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Plum PS, Pamuk A, Barutcu AG, Mallmann C, Niesen E, Berlth F, Zander T, Chon SH, Moenig SP, Quaas A, Bruns CJ, Hoelscher AH, Alakus H. Two decades of gastric and gastroesophageal junction cancer surgery. J Cancer Res Clin Oncol 2023; 149:7679-7688. [PMID: 37000260 PMCID: PMC10374756 DOI: 10.1007/s00432-023-04719-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Diagnosis and treatment of gastric and gastroesophageal junction cancer have undergone many critical changes during the last two decades. We addressed the question of how clinical reality outside of clinical trials has changed for gastric and gastroesophageal junction cancer patients in a European center for upper gastrointestinal surgery. METHODS In this retrospective cohort study, patients undergoing (sub)total gastrectomy for gastric or gastroesophageal junction adenocarcinoma between 1996 and 2017 in a tertiary upper gastrointestinal center were included. The time was divided into a) before (1996-2006) (pre-CTx) and b) after (2006-2017) (CTx) the MAGIC trial. Data were comprehensively analyzed for demographics, tumor stage, perioperative treatment, surgery, histopathology, and survival rates (SR). RESULTS 737 patients (32% female) underwent gastrectomy, 255 patients in the pre-CTx era and 482 patients in the CTx era. The median age was 65 years and the median follow-up was 27.5 months for surviving patients. Around 16.9% of patients received neoadjuvant treatment in the pre-CTx era versus 46.3% in the CTx era. The 3-year survival rate (3-YSR) was 46.4% in the pre-CTx and 60.9% in the CTx era (p < 0.001). For pretreated patients, 3-YSR was 39.0% (pre-CTx) versus 55.3% (CTx) (p = 0.168). Survival rate (SR) for locally advanced tumor stages (cT3/cT4) was higher when neoadjuvant therapy was administered (3-YSR: 56.7% vs 40.6%; p = 0.022). There were no significant differences according to sex (p = 0.357), age (p = 0.379), pT category (p = 0.817), pN stage (p = 0.074), cM stage (p = 0.112), Laurén classification (p = 0.158), and SRs (3-YSR: 60.3% vs 59.4%; p = 0.898) between the MAGIC and FLOT regimens. CONCLUSIONS Survival rates have dramatically improved for gastric cancer patients during the last two decades. MAGIC and FLOT regimens showed similar results in the postsurgical follow-up.
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Affiliation(s)
- Patrick S Plum
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Aylin Pamuk
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Atakan G Barutcu
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Christoph Mallmann
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Emanuel Niesen
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
- Gastrointestinal Cancer Group Cologne (GCGC), Cologne, Germany
| | - Felix Berlth
- Department of General, Visceral and Transplant Surgery, University Medical Center, Mainz, Germany
| | - Thomas Zander
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
- Gastrointestinal Cancer Group Cologne (GCGC), Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Stefan P Moenig
- Service de Chirurgie Viscéral, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexander Quaas
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Gastrointestinal Cancer Group Cologne (GCGC), Cologne, Germany
| | | | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany.
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Plum PS, Barutcu AG, Pamuk A, Mallmann C, Chon SH, Chiapponi C, Dübbers M, Hellmich M, Moenig SP, Quaas A, Hoelscher AH, Bruns CJ, Alakus H. Extension of resection after positive intraoperative pathology during surgery for gastric and gastroesophageal junction adenocarcinoma: a retrospective cohort study. Int J Surg 2023; 109:2324-2333. [PMID: 37222663 PMCID: PMC10442120 DOI: 10.1097/js9.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Residual tumor at the resection margins after surgery for gastric and gastroesophageal junction (GEJ) adenocarcinoma is a known prognostic factor. In this single-center, retrospective cohort study in a tertiary referral center, the authors aimed to evaluate the relevance of intraoperative pathology consultation (IOC) and consecutive extension of surgery on patient survival. STUDY DESIGN Of 737 consecutive patients undergoing (sub)total gastrectomy for gastric or GEJ adenocarcinoma, 679 cases with curative intent surgery between 05/1996 and 03/2019 were included. Patients were categorized into: R0 without further resection (direct R0), R0 after positive IOC and extension of resection (converted R0), and R1. RESULTS IOC was performed in 242 (35.6%) patients, in 216 (89.3%) at the proximal resection margin. Direct R0-status was achieved in 598 (88.1%), converted R0 in 26 (3.8%) of 38 (5.6%) patients with positive IOC and R1 in 55 (8.1%) patients. The median follow-up was 29 months for surviving patients. 3-year survival rate (3-YSR) was significantly higher for direct R0 compared to converted R0 with 62.3% compared to 21.8% (hazard ratio=0.298; 95% CI=0.186-0.477, P <0.001). 3-YSR was similar between converted R0 and R1 (21.8 vs. 13.3%; hazard ratio =0.928; 95% CI=0.526-1.636, P =0.792). In multivariate analysis, advanced T ( P <0.001), N ( P <0.001), R ( P =0.003), and M1 status ( P <0.001) were associated with worse overall survival. CONCLUSION IOC and consecutive extended resection for positive resection margins in gastrectomy for the proximal gastric and GEJ adenocarcinoma does not achieve long-term survival benefits in advanced tumor stages.
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Affiliation(s)
- Patrick S. Plum
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
- Gastrointestinal Cancer Group Cologne, Cologne, Germany
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig
| | - Atakan G. Barutcu
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Aylin Pamuk
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Christoph Mallmann
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Martin Dübbers
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute for Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan P. Moenig
- Service de chirurgie viscéral, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexander Quaas
- Gastrointestinal Cancer Group Cologne, Cologne, Germany
- Institute of Pathology, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Arnulf H. Hoelscher
- Germany Center for Esophageal Diseases, Elisabethkrankenhaus Essen Essen, Germany
| | - Christiane J. Bruns
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
- Gastrointestinal Cancer Group Cologne, Cologne, Germany
| | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplantat Surgery, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
- Gastrointestinal Cancer Group Cologne, Cologne, Germany
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Luebke T, Baldus SE, Spieker D, Grass G, Bollschweiler E, Schneider PM, Thiele J, Dienes HP, Hoelscher AH, Moenig SP. Is the Urokinase-type Plasminogen Activator System a Reliable Prognostic Factor in Gastric Cancer? Int J Biol Markers 2018; 21:162-9. [PMID: 17013798 DOI: 10.1177/172460080602100305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim The aim of this prospective study was to evaluate the clinical and prognostic impact of immunohisto-chemically assessed uPA and PAI-1 in patients with gastric cancer. Methods This prospective study analyzed specimens obtained from 105 gastric cancer patients who underwent gastrectomy with extended lymphadenectomy. The immunohistochemical expression of uPA and PAI-1 was studied semiquantitatively in the tumor epithelium and was correlated with the clinicopathological features of each patient. Results Univariate analysis revealed no statistically significant association of uPA levels with pT and pN category (p=0.655 and 0.053, respectively), grading (p=0.374), depth of tumor invasion (p=0.665), UICC classification (p=0.21) and the Laurén classification (p=0.578). PAI-1 expression showed no statistically significant correlation with pT, pN and M category (p=0.589, 0.414, and 0.167, respectively), grading (p=0.273), and the Laurén classification (p=0.368). Only the UICC classification was significantly correlated with PAI-1 (p=0.016). Kaplan-Meier analysis revealed no significant association of uPA and PAI-1 with overall survival (p=0.0929 and 0.0870, respectively). Conclusions Our results could not verify any prognostic value of uPA and PAI-1 levels in patients with gastric carcinoma. Therefore, the uPA-system as a biologically defined prognostic marker to identify high-risk gastric cancers should be applied with caution. However, considering the number of patients involved and the borderline level of significance observed in this study, a larger number of events may have resulted in significant differences.
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Affiliation(s)
- T Luebke
- Department of Surgery, University of Cologne, Cologne, Germany
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Al-Batran SE, Goetze TO, Mueller DW, Vogel A, Winkler M, Lorenzen S, Novotny A, Pauligk C, Homann N, Jungbluth T, Reissfelder C, Caca K, Retter S, Horndasch E, Gumpp J, Bolling C, Fuchs KH, Blau W, Padberg W, Pohl M, Wunsch A, Michl P, Mannes F, Schwarzbach M, Schmalenberg H, Hohaus M, Scholz C, Benckert C, Knorrenschild JR, Kanngießer V, Zander T, Alakus H, Hofheinz RD, Roedel C, Shah MA, Sasako M, Lorenz D, Izbicki J, Bechstein WO, Lang H, Moenig SP. The RENAISSANCE (AIO-FLOT5) trial: effect of chemotherapy alone vs. chemotherapy followed by surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction - a phase III trial of the German AIO/CAO-V/CAOGI. BMC Cancer 2017; 17:893. [PMID: 29282088 PMCID: PMC5745860 DOI: 10.1186/s12885-017-3918-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022] Open
Abstract
Background Historical data indicate that surgical resection may benefit select patients with metastatic gastric and gastroesophageal junction cancer. However, randomized clinical trials are lacking. The current RENAISSANCE trial addresses the potential benefits of surgical intervention in gastric and gastroesophageal junction cancer with limited metastases. Methods This is a prospective, multicenter, randomized, investigator-initiated phase III trial. Previously untreated patients with limited metastatic stage (retroperitoneal lymph node metastases only or a maximum of one incurable organ site that is potentially resectable or locally controllable with or without retroperitoneal lymph nodes) receive 4 cycles of FLOT chemotherapy alone or with trastuzumab if Her2+. Patients without disease progression after 4 cycles are randomized 1:1 to receive additional chemotherapy cycles or surgical resection of primary and metastases followed by subsequent chemotherapy. 271 patients are to be allocated to the trial, of which at least 176 patients will proceed to randomization. The primary endpoint is overall survival; main secondary endpoints are quality of life assessed by EORTC-QLQ-C30 questionnaire, progression free survival and surgical morbidity and mortality. Recruitment has already started; currently (Feb 2017) 22 patients have been enrolled. Discussion If the RENAISSANCE concept proves to be effective, this could potentially lead to a new standard of therapy. On the contrary, if the outcome is negative, patients with gastric or GEJ cancer and metastases will no longer be considered candidates for surgical intervention. Trial registration The article reports of a health care intervention on human participants and is registered on October 12, 2015 under ClinicalTrials.gov Identifier: NCT02578368; EudraCT: 2014–002665-30.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - Thorsten O Goetze
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Daniel W Mueller
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Arndt Vogel
- Department of Internal Medicine, Hannover Medical School, 30625, Hannover, Germany
| | - Michael Winkler
- Department of Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Sylvie Lorenzen
- Department of Internal Medicine, Klinikum rechts der Isar der TU München, 81675, Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar der TU München, 81675, Munich, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Nils Homann
- Department of Internal Medicine II, Academic Teaching Hospital Wolfsburg, 05361, Wolfsburg, Germany
| | - Thomas Jungbluth
- Department of Surgery, Academic Teaching Hospital Wolfsburg, 05361, Wolfsburg, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Hospital Carl Gustav Carus Dresden, 01307, Dresden, Germany
| | - Karel Caca
- Department of Internal Medicine, Klinikum Ludwigsburg, 71640, Ludwigsburg, Germany
| | - Steffen Retter
- Department of Surgery, Klinikum Ludwigsburg, 71640, Ludwigsburg, Germany
| | - Eva Horndasch
- Department of Internal Medicine, Kliniken des Landkreises Neumarkt, 92318, Neumarkt, Germany
| | - Julia Gumpp
- Department of Surgery, Kliniken des Landkreises Neumarkt, 92318, Neumarkt, Germany
| | - Claus Bolling
- Department of Internal Medicine, Agaplesion Markus Krankenhaus Frankfurter, Diakonie Kliniken gGmbH, 60431, Frankfurt, Germany
| | - Karl-Hermann Fuchs
- Department of Surgery, Agaplesion Markus Krankenhaus Frankfurter Diakonie Kliniken gGmbH, 60431, Frankfurt, Germany
| | - Wolfgang Blau
- Department of Medical Oncology, Gießen University Hospital, 35392, Gießen, Germany
| | - Winfried Padberg
- Department of Surgery, Gießen University Hospital, 35392, Gießen, Germany
| | - Michael Pohl
- Department of Internal Medicine, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Andreas Wunsch
- Department of Surgery, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Patrick Michl
- Department of Medical Oncology, Halle University Hospital, 06120, Halle (Saale), Germany
| | - Frank Mannes
- Department of Internal Medicine, Halle University Hospital, (Saale), 06120, Halle, Germany
| | | | - Harald Schmalenberg
- Department of Internal Medicine IV, Städtisches Klinikum Dresden, 01067, Dresden, Germany
| | - Michael Hohaus
- Department of Surgery, Städtisches Klinikum Dresden, 01067, Dresden, Germany
| | - Christian Scholz
- Department of Medical Oncology, Vivantes Klinikum Am Urban Berlin, 10967, Berlin, Germany
| | - Christoph Benckert
- Department of Surgery, Vivantes Klinikum Am Urban Berlin, 10967, Berlin, Germany
| | | | - Veit Kanngießer
- Department of Surgery, Marburg University Hospital, 35043, Marburg, Germany
| | - Thomas Zander
- Department of Internal Medicine, University Hospital Köln, 50937, Köln, Germany
| | - Hakan Alakus
- Department of Surgery, University Hospital Köln, 50937, Köln, Germany
| | | | - Claus Roedel
- Department of Radiation- Oncology, Frankfurt University Hospital, 60590, Frankfurt, Germany
| | - Manish A Shah
- Department of Medicine Hematology and Oncology, Weill Cornell Medicine, New York, USA
| | - Mitsuru Sasako
- Department of Surgery, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Dietmar Lorenz
- Department of General and Visceral Surgery, Sana- Klinikum Offenbach, 63069 Offenbach, Hamburg, Germany
| | - Jakob Izbicki
- Department of Surgery, Hamburg University Hospital, 20246, Hamburg, Germany
| | - Wolf O Bechstein
- Department of Surgery, Frankfurt University Hospital, 60590 Frankfurt, Hamburg, Germany
| | - Hauke Lang
- Department of Surgery, Mainz University Hospital, 55131, Mainz, Germany
| | - Stefan P Moenig
- Hôpitaux Universitaires de Genève, Service de Chirurgie viscéral, 1205, Genève, Switzerland
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Fetzner UK, Oana IC, Büschel P, Kasch R, Alakus H, Moenig SP, Herbold T, Stippel DL, Scheele J. Phytobezoar: impact of differential diagnosis and difficulties in technical diagnostics. Comment on: Park JW, Chae HD: phytobezoar of the stomach. Dig Surg 2009;26:451-452. Dig Surg 2010; 27:339. [PMID: 20689299 DOI: 10.1159/000308459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Luebke T, Baldus SE, Grass G, Bollschweiler E, Thiele J, Dienes HP, Hoelscher AH, Moenig SP. Histological grading in gastric cancer by Ming classification: correlation with histopathological subtypes, metastasis, and prognosis. World J Surg 2006; 29:1422-7; discussion 1428. [PMID: 16222448 DOI: 10.1007/s00268-005-7795-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this prospective study was to analyze Ming's classification in correlation with other currently used classification systems of gastric cancer. In addition, we wanted to define the prognostic significance of the Ming classification system. The present study analyzed material of 117 patients with gastric carcinoma who underwent D2-gastrectomy with curative intent. All specimens were categorized according to International Union Against Cancer (UICC) classification, World Health Organization (WHO) classification, Borrmann classification, Laurén classification, Goseki classification, Ming classification, and tumor differentiation. For analysis of correlation between the classification systems, the correlation coefficient according to Spearman was calculated. The survival curves have been calculated according to the Kaplan-Meier method. According to the Ming classification, 38.5% of the carcinomas exhibited an expanding growth pattern, and 61.5% of specimens showed an infiltrating growth pattern. The subtypes according to the Ming and Laurén classification correlated significantly (P < 0.001). WHO classification (P < 0.001), tumor differentiation (P < 0.001), and Goseki classification (P < 0.001), as well as the macroscopic classification of Borrmann (P < 0.001) and the pT and pN categories of the UICC classification exhibited a highly significant correlation with the Ming classification (P < 0.001 and 0.001, respectively). Median overall survival was 31.3 months. In Kaplan-Meier analysis, the 3-year survival rates were lower in the infiltrative tumor type when compared to the expansive tumor type according to Ming (P = 0.0847). In multivariate analysis, only the UICC system presented as an independent prognostic factor in multivariate analysis (P < 0.001). This study shows that the Ming classification correlates significantly with the currently used classification systems for gastric cancer and with the UICC staging system, especially, the pT and pN category. The 3-year survival rates were lower in the infiltrative tumor type than in the expansive tumor type according to Ming. However, the Ming classification is not an independent prognostic factor.
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Affiliation(s)
- Thomas Luebke
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, Cologne 50931, Germany
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Moenig SP, Luebke T, Baldus SE, Schroeder W, Bollschweiler E, Schneider PM, Hoelscher AH. Feasibility of sentinel node concept in gastric carcinoma: clinicopathological analysis of gastric cancer with solitary lymph node metastases. Anticancer Res 2005; 25:1349-52. [PMID: 15865090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The feasibility and diagnostic reliability of sentinel lymph node biopsy of gastric carcinoma are still unclear and controversial. PATIENTS AND METHODS To assess the applicability of the sentinel node concept to gastric carcinoma, we retrospectively analyzed the location of metastatic lymph nodes in patients with only one or two lymph node metastases. RESULTS A total of 135 patients, who underwent gastrectomy with D2 lymphadenectomy for primary gastric adenocarcinoma between 1997 and 2001, were enrolled in this study. An average of 39 lymph nodes were resected and analyzed for each patient. Of the 135 patients, 88 (65%) were subtyped as pN+ (with lymph node metastasis); of the latter, 15 cases (pT1-3; 17% of N+ cases) showed one or two lymph node metastases. In 14 (93%) of these patients, lymph nodes directly adjacent to the primary tumor were involved. Skip metastases were only seen in one patient with cardia carcinoma and lymph node involvement of compartment II (left gastric artery). CONCLUSION In patients with gastric carcinoma, especially in early stage carcinoma, the phenomenon of skip metastasis is infrequent. Therefore, the sentinel node concept may be feasible in gastric cancer.
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Affiliation(s)
- S P Moenig
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany.
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Luebke T, Beckurts KTE, Wickenhauser C, Schneider P, Hoelscher AH, Moenig SP. Masaoka staging is of prognostic relevance in type B3 / C thymomas. Anticancer Res 2004; 24:4113-9. [PMID: 15736461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND The purpose of this study was to correlate the Ki67 labelling index (LI) with the Masaoka classification and the new WHO-classification in type B3 / C thymomas. PATIENTS AND METHODS Fourteen patients with type B3 / C thymomas were evaluated, and archived specimens were histologically reclassified according to Masaoka staging, the new WHO classification and the Ki-67 LI in a retrospective analysis. RESULTS Four patients presented with Masaoka stage II disease (all WHO-type B3), 1 patient had stage III (WHO-type C), 6 stage IVa (3 WHO-type B3 and 3 WHO-type C), and another 3 patients stage IVb (all WHO-type C). The statistical analysis revealed a significant correlation between Masaoka staging and Ki-67 LI (II, III vs. IV; p = 0.007). As well, WHO-classification correlated significantly with Ki-67 LI (B3 vs. C; p = 0.015). Masaoka staging (II, III vs. IV) correlated significantly with survival status (p = 0.0237) in patients with type B3 / C thymoma whereas WHO-classification did not (p = 0.3266). Between survivors and non-survivors there was no statistically significant correlation concerning Ki-67 LI (p = 0.075). CONCLUSION Our study indicated that the Masaoka staging system is of prognostic relevance in type B3 / C thymomas.
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Affiliation(s)
- T Luebke
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50931 Cologne, Germany
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Abstract
Heterotopic pancreas is an uncommon cause of gastrointestinal complaints such as epigastric pain, nausea, vomiting, and upper gastrointestinal bleeding. Despite the development of modern diagnostic procedures, it is still difficult to differentiate heterotopic pancreatic tissue from other benign or malignant gastric tumors. Local excision of the gastric wall is regarded as the diagnostic and therapeutic procedure of choice. We present two cases and an overview of the literature.
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Affiliation(s)
- S A Boehm
- Klinik und Poliklinik für Visceral- und Gefässchirurgie, Universität zu Köln, Cologne
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Boehm SA, Moenig SP, Wolfgarten EE, Wickenhauser C, Wolters U, Hoelscher AH. Synchronous nonfunctioning neuroendocrine carcinoma of the pancreas and appendix. J Clin Gastroenterol 2003; 36:452-3. [PMID: 12702994 DOI: 10.1097/00004836-200305000-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
In addition to the tumor suppressor gene p53, Cyclin Dependent Kinases (CDK) are well known to influence the cell cycle in normal human tissues and various neoplasias as well. The purpose of our present study was to evaluate the expression of the CDK-inhibitor p21/waf1/cip1 in colorectal cancer with special emphasis on the prognostic impact. Between 1985 and 1991, 294 patients (median age, 65 years) underwent surgical operative therapy for colorectal cancer. Formalin-fixed and paraffin-embedded tumor specimens were investigated. For immunohistochemistry the Catalysed Reporter Deposition (CARD) technique was performed. The survival probability was calculated and possible prognostic risk factors were tested using multivariate analysis. The p21/ waf1/cip1 staining pattern was positive in 197 (67%) specimens and negative in 97 (33%) samples. No significant correlation could been calculated between p21/waf1/cip1 expression and other variables such as age, sex, WHO-Classification, localisation, grading, TNM-classification or UICC-stage. Patients with a positive staining reaction had a significantly better survival (p < 0.0052). Moreover, p21/waf1/cip1 was shown to be an independent prognostic parameter by multivariate analysis (p < 0.022). In contrast with these findings, the p53 tumor status had no impact on survival. P21/ waf1/cip1 appears to be an independent prognostic parameter in colorectal cancer and is associated with a favorable survival. This feature may be related to a cell cycle arrest in the G1 phase induced by p21/waf1/cip1, resulting in lower tumor cell proliferative activity.
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Affiliation(s)
- T K Zirbes
- Institute of Pathology, University of Cologne, Germany
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Zirbes TK, Baldus SE, Moenig SP, Schmitz K, Thiele J, Holscher AH, Dienes HP. Tenascin expression in gastric cancer with special emphasis on the WHO-, Lauren-, and Goseki-classifications. Int J Mol Med 1999; 4:39-42. [PMID: 10373635 DOI: 10.3892/ijmm.4.1.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ample evidence has been provided concerning the presence of tenascin in various histological subtypes of gastric cancer. However, conflict and discussion still persist regarding the correlation with different classification systems and prognostic impact. Therefore, we studied 203 adenocarcinomas of the stomach with special emphasis to the WHO-classification, Lauren's and Goseki's subtypes as well. The immunohistochemical ABC-method was applied using a monoclonal anti-human-tenascin antibody. 30% of all tumours showed a distinct staining reaction. Tubulo-papillary carcinomas (WHO) revealed a significantly stronger reactivity than signet-ring subtypes. Adenocarcinomas of intestinal type (Lauren) were significantly more positive than the diffuse types. Mucin-poor tumours (Goseki I+III) stained positive in a much higher degree compared to mucin-rich subtypes (Goseki II+IV). However, no correlation could been demonstrated regarding TNM-stage or prognosis.
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Affiliation(s)
- T K Zirbes
- Institute of Pathology, University of Cologne, 50924 Cologne, Germany
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Zirbes TK, Lorenzen J, Baldus SE, Moenig SP, Wolters U, Ottlik A, Thiele J, Hölscher AH, Dienes HP. Apoptosis and expression of bcl-2 protein are inverse factors influencing tumour cell turnover in primary carcinoid tumours of the lung. Histopathology 1998; 33:123-8. [PMID: 9762544 DOI: 10.1046/j.1365-2559.1998.00466.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS This study evaluates potential regulating factors in primary pulmonary carcinoid tumours, 16 typical and four atypical samples, with special emphasis on apoptosis and the bcl-2 gene family. Furthermore, p53-related oncogenes were analysed in a search for associated biological parameters. METHODS AND RESULTS The in-situ end-labelling technique (ISEL) was used to determine apoptotic cells, in addition to immunohistochemical methods, which were used to investigate the expression of the Ki67 antigen (avidinbiotin complex (ABC) method) and bcl-2, bcl-x, p53, p21/waf1, p27 and mdm-2 proteins (catalysed reporter deposition (CARD) technique). The incidence of apoptotic tumour cells was significantly enhanced in typical carcinoids. The bcl-2 protein was expressed to a higher degree in atypical carcinoids, which displayed a higher proliferative capacity as well. In contrast, bcl-x was observed predominantly in so-called typical carcinoids. The tumour cell turnover index was the most distinguishing parameter between both entities. All carcinoid tumours failed to show a staining for p53, p21/waf. p27 and mdm-2 proteins. CONCLUSIONS The different biological behaviour of the carcinoid tumours under study seems to be influenced by the bcl-2 gene family preventing programmed cell death. We speculate that this results in a more aggressive course in atypical carcinoid tumours.
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Affiliation(s)
- T K Zirbes
- Department of Pathology, University of Cologne, Germany
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