PURPOSE: p53 and bcl-2 are important markers of apoptosis. The expression of p53 and bcl-2 in gastric adenocarcinoma was examined in relation to prognosis and survival rate. MATERIALS AND METHODS: The clinicopathologic data from 238 patients who underwent gastrectomies for gastric adenocarcinoma between December 1999 and July 2007 were reviewed. Immunohistochemical staining of gastric adenocarcinoma tissues embedded in paraffin blocks was performed using an Envision kit (DAKO, Glostrup, Denmark). Statistical comparisons were made between age, gender, tumor invasion, lymph node metastasis, TNM stage, Lauren's classification, cell differentiation, and the relationship with p53 and bcl-2. RESULTS: The expression of p53 was related to cell differentiation (P=0.028) and UICC TNM stage (P<0.001). The expression of bcl-2 was related to UICC TNM stage (P=0.005). The co-expression of p53 and bcl-2 was related to UICC TNM stage (P=0.002). The co-expression group exhibited a greater reduction in the survival rate (P=0.001). CONCLUSION: The expression of p53 and bcl-2 nuclear proteins has significant relationships with other conventional prognostic factors and the survival rate. Bcl-2 will be characterized through analysis of a greater number of patients and comparison with survival data over a longer period of time.
Adenocarcinoma ; Apoptosis ; Cell Differentiation ; Gastrectomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Nuclear Proteins ; Paraffin ; Prognosis ; Survival Rate

Serum pepsinogen (sPG) is a marker of gastric mucosal atrophy, a condition that has been associated with an increased risk of gastric neoplasia. A low sPGI level and a low PG I/II ratio have been associated with severe gastric atrophy, and are frequently found in gastric cancer. Because the prevalence of gastric cancer is high in Korea, it would be convenient if a good biomarker for gastric cancer were developed. Two studies recently investigated the efficacy of sPG along with Helicobacter pylori (H. pylori) as a screening tool for gastric cancer. In these studies, sPG was measured using a Latex enhanced Turbidimetric Immunoassay. We found that H. pylori IgG status, age and gender were associated with serum pepsinogen levels. Thus, to increase the ability of the PG I/II ratio to detect atrophic gastritis, the cutoff value for the PG I/II ratio should be stratified according to the H. pylori IgG status. In addition, a PG I/II ratio (< or =3.0), which has been widely used as an international standard for gastric cancer, was found to be a reliable marker for the detection of gastric dysplasia or gastric cancer, especially of the intestinal type. The efficacy of the test in Korea was lower than the efficacy in Japan. However, the detecting power of a PG I/II ratio (< or =3.0) was significantly increased in the presence of H. pylori. The ratio together with H. pylori psotivitiy could provide a means of identifying persons at high risk of developing gastric cancer in Korea.
Atrophy ; Gastrins ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Immunoassay ; Immunoglobulin G ; Japan ; Korea ; Latex ; Mass Screening ; Pepsinogen A ; Prevalence ; Stomach Neoplasms

Endoscopic resection is one of the curative options for early gastric cancer. However, based on large-scale data about the risk of lymph node metastasis in early gastric cancer, endoscopic resection has been attempted for the following: differentiated intramucosal gastric cancer, regardless of size and without ulcers; differentiated intramucosal cancer, 30 mm in size with ulcers; minute submucosal differentiated cancer <30 mm in size; and undifferentiated intramucosal cancer, <20 mm in diameter without venous or lymphatic involvement. However, undifferentiated early gastric cancer exhibits different biologic behavior from differentiated early gastric cancer. Thus, the application of endoscopic resection for undifferentiated early gastric cancer remains controversial. In this review, we discuss the application of endoscopic resection for undifferentiated early gastric cancer based on analysis of biologic behavior and data of endoscopic resection.
Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms

Hyponatremia is a dangerous electrolyte disturbance in patients on chemotherapy and may cause sudden death if not detected early. SIADH (syndrome of inappropriate antidiuretic hormone) is one of the known causes of hyponatremia in patients undergoing chemotherapy. Few chemotherapeutic agents, however, are reported to cause SIADH. The current study reports that SIADH developed in a 55 year old woman on S-1 (80 mg/m2) and cisplatin (60 mg/m2) chemotherapy for the peritoneal metastasis of gastric cancer. The patient underwent a total gastrectomy, a splenectomy, and a segmental resection of the transverse colon for gastric cancer. She had used thiazide and betablocker to treat hypertension for 12 years. She admitted to our hospital with complaining of general weakness, dysarthria, loss of appetite, and urinary discomfort. The serum level of sodium and potassium were 94 mEq/L and 2.2 mEq/L respectively. The hyponatremia completely resolved uneventfully after 3% saline infusion, which led to normalized electrolyte balance. The patient was discharged on the 13th hospital day.
Appetite ; Cisplatin ; Colon, Transverse ; Death, Sudden ; Drug Therapy ; Dysarthria ; Female ; Gastrectomy ; Humans ; Hypertension ; Hyponatremia ; Inappropriate ADH Syndrome* ; Middle Aged ; Neoplasm Metastasis ; Potassium ; Sodium ; Splenectomy ; Stomach Neoplasms ; Water-Electrolyte Balance

Melanoma is a malignant neoplasm of melanocytes most frequently arising from the skin, but primary melanoma can also arise from the mucosa of the gastrointestinal tract. Gastrointestinal melanomas are most commonly metastases from a cutaneous melanoma. Primary melanoma of the stomach is rare and carries a poor prognosis. Reported here is the case of a 75-year-old man with a primary gastric melanoma who presented with a melena, abdominal pain, and weight loss. Most cases of melanoma are treated by excision of the primary tumor. Patients with melanoma have been treated with adjuvant chemotherapy, radiation therapy, and immunotherapy. None of these modalities has been demonstrated to prolong the survival rate. To improve long-term disease-free survival, early diagnosis and surgical intervention are very important.
Abdominal Pain ; Aged ; Cardia* ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Early Diagnosis ; Gastrointestinal Tract ; Humans ; Immunotherapy ; Melanocytes ; Melanoma* ; Melena ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; Skin ; Stomach* ; Survival Rate ; Weight Loss

Acute disseminated intravascular coagulation (DIC) associated with gastric cancer is not common and has short survival of 1 to 3 weeks. Systemic chemotherapy in spite of hematologic unstability for gastric cancer may prolong survival time. A 47-year-old woman who complained of dyspnea, vaginal bleeding and easy bruisibility was diagnosed to stage IV gastric cancer with acute disseminated intravascular coagulation based on the laboratory data. She also had multiple bone metastases and bone marrow involvement. This is the first case treated with combination chemotherapy of irinotecan and cisplatin for advanced gastric cancer complicated by disseminated intravascular coagulation at the time of diagnosis. With systemic chemotherapy, some of the bleeding symptoms and the DIC process improved, even not completely recovered. However the patient died of disease progression and survival time was 12 weeks.
Bone Marrow ; Cisplatin* ; Dacarbazine ; Diagnosis ; Disease Progression ; Disseminated Intravascular Coagulation* ; Drug Therapy ; Drug Therapy, Combination* ; Dyspnea ; Female ; Hemorrhage ; Humans ; Middle Aged ; Neoplasm Metastasis ; Stomach Neoplasms* ; Uterine Hemorrhage

PURPOSE: Heregulin is a natural ligand for erbB3 and erbB4. However, very little is known about their roles in the gastric cancer. This retrospective study was performed to evaluate the frequencies of heregulin and erbB family protein expression and to compare their expressions with clinicopathologic parameters. MATERIALS AND METHODS: Immunohistochemical expressions of heregulin and erbB family proteins were examined with tissue micro-array slides. A total of 251 gastric adenocarcinomas were classified as early cancers and advanced cancers and as having and not having lymph node metastases. RESULTS: The positive rates of the heregulin, erbB1, erbB2, erbB3, and erbB4 protein stainings were 64%, 68%, 6%, 88%, and 76%, respectively. Intestinal type gastric adenocarcinomas showed higher expression of heregulin, erbB2, erbB3, and erbB4 proteins. Heregulin and erbB4 proteins showed lower expressions in advanced gastric carcinomas. However, erbB2 protein showed higher expression in advanced gastric carcinomas. The protein expressions of heregulin and erbB family proteins showed no relationship with survival rate. Co-expression groups of heregulin and erbB3 proteins or heregulin and erbB4 proteins showed higher expressions in intestinal type adenocarcinomas and early gastric carcinomas. CONCLUSION: Heregulin, erbB3, and erbB4 proteins may play a role in the early stage of adenocarcinomas.
Adenocarcinoma* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Neuregulin-1* ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: The TNM staging system showed limitation in stratifying patients into different prognostic groups with gastric cancer. Since the treatment for stage IV gastric cancer with distant metastasis (M1) is defined as non-curative one, we hypothesized that the survival rate of stage IV gastric cancer with M1 is different to that of stage IV gastric cancer with no distant metastasis (M0), which will provide a rationale to subdivide stage IV into IVa and IVb. MATERIALS AND METHODS: From June 1992 to December 2005, of 1,630 gastric cancer patients who underwent surgery, 308 patients with stage IV gastric cancer were selected and analyzed. The clinicopathologic characteristics and survival of the patients, according to distant metastasis, were determined retrospectively. Median follow-up period was 13 months (range: 1~154 month). RESULTS: 5 year survival rate of M0 and M1 group was 35% and 16% respectively with statistic significance (P=0.0000). When the survival rate of M0 group was analyzed according to the difference of T and M factor, T1-3N3M0 and T4N1-2M0 group showed no significant statistical difference (P=0.1898). CONCLUSION: Given the result in this study, we suggest that the stage IV gastric cancer be subclassified into stage IVa and IVb according to M factor.
Follow-Up Studies ; Humans ; Neoplasm Metastasis* ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The laparoscopy assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, expert surgeons, who have performed a conventional open gastrectomy for a long time, tend to have a negative attitude toward laparoscopic procedures. The aim of this study was to determine the learning curve of a laparoscopy assisted distal gastrectomy (LADG) for a surgeon expert in performing an open gastrectomy and to analyze the factors that have an effect on a LADG. MATERIALS AND METHODS: Between April 2005 and March 2006, 62 patients underwent a LADG with D1+beta lymph-node dissection. The 62 patients were divided into 10 sequential groups with 6 cases in each group (the last group was 8 cases), and the time required to reach the plateau of the learning curve was determined by examining the average operative times of these 10 groups. Other factors, such as sex, BMI, complications, transfusion requirements, the number of retrieved lymph nodes, and change of postoperative hemoglobin level, were also analyzed. RESULTS: With the 5th group (after 30 cases), the operative time reached a plateau (average: 170 min/operation). The differences between before the 30th case and after the 31st case with respect to changes in the postoperative hemoglobin level, the number of retrieved lymph nodes, the transfusion requirements, and the complications rate were not significant. CONCLUSION: According to an analysis of the operative time, experience with 30 LADGs in patients with early gastric cancer is the point at which the plateau of the learning curve (7 months) is reached. Abundant experience with a conventional open gastrectomy and a well-organized laparoscopic surgery team are important factors in overcoming the learning curve earlier.
Gastrectomy* ; Humans ; Laparoscopy* ; Learning Curve* ; Learning* ; Lymph Nodes ; Operative Time ; Stomach Neoplasms

PURPOSE: Recently, the incidence of early gastric cancer (EGC) patients is rapidly increased in Korea. However, they're often not perceptible by surgical palpation or inspection. The aim of this study is 1) to develope a software that can locate the tumor and measure the mucosal distance from an anatomic landmark to the tumor using CT gastrography and 2) to compare the distance measured by the developed software with the distance measured by the pathologic findings. MATERIALS AND METHODS: Between January 2004 and September 2005, sixty patients (male=45, female=15, mean 57.8 years old) estimated for EGC with preoperative CT scans and undergone gastrectomies in Kyungpook National University Hospital were enrolled in this study. Preoperative CT scans were performed after insufflations of room air via 5 Fr NG tube. The scans included the following parameters: (slice thickness/reconstruction interval: 0.625 mm, kVp: 120, mAs: 200). 3D volume rendering and measurement of the surface distance from the pylorus to the EGC were performed using the developed software. RESULTS: The average difference between the lesion to pylorus distances measured from pathologic specimens and CT gastrography was 5.3+/-2.9 mm (range 0~23 mm). The lesion to pylorus distance measured from CT gastrography was well correlated with that measured from the pathologic specimens (r=0.9843, P<0.001). CONCLUSION: These results suggest that the surface distance from an anatomic landmark to the EGC can be measured accurately by CT gastrography. This technique could be used for preoperative localization of early gastric carcinomas to determine the optimal extent of surgical resection.
Anatomic Landmarks ; Gastrectomy ; Gyeongsangbuk-do ; Humans ; Incidence ; Insufflation ; Korea ; Palpation ; Pylorus ; Stomach Neoplasms* ; Tomography, X-Ray Computed