatment. A D2 lymphadenectomy is the standard surgical treatment for cT1N+ and T2-T4 cancers, which are potentially curable. Recently, the TNM classification system was reorganized, and the margins for gastrectomy and lymphadenectomy were revised. Endoscopic, laparoscopic and robotic treatments of gastric cancer have progressed rapidly with development of surgical instruments and techniques, especially in Eastern countries. Different endoscopic resection techniques have been identified, and these can be divided into two main categories: endoscopic mucosal resection and endoscopic submucosal dissection. Minimally invasive surgery has been reported to be safe and effective for early gastric cancer, and it can be successfully applied to advanced gastric cancer with increasing experience. Cytoreductive surgery and hyperthermıc intraperıtoneal chemotherapy were developed as a combined treatment modality from the results of experimental and clinical studies. Also, hyperthermia increases the antitumor activity and penetration of chemotherapeutics. Trastuzumab which is a monoclonal antibody interacts with human epidermal growth factor (HER) 2 and is related to gastric carcinoma. The anti-tumor mechanism of trastuzumab is not clearly known, but mechanisms such as interruption of the HER2-mediated cell signaling pathways and cell cycle progression have been reported previously. H. pylori is involved in 90% of all gastric malignancies and Japanese guidelines strongly recommend that all H. pylori infections should be eradicated regardless of the associated disease. In this review, we present innovations discussed in recent studies.
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137
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Choi YY, Kim SJ, Choi CW, Kang DH, Kim HW, Park SB, Nam HS. Risk Factors of Submucosal or Lymphovascular Invasion in Early Gastric Cancer <2 cm. Medicine (Baltimore) 2016; 95:e3822. [PMID: 27258528 PMCID: PMC4900736 DOI: 10.1097/md.0000000000003822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Although prediction of submucosal (SM) or lymphovascular (LV) invasion is important before endoscopic resection of early gastric cancer (EGC), it can only be confirmed following endoscopic resection. After endoscopic resection, patients with SM or LV invasion may require additional surgery due to high risk of lymph node metastasis.We conducted a retrospective study to identify risk factors for SM or LV invasion before endoscopic submucosal dissection (ESD) of EGC. Between January 2009 and May 2014, we reviewed the data of patients with EGC who met the absolute indications for ESD before procedure: well and/or moderately differentiated adenocarcinomas, tumors ≤ 2 cm in length and absence of ulcer or ulcer-scar.During study period, a total of 308 lesions in 297 patients were included. SM or LV invasion was detected in 34 lesions (34/308, 11.0%). Multivariate analysis revealed that a moderately differentiated adenocarcinoma (odds ratio [OR] 4.157, P = 0.000) and location of the stomach (the upper and middle third; OR 3.100, P = 0.008) were significant risk factors for SM or LV invasion.Careful consideration of endoscopic treatment decision might be necessary for the patients with a moderately differentiated adenocarcinoma and EGC located on the upper and middle third of the stomach.
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Affiliation(s)
- Yu Yi Choi
- From the Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Kim YI, Kim HS, Kook MC, Cho SJ, Lee JY, Kim CG, Ryu KW, Kim YW, Choi IJ. Discrepancy between Clinical and Final Pathological Evaluation Findings in Early Gastric Cancer Patients Treated with Endoscopic Submucosal Dissection. J Gastric Cancer 2016; 16:34-42. [PMID: 27104025 PMCID: PMC4834619 DOI: 10.5230/jgc.2016.16.1.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Early gastric cancer cases that are estimated to meet indications for treatment before endoscopic submucosal resection are often revealed to be out-of-indication after the treatment. We investigated the short-term treatment outcomes in patients with early gastric cancer according to the pretreatment clinical endoscopic submucosal resection indications. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients with early gastric cancer that met the pretreatment endoscopic submucosal resection indications, from 2004 to 2011. Curative resection rate and proportion of out-of-indication cases were compared according to the pre-endoscopic submucosal resection indications. Pre-endoscopic submucosal resection factors associated with out-of-indication in the final pathological examination were analyzed. RESULTS Of 756 cases, 660 had absolute and 96 had expanded pre-endoscopic submucosal resection indications. The curative resection rate was significantly lower in the patients with expanded indications (64.6%) than in those with absolute indications (81.7%; P<0.001). The cases with expanded indications (30.2%) were revealed to be out-of-indication more frequently than the cases with absolute indications (13.8%; P<0.001). Age of >65 years, tumor size of >2 cm, tumor location in the upper-third segment of the stomach, and undifferentiated histological type in pre-endoscopic submucosal resection evaluations were significant risk factors for out-of-indication after endoscopic submucosal resection. CONCLUSIONS Non-curative resection due to out-of-indication occurred in approximately one-third of the early gastric cancer cases that clinically met the expanded indications before endoscopic submucosal resection. The possibility of additional surgery should be emphasized for patients with early gastric cancers that clinically meet the expanded indications.
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Affiliation(s)
- Young-Il Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hyoung Sang Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | | | - Soo-Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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139
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Degiuli M, De Manzoni G, Di Leo A, D’Ugo D, Galasso E, Marrelli D, Petrioli R, Polom K, Roviello F, Santullo F, Morino M. Gastric cancer: Current status of lymph node dissection. World J Gastroenterol 2016; 22:2875-2893. [PMID: 26973384 PMCID: PMC4779911 DOI: 10.3748/wjg.v22.i10.2875] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/09/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023] Open
Abstract
D2 procedure has been accepted in Far East as the standard treatment for both early (EGC) and advanced gastric cancer (AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials (RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council (MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recurrence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC.
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140
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You YH, Kim YM, Ahn DH. Beginner Surgeon's Initial Experience with Distal Subtotal Gastrectomy for Gastric Cancer Using a Minimally Invasive Approach. J Gastric Cancer 2015; 15:270-7. [PMID: 26819806 PMCID: PMC4722994 DOI: 10.5230/jgc.2015.15.4.270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Minimally invasive gastrectomy (MIG), including laparoscopic distal subtotal gastrectomy (LDG) and robotic distal subtotal gastrectomy (RDG), is performed for gastric cancer, and requires a learning period. However, there are few reports regarding MIG by a beginner surgeon trained in MIG for gastric cancer during surgical residency and fellowship. The aim of this study was to report our initial experience with MIG, LDG, and RDG by a trained beginner surgeon. MATERIALS AND METHODS Between January 2014 and February 2015, a total of 36 patients (20 LDGs and 16 RDGs) underwent MIG by a beginner surgeon during the learning period, and 13 underwent open distal subtotal gastrectomy (ODG) by an experienced surgeon in Bundang CHA Medical Center. Demographic characteristics, operative findings, and short-term outcomes were evaluated for the groups. RESULTS MIG was safely performed without open conversion in all patients and there was no mortality in either group. There was no significant difference between the groups in demographic factors except for body mass index. There were significant differences in extent of lymph node dissection (LND) (D2 LND: ODG 8.3% vs. MIG 55.6%, P=0.004) and mean operative time (ODG 178.8 minutes vs. MIG 254.7 minutes, P<0.001). The serial changes in postoperative hemoglobin level (P=0.464) and white blood cell count (P=0.644) did not show significant differences between the groups. There were no significant differences in morbidity. CONCLUSIONS This study showed that the operative and short-term outcomes of MIG for gastric cancer by a trained beginner surgeon were comparable with those of ODG performed by an experienced surgeon.
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Affiliation(s)
- Yung Hun You
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yoo Min Kim
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dae Ho Ahn
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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141
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Diagnostic group classifications of gastric neoplasms by endoscopic resection criteria before and after treatment: real-world experience. Surg Endosc 2015; 30:3987-93. [PMID: 26694184 DOI: 10.1007/s00464-015-4710-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/27/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND STUDY AIMS There are often discrepancies between the pretreatment evaluation of gastric neoplasms by endoscopy with biopsy and the final diagnosis of resected specimen in terms of pathology and depth of invasion. We evaluated the spectrum of discrepancies between pretreatment and posttreatment diagnosis which may deliver significant differences on clinical practice. PATIENTS AND METHODS A total of 2041 patients with gastric dysplasia or cancer who underwent curative endoscopic resections or surgeries in 2012 were enrolled. Patients were classified into five different diagnostic groups: low-grade dysplasia (LGD), high-grade dysplasia (HGD), absolute indication early gastric cancer (AI-EGC), beyond absolute indication early gastric cancer (BAI-EGC), and advanced gastric cancer (AGC). The choice of initial treatment and final pathologic diagnosis was analyzed. RESULTS The study patients belonged to the following pretreatment diagnostic groups: LGDs in 162, HGDs in 164, AI-EGCs in 396, BAI-EGCs in 824, and AGCs in 495 cases. Posttreatment diagnostic groups were LGDs in 140, HGDs in 121, AI-EGCs in 322, BAI-EGCs in 947, AGCs in 505, and no residual tumor in 6 cases. In general, 6.9 % (141/2041) of cases were downgraded and 15.9 % (324/2041) were upgraded. Thirty-four percent of pretreatment HGDs (56/164) were changed to cancers after endoscopic resection. Thirty-three percent of pretreatment AI-EGCs (131/396) were regrouped as posttreatment BAI-EGCs. The additional surgery rate in each pretreatment group was 0.6 % in LGD, 4.3 % in HGD, 15.7 % in AI-EGC, 23.6 % in BAI-EGC among the patients with initial endoscopic resection (p < 0.01). CONCLUSIONS Twenty-three percent of gastric neoplasms changed in their final diagnostic group after endoscopic resection or surgery. This discrepancy should be considered when the initial treatment strategy is being selected.
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142
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Kim SJ, Cho YS, Moon SH, Bae JM, Kim S, Choe YS, Kim BT, Lee KH. Primary Tumor 18F-FDG Avidity Affects the Performance of 18F-FDG PET/CT for Detecting Gastric Cancer Recurrence. J Nucl Med 2015; 57:544-50. [DOI: 10.2967/jnumed.115.163295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/20/2015] [Indexed: 01/19/2023] Open
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Adjuvant and neoadjuvant options in resectable gastric cancer: is there an optimal treatment approach? Curr Oncol Rep 2015; 17:18. [PMID: 25708803 DOI: 10.1007/s11912-015-0442-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Gastric cancer is one of the most prevalent and deadliest forms of cancer worldwide. Even though neoadjuvant, perioperative, and adjuvant chemotherapy and/or radiation therapy may improve outcomes compared with surgery alone, the optimal combination of treatment modalities remains controversial. While European and North American trials established perioperative chemotherapy and adjuvant chemoradiation regimens for gastric cancer, Asian countries have focused on the use of adjuvant chemotherapy. This review summarizes results from contemporary randomized controlled trials and meta-analyses to elucidate the relative merits of each treatment approach.
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144
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Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a comparison study to surgery using propensity score-matched analysis. Surg Endosc 2015; 30:3762-73. [DOI: 10.1007/s00464-015-4672-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/07/2015] [Indexed: 02/06/2023]
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145
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Okabe H, Hata H, Ueda S, Zaima M, Tokuka A, Yoshimura T, Ota S, Kinjo Y, Yoshimura K, Sakai Y. A phase II study of neoadjuvant chemotherapy with S-1 and cisplatin for stage III gastric cancer: KUGC03. J Surg Oncol 2015; 113:36-41. [PMID: 26604064 DOI: 10.1002/jso.24096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/03/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES A multi-center phase II study was conducted to evaluate the safety and efficacy of neoadjuvant chemotherapy (NAC) with S-1 plus cisplatin for advanced gastric cancer. METHODS The eligibility criteria were clinical T3/T4 or N2, not Stage IV. Patients received two 35-day cycles of S-1 plus cisplatin, and then underwent D2 gastrectomy. The primary endpoint was 3-year progression free survival (PFS). Secondary endpoints were ratio of R0 resection, response rate, adverse events, and overall survival. A sample size of 49 was determined to have 80% power for detecting 15% improvement in the 3-year PFS over 55% at a one-sided alpha of 0.1. RESULTS Among 53 patients enrolled, 44 patients completed two cycles of NAC (83%), and 48 patients underwent R0 resection (91%). Postoperative complications occurred in 13 patients (26%). A pathological response was confirmed in 24 patients (45%), including four complete responses. The 3-year PFS was 50.7%, while the 3-year OS was 74.9%. CONCLUSIONS Although the observed 3-year PFS rate was worse than expected, NAC with S1 plus cisplatin was safe and led to a high rate of R0 resection. A randomized controlled trial is needed to make conclusions about the effectiveness of NAC in Japanese patients undergoing D2 resection.
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Affiliation(s)
- Hiroshi Okabe
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Hiroaki Hata
- Department of Surgery, Kyoto Medical Center, Kyoto, Japan
| | - Shugo Ueda
- Department of Gastroenterological Surgery, Kitano Hospital, Osaka, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga Medical Center for Adults, Shiga, Japan
| | - Atsuo Tokuka
- Department of Surgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | | | - Shuichi Ota
- Department of Surgery, Saiseikai Noe Hospital, Osaka, Japan
| | - Yousuke Kinjo
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University Hospital, Ishikawa, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan
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146
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Lee H, Lee JH. Expanding indications of endoscopic submucosal dissection for early gastric cancer: hope or hype? Gut Liver 2015; 9:135-6. [PMID: 25720997 PMCID: PMC4351015 DOI: 10.5009/gnl15008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Li H, Chen L, Huo Z, Xi H, Cui J, Zhao X. Defining a Subgroup Treatable for Laparoscopic and Endoscopic Cooperative Surgery in Undifferentiated Early Gastric Cancer: the Role of Lymph Node Metastasis. J Gastrointest Surg 2015. [PMID: 26224040 DOI: 10.1007/s11605-015-2897-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, the use of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and the development of laparoscopic and endoscopic cooperative surgery (LECS) have enabled either the preservation of the stomach or the minimization of the extent of partial resection. ESD has recently been practiced on a differentiated type of EGC. However, there is no clear evidence for endoscopic treatments of undifferentiated EGC. The purposes of this study are to investigate predictive factors of lymph node metastasis (LNM) in undifferentiated EGC and expand the possibility of using LECS for the treatment of undifferentiated EGC. METHODS Data from 116 patients with undifferentiated EGC and surgically treated were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95 % confidence interval (95 % CI) were calculated. RESULTS The tumor size (OR = 11.748, 95 % CI 2.034-62.213, P = 0.008), depth of invasion (OR = 13.928, 95 % CI 1.971-92.434, P = 0.016), and lymphatic vessel involvement (OR = 11.522, 95 % CI 2.645-59.172, P = 0.021) that were significantly associated with LNM by univariate analysis were found to be significant and independent risk factors for LNM by multivariate analysis. The LNM rate was 5.9 % (4/68) and 29.2 % (14/48) with intramucosal and submucosal undifferentiated EGC, respectively. LNM was observed in 66.7 % (2/3) of patients with both risk factors (tumor larger than or equal to 2.0 cm and the presence of lymphatic vessel involvement (LVI)), but in none of 36 patients without the two risk factors in intramucosal undifferentiated EGC. The 5-year survival rates were 88.9, 72.4, and 33.3 %, respectively, in cases with none, one, and two of the risk factors, respectively, in intramucosal undifferentiated EGC (P < 0.05). CONCLUSIONS ESD alone may be a sufficient treatment for intramucosal undifferentiated EGC if the tumor is less than 2.0 cm in size and when LVI is absent upon postoperative histological examination. LECS is feasible and safe for patients with undifferentiated EGC.
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Affiliation(s)
- Hua Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.,Department of Surgical Oncology, Affiliated Xing Tai People Hospital of Hebei Medial University, Xingtai, 054001, Hebei Province, China
| | - Lin Chen
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Zhibin Huo
- Department of Surgical Oncology, Affiliated Xing Tai People Hospital of Hebei Medial University, Xingtai, 054001, Hebei Province, China
| | - Hongqing Xi
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Jianxin Cui
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Xudong Zhao
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
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Kim SY, Ko YS, Park J, Choi Y, Park JW, Kim Y, Pyo JS, Yoo YB, Lee JS, Lee BL. Forkhead Transcription Factor FOXO1 Inhibits Angiogenesis in Gastric Cancer in Relation to SIRT1. Cancer Res Treat 2015; 48:345-54. [PMID: 25761483 PMCID: PMC4720104 DOI: 10.4143/crt.2014.247] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/05/2014] [Indexed: 01/26/2023] Open
Abstract
Purpose We previously reported that forkhead transcription factors of the O class 1 (FOXO1) expression in gastric cancer (GC) was associated with angiogenesis-related molecules. However, there is little experimental evidence for the direct role of FOXO1 in GC. In the present study, we investigated the effect of FOXO1 on the tumorigenesis and angiogenesis in GC and its relationship with SIRT1. Materials and Methods Stable GC cell lines (SNU-638 and SNU-601) infected with a lentivirus containing FOXO1 shRNA were established for animal studies as well as cell culture experiments. We used xenograft tumors in nude mice to evaluate the effect of FOXO1 silencing on tumor growth and angiogenesis. In addition, we examined the association between FOXO1 and SIRT1 by immunohistochemical tissue array analysis of 471 human GC specimens and Western blot analysis of xenografted tumor tissues. Results In cell culture, FOXO1 silencing enhanced hypoxia inducible factor-1α (HIF-1α) expression and GC cell growth under hypoxic conditions, but not under normoxic conditions. The xenograft study showed that FOXO1 downregulation enhanced tumor growth, microvessel areas, HIF-1α activation and vascular endothelial growth factor (VEGF) expression. In addition, inactivated FOXO1 expression was associated with SIRT1 expression in human GC tissues and xenograft tumor tissues. Conclusion Our results indicate that FOXO1 inhibits GC growth and angiogenesis under hypoxic conditions via inactivation of the HIF-1α–VEGF pathway, possibly in association with SIRT1. Thus, development of treatment modalities aiming at this pathway might be useful for treating GC.
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Affiliation(s)
- Sue Youn Kim
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Young San Ko
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Jinju Park
- Tumour Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yiseul Choi
- Tumour Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Wan Park
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea ; Ischemic/Hypoxic Disease Institute Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Younghoon Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Soo Pyo
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bok Yoo
- Department of Anatomy, Dankook University School of Medicine, Cheonan, Korea
| | - Jae-Seon Lee
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon, Korea
| | - Byung Lan Lee
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea ; Tumour Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea ; Ischemic/Hypoxic Disease Institute Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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