Gastric malignancies in Northern Jordan with special emphasis on descriptive epidemiology

Predictive Factors Associated with Survival in Female Gastric Cancer Patients in Southeast Asia

Introduction

Association of Southeast Asian Nations (ASEAN) countries have high Helicobacter pylori infections, and gastric cancer (GC) is a leading fatal cancer in this region, especially in female patients. This study aimed to compare clinical manifestations, histopathological subtypes, and prognostic factors associated with the overall survival rate of female GC patients in this important region.

Methods

This retrospective cohort study was conducted between 2007 and 2022 at a tertiary care center in Thailand. All clinical information, endoscopic findings, and histological types were extensively reviewed. Furthermore, all qualified studies in ASEAN published in PubMed and Scopus between 2000 and 2022 were extracted and thoroughly analyzed. Young female GC patients are defined as those ≤50 years of age.

Results

A total of 98 Thai female GC patients were included, with a mean age of 58.99 ± 14 years; 70.4% were elderly women. The common presenting symptoms were weight loss (69.4%) and dyspepsia (68.4%). Younger female GC patients had significantly more common diffuse-type GC than elderly female GC patients (82.8% vs. 53.6%, p-value = 0.007). Moreover, elderly female GC patients demonstrated significantly better survival than younger female GC patients (44.8% vs. 20.7%, odds ratio = 3.49; 95% confidence interval: 1.20-10.14, p-value = 0.022). Furthermore, a total of 1,491 female GC patients from ASEAN were reviewed and included in this study, aged 15 to 93 years. The top three countries with the highest proportion of female GC from ASEAN were Indonesia (66.7%), Thailand (44.9%), and Singapore (38.4%).

Conclusion

GC in women is not uncommon in ASEAN and presents at an advanced stage with a grave prognosis. This study showed that ASEAN countries with the highest disease burden were Indonesia, Thailand, and Singapore. Overall, survival rates for female GC patients in ASEAN countries were relatively low, highlighting the need for proactive measures such as intensive H. pylori eradication and the development of early detection methods for GC.

Epidemiology, Risk Factors for Gastric Cancer and Surveillance of Premalignant Gastric Lesions: A Prospective Cohort Study of Central Saudi Arabia

(1) Background: Saudi Arabia (SA) is a country with a low incidence of gastric cancer (GC). In this study, we sought to assess the epidemiology of GC, its clinicopathological profiles, and its association with risk factors as well as to identify premalignant gastric lesions (PGL) and examine neoplastic progression. (2) Methods: This five-year prospective study screened for GC and PGL in asymptomatic Saudi patients, aged 45-75 years (n = 35,640) and living in Al Kharj, Riyadh province in central SA. Those who were positive in a high-sensitivity guaiac fecal occult blood test (HSgFOBT+) and had negative results in colonoscopy offered to undergo upper GI endoscopy (n = 1242). Factors associated with GC were examined. (3) Results: The five-year participation rate was 87% (1080/1242). The incidence rate of GC was 26.9 new cases per 100,000 population per year (9.6 new cases per year/total population at risk-35,640), and it was 8.9 cases per 1000 persons per year among the 1080 subjects with HSgFOBT+ and negative colonoscopy results. The five-year mortality rate was 67% among patients with GC (n = 48), 3.0% among participants in the gastric screening program (n = 1080) and 0.09% among the original population participating in the colorectal screening program (n = 35,640). Intestinal-type adenocarcinoma was the most frequent type (77%), with the tumor most commonly located in the antrum (41%). Overall, 334 participants had PGL, and seven of them (2.1%) showed neoplastic progression to GC during the follow-up. Factors associated with GC were age, Helicobacter pylori (HP) infection, obesity (body mass index BMI > 30), smoking, a diet of salty preserved foods, low income and a family history of GC. (4) Conclusions: The incidence of GC is low in central SA, but screening for PGL and GC among patients with HSgFOBT+ and negative colonoscopy may prevent or result in the early treatment of GC. HP eradication, normal body weight, not smoking and adhering to a healthy diet can reduce the risk of GC. The resulting data provide important input for the improvement of national guidelines.

The first Middle East and North Africa expert consensus recommendations for management of advanced gastric cancer

Gastric cancer (GC) ranks as the fifth most prevalent cancer and the fourth deadliest cancer worldwide. In the Middle East and North Africa (MENA) region, GC represents about 4.8% of cancer cases with more than 35,000 new cases in 2020. To strengthen and improve the management of this cancer in the region, a group of MENA experts in the field of GC developed the first MENA consensus recommendations for the management of advanced GC. A total of 28 statements were drafted, discussed and voted on, using a modified Delphi process, during a virtual consensus meeting. The statements addressed the areas of epidemiology, biomarkers and treatment.

A Genetic and Immunohistochemical Analysis of Helicobacter pylori Phenotypes and p27 Expression in Adenocarcinoma Patients in Jordan

Stomach (gastric) cancer is one of the most prevalent and deadly cancers worldwide and most gastric cancers are adenocarcinomas. Based on prior research, there is an association between Helicobacter pylori (H. pylori) infection together with the frequency of duodenal ulcer, distal gastric adenocarcinoma, mucosa-associated lymphoid tissue (MALT) lymphoma, and antral gastritis. Helicobacter pylori virulence and toxicity factors have been identified before that significantly influence the clinical outcomes of H. pylori infection and gastric adenocarcinoma. However, it remains unclear exactly how different strains of H. pylori affect gastric adenocarcinoma. Current research suggests this involves tumor suppressor genes, like p27 but also H. pylori toxic virulence proteins. Therefore, we quantified known H. pylori genotypes within adenocarcinoma patients to establish the prevalence of known toxins that include cytotoxin-associated gene A (cagA) as well as vacuolating cytotoxin A (vacA) within patients of variable adenocarcinoma diagnosis. This analysis used gastrectomy samples validated for DNA viability. The incidence of H. pylori in adenocarcinoma patients in Jordan was established to be 54.5% positive (ureA gene positive) with cagA genotype occurrence at 57.1%, but also in this population study vacA gene ratios found to be 24.7%:22.1%:14.3%:14.3%. (vacAs1:vacAs2:vacAm1:vacAm2). Using immunohistochemistry (IHC), we confirmed with statistical significance that p27 was dysregulated and suppressed, within nearly all H. pylori vacA genotypes. In addition, within 24.6% of H. pylori samples analyzed was a different bacterial genotype, and curiously that p27 protein expression was retained in 12% of tested adenocarcinoma H. pylori samples. This is suggestive that p27 could be used as a prognostic indicator but also that an unknown genotype could be contributing to the regulatory effects of p27 protein within this bacterial and cellular environment that may include other virulence factors and unknown immune system regulatory changes.

Sex Disparity in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis aimed to ascertain whether sex-based differences influence clinicopathological characteristics and survival outcomes of gastric cancer patients.

BACKGROUND

Gastric cancer in females has received less attention than in males. Clinicopathological features and survival outcomes of females with gastric cancer have been reported in several studies with controversial results.

METHODS

We systematically reviewed clinical studies from PubMed, Cochrane Library, Embase, and Web of Science published up to June 2022. The effect sizes of the included studies were estimated using odds ratios (ORs). Heterogeneity was investigated using the χ2 and I ² tests, while sensitivity analyses were performed to identify the source of substantial heterogeneity. All data used in this study were obtained from previously published studies obviating the need for ethical approval and patient consent.

RESULTS

Seventy-six studies with 775,003 gastric cancer patients were included in the meta-analysis. Gastric cancer patients were less likely to be females (P < 0.00001). Female patients were younger in age (P < 0.00001) and showed a higher percentage of distal (P < 0.00001), non-cardia (P < 0.00001), undifferentiated (P < 0.00001), diffuse (P < 0.00001), and signet-ring cell carcinoma (P < 0.00001). Female patients showed better prognosis in both 3-year (P = 0.0003) and 5-year overall survival (OS) (P < 0.00001), especially White patients. However, females were associated with lower 5-year OS relative to males in the younger patients (P = 0.0001).

CONCLUSIONS

In conclusion, gender differences were observed in clinicopathological characteristics and survival outcomes of gastric cancer. Different management of therapy will become necessary for different genders.

Epidemiologic characteristics of gastric malignancies among Jordan University Hospital patients

OBJECTIVES

To discover the epidemiologic distribution of gastric malignancies among Jordan University Hospital patients and to compare this distribution with the neighboring Arab countries. Methods: Retrospective study covering the period between  January 2006, and May 2016, in Jordan University Hospital, Amman, Jordan. All cases were retrieved from the computer system and analyzed using IBM SPSS version 23 software.  Results: One hundred and sixty-five cases were analyzed. Male-to-female ratio was 1.2:1. The mean age was 58.6 with 32.1% of patients aged 50 or younger. Primary adenocarcinoma was the most common tumor, half of which were diffuse type, followed by carcinoid tumors (15.2 %), lymphomas (10.3%), and gastrointestinal stromal tumors (8.5%). Proximally located tumors accounted for 15.4%. Helicobacter pylori were present in approximately half of the cases and 34.6% of cases contained intestinal metaplasia.  Conclusion: Jordan is a low-risk area for gastric cancer, but carcinoma occurs at a young age and is associated with gastritis, Helicobacter pylori infection, and intestinal metaplasia in a large proportion of cases. Better strategic health planning and early detection is needed, especially in young patients suffering from gastritis.

Advanced gastric cancer in jordan from 2004 to 2008: a study of epidemiology and outcomes

BACKGROUND

WE REPORT THE EPIDEMIOLOGIC FEATURES AND THE TREATMENT EXPERIENCE OF ADVANCED GASTRIC CANCER (GC) AT KING HUSSEIN CANCER CENTER (KHCC) IN JORDAN, AND WE RETROSPECTIVELY COMPARE OUTCOMES OF TWO DIFFERENT REGIMENS: DCF (docetaxel/cisplatin/5-fluorouracil) vs. ECF (epirubicin/cisplatin/5-fluorouracil).

METHODS

Charts of 162 patients with inoperable GC treated between January 2004 and December 2008 were reviewed. A total 143 patients received chemotherapy (ECF = 113; DCF = 30). Choice of regimen was changed from ECF to DCF on January 2008 according to KHCC guidelines.

RESULTS

The median patient age was 59 years, with a male:female ratio of 1.8:1. Lymph nodes (67.9%) and liver (49.4%) were the most common sites of metastasis. Primary disease site was stomach in 78.4%, gastroesophageal junction in 16.7%, lower esophagus in 4.9%. Poorly differentiated histology was predominant (46.9%). Anemia (53.7%), pain (48.1%), and reflux (44.4%) were the most common presenting symptoms. Helicobacter pylori infection was present in 79%. Average time between initial symptom and diagnosis was 6.0 months. The overall response rate (ORR) was 59.3% with DCF and 32.6% with ECF (P = .01). Time to tumor progression (TTP) was 6.9 months with DCF and 5.9 months with ECF (P = .005). Median survival was 11.0 months with DCF and 10.2 months with ECF (P = .17).

CONCLUSION

Some epidemiologic features of GC in Jordan mimic those of high-risk areas. Our outcomes of chemotherapy are comparable to internationally reported data and suggest superiority of DCF over ECF in terms of ORR and TTP.

Prognostic factors and survival in stomach cancer - analysis of 15 years of data from a referral hospital in iran and evaluation of international variation

BACKGROUND

Stomach cancer is the most common cancer among Iranian men. We studied survival rates and prognostic factors of stomach cancer in a referral hospital in Tehran, Iran.

PATIENTS AND METHODS

We followed 367 stomach cancer patients hospitalized between 1991 and 2007 in the Baqyiatallah Hospital. We estimated survival rates overall and among operable patients exclusively. Hazard ratios (HR) for the different prognostic factors were estimated with the Cox regression model. Furthermore, we studied international variations in stage distribution and 5 year survival for stomach cancer.

RESULTS

Overall, 5 year survival of stomach cancer was low (14%), and the majority of patients (53%) were diagnosed at stage IV. Stage, tumor size, age, and gender were statistically significant prognostic factors. Relative risk of mortality in stage IV compared to stage IA was 9.9 (95% confidence interval 5.8-16.9). The highest 5 year survival was reported from Japan, particularly among screening detected patients (89.4%). Among operable patients, 5 year survival was 32.6% in France, 26% in the USA, and 30.5% in China, which was close to the rates estimated in our study (24%).

CONCLUSIONS

Due to stomach cancer being frequently diagnosed in advanced stages, its prognosis is poor in Iran. Early diagnosis and downstaging strategies need to be prioritized to improve the prognosis of stomach cancer.

Correlation of p53 over-expression and alteration in p53 gene detected by polymerase chain reaction-single strand conformation polymorphism in adenocarcinoma of gastric cancer patients from India

AIM: To study the alterations in p53 gene among Indian gastric cancer patients and to correlate them with the various clinicopathological parameters.

METHODS: A total of 103 gastric cancer patients were included in this study. The p53 alterations were studied by both immunohistochemical method as well as polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) analysis. We only studied four (exon 5, 6, 7, and 8) of the 11 p53 exons. The alterations in p53 were also correlated with respect to various clinicopathological parameters.

RESULTS: Among 103 cases, p53 over-expression and alteration were detected in 37 (35.92%) and 19 (18.44%) cases, respectively. Most of the p53 alterations were found at exon 5 (31.54%), followed by exon 6 (26.31%), exon 7 (21.04%) and exon 8 (21.04%). A significant correlation of p53 over-expression was found with p53 alteration (P = 0.000). Concordance between p53 alteration (as detected by SSCP) and over-expression [as detected by immunohistochemistry (IHC)] was found in 75% cases. We found that IHC-positive/SSCP-negative cases accounted for 21% of cases and IHC-negative/SSCP-positive cases accounted for remaining 4% cases.

CONCLUSION: Our results show that p53 gene mutations are significantly correlated with p53 protein over-expression, with 75% concordance in over-expression and alteration in the p53 gene, but 25% disconcordance also cautions against the assumption that p53 over-expression is always associated with a gene mutation. There may be other mechanisms responsible for stabilization and accumulation of p53 protein with no evidence of gene mutation that reflect an accumulation of a non-mutated protein, or a false negative SSCP result.

[Evaluation of endoscopic visualisation for identifying premalignant gastric lesions in a Columbian population using histopathology as a reference]

AIM

To evaluate the performance of endoscopic visualization in the identification of premalignant gastric lesions, with histopathological examination of biopsy samples as a reference test, in Bucaramanga, Colombia.

LOCATION

League for the Fight Against Cancer, Bucaramanga, Colombia.

DESIGN

Diagnostic technology evaluation with cross-sectional sampling.

MEASUREMENTS

We calculate the sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio (+), likelihood ratio (-), kappa index and the prevalence rate kappa.

RESULTS

A total of 155 patients were studied, with a mean age of 45.43 (14.15) years and an approximate male:female ratio of 2:1. The endoscopic visualization had a sensitivity of 87.84%, a specificity of 55.56%, a positive predictive value of 64.36%, a negative predictive value of 83.33%, a likelihood ratio+of 1.98, a likelihood ratio-de 0.22 and a kappa index of 0.4272, in the identification of preneoplastic lesions of the stomach in a population with a disease prevalence of 47.74%.

CONCLUSIONS

The endoscopic visualization of the gastrointestinal mucosa, allows a moderate and fast identification of early preneoplastic lesions, providing an opportunity of its early histopathological diagnosis.

Outcome as a measure of quality of care in oncology: experience at sultan qaboos university hospital, oman

OBJECTIVES

Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital (SQUH), Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman.

METHODS

The cancers included non-Hodgkin's lymphoma (NHL), Hodgkin's lymphoma (HL), breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies.

RESULTS

For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5 %; 24% for the non-metastatic group.

CONCLUSION

The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting with advanced stage disease and several adverse prognostic factors.

Strong activation of PAR-2 receptors: a common trigger for the development of gastrointestinal adenocarcinomas?

Helicobacter pylori infection is considered to be an important factor in the development of gastric cancer, while duodenogastroesophageal reflux is claimed to be the main cause of development of esophageal adenocarcinoma. A pronounced activation of PAR-2 receptors may be a common denominator in triggering the development of these cancers, and possibly pancreatic and colonic cancers as well. Evidence supporting such a concept is presented.

Effect of p27(KIP1) on cell cycle and apoptosis in gastric cancer cells

AIM

To elucidate the effect of p27(KIP1) on cell cycle and apoptosis regulation in gastric carcinoma cells.

METHODS

The whole length of p27(KIP1) cDNA was transfected into human gastric cancer cell line SCG7901 by lipofectamine. Expression of p27(KIP1) protein or mRNA was analyzed by Western blot and RNA dot blotting, respectively. Effect of p27(KIP1) on cell growth was observed by MTT assay and anchorage-independent growth in soft agar. Tumorigenicity in nude mice was used to assess the in vivo biological effect of p27(KIP1). Flow cytometry, TUNEL, and electron microscopy were used to assess the effect of p27(KIP1) on cell cycle and apoptosis.

RESULTS

Expression of p27(KIP1) protein or mRNA increased evidently in SCG7901 cells transfected with p27(KIP1). The cell growth was reduced by 31% at 48 h after induction with zinc determined by cell viability assay. The alteration of cell malignant phenotype was evidently indicated by the loss of anchorage-independent growth ability in soft agar. The tumorigenicity in nude mice was reduced evidently (0.55+/-0.14 cm vs 1.36+/-0.13 cm, P<0.01). p27(KIP1) overexpression caused cell arrest with 36% increase (from 33.7% to 69.3%, P<0.01) in G1 population. Prolonged p27(KIP1) expression induced apoptotic cell death reflected by pre-G1 peak in the histogram of FACS, which was also confirmed by TUNEL assay and electron microscopy.

CONCLUSION

p27(KIP1) can prolong cell cycle in G1 phase and lead to apoptosis. p27(KIP1) may be a good candidate for cancer gene therapy.

Different regression equations relate age to the incidence of Lauren types 1 and 2 stomach cancer in the SEER database: these equations are unaffected by sex or race

Background

Although impacts upon gastric cancer incidence of race, age, sex, and Lauren type have been individually explored, neither their importance when evaluated together nor the presence or absence of interactions among them have not been fully described.

Methods

This study, derived from SEER (Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute) data, analyzed the incidences of gastric cancer between the years 1992–2001. There were 7882 patients who had developed gastric cancer. The total denominator population was 145,155, 669 persons (68,395,787 for 1992–1996, 78,759,882 for 1997–2001). Patients with multiple tumors were evaluated as per the default of the SEER*Stat program. 160 age-, five year period (1992–1996 vs 1997–2001)-, sex-, race (Asian vs non-Asian)-, Lauren type- specific incidences were derived to form the stratified sample evaluated by linear regression. (160 groups = 2 five year periods × 2 race groups × 2 sexes × 2 Lauren types × 10 age groups.) Linear regression was used to analyze the importance of each of these explanatory variables and to see if there were interactions among the explanatory variables.

Results

Race, sex, age group, and Lauren type were found to be important explanatory variables, as were interactions between Lauren type and each of the other important explanatory variables. In the final model, the contribution of each explanatory variable was highly statistically significant (t > 5, d.f. 151, P < 0.00001). The regression equation for Lauren type 1 had different coefficients for the explanatory variables Race, Sex, and Age, than did the regression equation for Lauren type 2.

Conclusion

The change of the incidence of stomach cancer with respect to age for Lauren type 1 stomach cancer differs from that for Lauren type 2 stomach cancers. The relationships between age and Lauren type do not differ across gender or race. The results support the notion that Lauren type 1 and Lauren type 2 gastric cancers have different etiologies and different patterns of progression from pre-cancer to cancer. The results should be validated by evaluation of other databases.

Apoptosis induced by preoperative oral 5’-DFUR administration in gastric adenocarcinoma and its mechanism of action

AIM: To study the apoptosis induced by preoperative oral 5’-DFUR administration in gastric adenocarcinoma and its mechanism of action.

METHODS: Sixty gastric cancer patients were divided randomly into three groups (20 each group) before operation: group one: 5’-DFUR oral administration at the dose of 800-1200mg/d for 3 - 5 d, group two: 500mg 5-FU + 200 mg/d CF by venous drip for 3 - 5 d, group three (control group). One or two days after chemotherapy, the patients were operated. Fas/FasL, PD-ECGF and PCNA were examined by immunohistochemistry and apoptotic tumor cells were detected by in situ TUNEL method. Fifty-four patients received gastrectomy, including 12 palliative resections and 42 radical resections. Six patients were excluded. Finally 18 cases in 5’-DFUR group, 16 cases in CF + 5-FU group, and 20 cases in control group were analyzed.

RESULTS: There was no significant difference in patient mean age, gender, white blood cell count, haematoglobin (HB), thromboplastin, perioperative complication incidence, radical or palliation resection, invasion depth (T), lymphonode involvement (N), metastasis (M) and TNM staging among the three groups. However, the PCNA index (PI) in 5’-DFUR group (40.51 ± 12.62) and 5-FU + CF group (41.12 ± 15.26) was significantly lower than that in control group (58.33 ± 15.69) (F = 9.083, P = 0.000). The apoptotic index (AI) in 5’-DFUR group (14.39 ± 9.49) and 5-FU + CF group (14.11±9.68) was significantly higher than that in control group (6.88 ± 7.37) (F = 4.409, P = 0.017). The expression rates of Fas and FasL in group one and group three were 66.7% (12/18) and 50% (9/18), 43.8% (7/16) and 81.3% (13/16), 45.0% (9/20) and 85% (17/20), respectively. The expression rate of FasL in 5’-DFUR group was significantly lower than that in the other two groups (χ²=6.708, P = 0.035). Meanwhile, the expression rate of PD-ECGF was significantly lower in 5’-DFUR group (4/18，28.6%) than in CF + 5-FU group（9/16，56.3%）and control group (13/20，65.0%) (χ²= 7.542, P = 0.023). The frequency of Fas expression was significantly correlated with palliative or radical resection (χ²= 7.651, P = 0.006), invasion depth (χ²= 8.927, P = 0.003), lymphatic spread (χ²= 4.488, P = 0.034) and UICC stages (χ²= 8.063, P = 0.045) respectively. By the end of March 2005, 45 patients were followed up. The 0.5-, 1-, 2-, 3-year survival rates were 96%，73%，60%，48%, respectively, which were related with T, N, M and Fas expression, but not with PD-ECGF and FasL expression.

CONCLUSION: Preoperative oral 5’-DFUR administration may induce apoptosis of gastric carcinoma cells and decrease tumor cell proliferation index, but cannot improve the prognosis of patients with gastric cancer. Down-regulation of FasL and PD-ECGF expression mediated by 5’-DFUR may be one of its anti-cancer mechanisms. Fas expression correlates with the progression of gastric carcinoma and may be an effective prognostic factor.

Combined evaluation of expressions of cyclin E and p53 proteins as prognostic factors for patients with gastric cancer

BACKGROUND

There is a lack of consistency regarding the prognostic value of cyclin E overexpression in gastric cancer (gastric cancer). Our aim was to report on this overexpression and to analyze its correlations with the clinicopathologic variables. Another aim was to examine if aberrant expression of both cyclin E and p53 might increase the malignant potential of gastric cancer.

METHODS

Specimens from 89 patients with gastric cancer treated with "curative" intent were evaluated for cyclin E and p53 expressions using immunohistochemical method. The correlations between cyclin E overexpression alone or in combination with p53 expression and the patient's clinicopathologic variables were analyzed.

RESULTS

Cyclin E overexpression and p53 expression were shown in 35 (39.3%) and 46 (51.7%) tumors, respectively. The incidence of cyclin E overexpression was significantly higher in deeply invasive cancers (P < 0.0001), in cancers with lymph node metastasis (P = 0.003), and in cancers with advanced stages (P < 0.0001). There were no significant correlations with other clinicopathologic variables. Patients in whom their tumors showed cyclin E overexpression alone or in combination with p53 survived less than patients with negative cyclin E tumors. Multivariate analysis revealed that combined cyclin E overexpression and p53 expression was significantly associated with poor survival after adjusting for other variables (hazard ratio, 3.12; P = 0.009).

CONCLUSIONS

Cyclin E overexpression is a common event in gastric cancer. Gastric cancer with cyclin E overexpression exhibit increased aggressiveness in the presence of aberrant p53. The combination of cyclin E overexpression with the p53 expression in gastric cancer further distinguished a subgroup of patients with poor prognosis.