BACKGROUND/AIMS: The prognosis of patients with pancreatic cancer remains very poor. Although many studies have evaluated the prognostic factors of pancreatic cancer, their results are inconclusive because of different inclusion criteria, tumor stages, and treatment modalities. This large scale retrospective analysis was performed to assess whether active treatment of pancreatic cancer, even in its advanced stage, could improve patients' survival. In addition, we sought to identify factors associated with favorable prognosis of pancreatic cancer. METHODS: Between 1994 and 2004, a total of 971 patients with pancreatic cancer were treated at Asan Medical Center. The patients were classified into three groups according to clinical stages: resectable (RE, n=226), locally advanced (LA, n=409), and far advanced (FA, n=336). Treatment response and prognostic factors for survival were analyzed in each group. RESULTS: Compared to supportive care, active treatment significantly increased the median survival time in all groups (RE: 18.0 vs. 9.0 months; LA: 10.0 vs. 7.0 months; FA: 5.0 vs. 3.0 months). Multivariate analysis showed that prognostic factors for survival differed according to clinical stages. In the RE group, unfavorable prognostic factors were high CA 19-9, poor histologic differentiation, large tumor size, and regional lymph node involvement. In the FA group, however, poor outcomes were associated with old age, poor performance status, and hypoalbuminemia. CONCLUSIONS: More active treatment of pancreatic cancer, even in advanced stage, can make a significant difference in terms of patient's survival. The prognosis of resectable pancreatic cancer is dependent on tumor-related factors, while the prognosis of patients with far advanced pancreatic cancer is dependent on patient-related factors.
Aged ; CA-19-9 Antigen/analysis ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Pancreatic Neoplasms/*mortality/pathology/therapy ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Tumor Markers, Biological/blood

BACKGROUND/AIMS: In spite of various diagnostic modalites, biliary cystic neoplasms (biliary cystadenoma and cystadenocarcinoma) remain to be difficult to diagnose preoperatively. Recently, there are some reports that elevated CA19-9 level in serum and/or cystic fluid could be a useful finding in the differential diagnosis of biliary cystic neoplasm. This study aimed to evaluate the expression of CA19-9 and to elucidate its significances in intrahepatic biliary cystic neoplasms and simple hepatic cysts. METHODS: In 8 patients with biliary cystic neoplasms and 6 simple hepatic cysts, symptoms, radiologic and laboratory findings were reviewed retrospectively. In 5 biliary cystic neoplasms (4 bililary cystadenomas, 1 biliary cystadenocarcinoma) and 5 simple hepatic cysts, immunohistochemical stainings for CA19-9 were performed with formalin-fixed, paraffin-embedded tissues. RESULTS: In 8 biliary cystic neoplasms, two cases were suspected as biliary cystadenoma preoperatively and 6 cases could not be distinguished from simple cysts or cholangiocarcinoma preoperatively. In 6 simple hepatic cysts, 3 cases were diagnosed preoperatively and 3 cases could not be distinguished from biliary cystadenoma or pancreatic pseudocyst preoperatively. Expression of CA19-9 in simple hepatic cysts and biliary cystic neoplasms were 80% in both groups. Expression of CA19-9 is not related to the elevated level of CA19-9 in serum. CONCLUSINOS: Our data suggests that the elevated level of CA19-9 in serum may not be helpful in the preoprative diagnosis of biliary cystic neoplasm.
Adult ; Aged ; Biliary Tract Neoplasms/*diagnosis ; CA-19-9 Antigen/*analysis/blood ; Cystadenocarcinoma/*diagnosis ; Cystadenoma/*diagnosis ; Cysts/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Liver Diseases/*diagnosis ; Male ; Middle Aged

OBJECTIVETo investigate the predictive value of preoperative Glasgow prognostic score (GPS) for the postoperative complications and survival in patients with colorectal cancer (CRC) undergoing laparoscopic radical resection.

METHODSThis retrospective study was conducted in the Beijing Hospital between January 2009 and January 2012. A total of 228 patients with primary CRC undergoing laparoscopic radical resection were analyzed. The GPS was constructed based on routine preoperative blood tests of C-reactive protein and serum albumin. The patients were classified into three groups according to GPS (GPS 0, 1, 2 groups). Survival curves were described by the Kaplan-Meier method and compared by the Log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the influence of GPS on prognosis in patients with CRC undergoing laparoscopic radical resection.

RESULTSPreoperative CRP level was increased in 48 cases (21.1%), and preoperative serum albumin level was decreased in 104 cases (45.6%) in the whole group. These 228 patients were classified into 99, 105 and 24 patients in GPS 0, 1, 2 group respectively. GPS was significantly associated with age, preoperative body mass index (BMI), carcinoembryonic antigen (CEA), CA19-9, tumor location, tumor differentiation and TNM stage (all P<0.05). Postoperative complication rates of GPS 0, 1, 2 group were 6.1%, 14.3% and 70.8% respectively (χ=59.147, P=0.000). Serious postoperative complication rates were 3.0%, 6.7% and 58.3% respectively (χ=65.807, P=0.000). Univariate and multivariate analyses revealed that GPS was an independent risk factor of postoperative complications(HR=21.611, 95%CI: 5.936-78.681, P=0.000) and severe complications (HR=35.833, 95%CI: 7.364-174.355, P = 0.000). The 5-year survival rate was 50% and the average total survival time was 58.2 (95% CI: 54.6-61.7) months in the whole group. The median overall survival time in GPS 0, 1, 2 group was 74.6(95%CI: 70.4-78.7) months, 49.8(95%CI: 45.2-54.4) months and 27.8 (95%CI: 21.8-33.8) months respectively(χ=98.425, P=0.000). The median disease-free survival time was 73.9(95%CI: 69.2-78.7) months, 47.4 (95% CI: 41.6-53.1) months and 19.9 (95%CI: 14.8-25.0) months respectively (χ=91.305, P=0.000). GPS was an independent risk factor of disease-free survival (HR=4.840, 95%CI: 2.413-9.709, P=0.000) and overall survival (HR=6.267, 95%CI: 3.073-12.784, P=0.000).

CONCLUSIONSGPS can be used as an effective predictor of the prognosis for patients with CRC undergoing laparoscopic radical surgery. Higher GPS suggests more postoperative complications and worse prognosis.

Adult ; Aged ; Biomarkers, Tumor ; analysis ; C-Reactive Protein ; analysis ; CA-19-9 Antigen ; analysis ; Carcinoembryonic Antigen ; analysis ; Colorectal Neoplasms ; blood ; surgery ; Disease-Free Survival ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Survival Rate

OBJECTIVETo evaluate the correlation between different therapies and survival of liver metastasis from colorectal cancer ( LMCC) , and to compare the clinical outcome of synchronous liver metastasis (SLM) with that of metachronous liver metastasis (MLM).

METHODSThe clinical data of 363 patients with LMCC were retrospectively reviewed with focus on the correlation between different therapy and survival.

RESULTSOf these 363 patients, 160 had SLM and 203 had MLM. Between the SLM and MLM group, there was no significant difference in age, or gender or primary cancer site (P > 0. 05 ), but significant differences were observed in condition of liver metastasis including liver lobe involved, focus number, maximum focus diameters and level of serum CEA and CA199 before therapy(P <0. 05). Ninety-one patients underwent curative hepatic resection, 22 of them in the SLM group and 69 in the MLM group. Mortality rate related to operation was 4. 5% (1/22) in SLM group and 2. 9% (2/69) in MLM group( P < 0.05). All patients were followed until 31/6/2005. The 3-year survival rate was 5. 2% with a median survival time of 10 +/- 1 months for the SLM group, and it wasl6. 4% and 17 +/- 1 months for the MLM group (P<0.01). Regarding to the treatment modalities, the 3-year survival rate was 30. 2% with a median survival time of 26 months for curative hepatic resection group, and it was 0% - 16. 7% and 10 - 17 months for non-operation groups treated by intervention, chemotherapy, radiofrequency therapy, percutaneous ethanol injection and Chinese traditional drugs (P <0. 05, P <0. 01 ).

CONCLUSIONCurative hepatic resection is still the first choice for liver metastasis from colorectal cancer improving the survival significantly. Other non-operative methods also can improve phase II resection rate. Metachronous liver metastasis has higher resection rate and better survival than the synchronous liver one.

Antineoplastic Agents, Phytogenic ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; CA-19-9 Antigen ; blood ; Carcinoembryonic Antigen ; blood ; Chemoembolization, Therapeutic ; Colonic Neoplasms ; blood ; pathology ; therapy ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; blood ; secondary ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Phytotherapy ; methods ; Rectal Neoplasms ; blood ; pathology ; therapy ; Retrospective Studies ; Survival Analysis

OBJECTIVETo evaluate the clinical significance of No.12 lymph node dissection for advanced gastric cancer with D2 lymphadenectomy.

METHODSClinicopathologic data and No.12 lymph node dissection of 256 advanced gastric cancer patients undergoing radical operation in our department between January 2005 and December 2010 were retrospectively summarized and the influence factors of metastasis in No.12 lymph nodes were analyzed.

RESULTSOf 256 patients, 179 were male and 77 were female with the average age of 59.2 years. Tumor located in the upper of stomach in 24 cases, middle of stomach in 41 cases, lower of stomach in 174 cases, multi-focus or diffuse distribution of stomach in 17 cases. Tumor diameter was <3 cm in 39 cases, 3 to 5 cm in 100 cases, >5 cm in 117 cases. Serum carcinoembryonic antigen (CEA) level increased in 61 cases, serum carbohydrate antigens (CA)72-4 increased in 56 cases and CA19-9 increased in 61 cases. The number of No.12 lymph nodes resected from all the patients was 1 152, and the average number was 4.5±1.9. The metastasis rate of No.12 lymph nodes was 9.4%(24/256) after hematoxylin eosin staining (positive group). All the patients received effective follow-up to December 2015, and the average follow-up time was 101.2 months. The median survival time of positive No.12 group (24 cases) was 29.8 months and of negative No.12 group (232 cases) was 78.2 months, whose difference was statistically significant (χ=21.715, P=0.000). Univariate analysis found that No.12 lymph node metastasis was not associated with age, gender, tumor differentiation (all P>0.05), but was associated with tumor location, tumor diameter, invasive depth (all P<0.05), and was closely associated with Borrmann type, outside metastatic lymph nodes of No.12 and high levels of serum CEA, CA72-4 and CA19-9 (all P=0.000). Multivariate regression analysis found that tumor location (RR=2.452, 95%CI:1.537 to 3.267, P=0.000), Borrmann type (RR=1.864, 95%CI:1.121 to 3.099, P=0.016) and number of outside metastatic lymph nodes of No.12 (RR=2.979, 95%CI: 2.463 to 3.603, P=0.000) were the independent risk factors of the No.12 metastasis (P<0.05).

CONCLUSIONSMetastasis in No.12 lymph nodes indicates poorer prognosis. The No.12 lymph nodes of advanced gastric cancer patients with curative resection, especially those with the tumor located in the lower part, Borrmann type IIII(, outside metastatic lymph nodes of No.12, should be regularly cleaned.

Antigens, Tumor-Associated, Carbohydrate ; blood ; CA-19-9 Antigen ; blood ; Carcinoembryonic Antigen ; blood ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; diagnosis ; pathology ; physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; statistics & numerical data ; Neoplasm Invasiveness ; Neoplasm Staging ; statistics & numerical data ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; blood ; mortality ; pathology ; Survival Rate

OBJECTIVEThe aim of this cohort study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head.

METHODSpatients with pancreatic head cancer undergoing curative resection (R0) between 1997 and 2002 were included in this study. Univariate and multivariate analyses were performed to examine factors affecting clinical outcome and recurrence of the cancer.

RESULTSSurgical procedures consisted of 58 (43.3%) extended pancreaticoduodenectomies (EPD), 47 (35.1%) pancreaticoduodenectomies (PD) and 29 (21.6%) pylorus-preserving pancreaticoduodenectomies (PPPD). The results showed that 81.3% (109/134) of patients had a recurrence during the study period, mainly retroperitoneal combined with distant metastasis (53.7%). The median postoperative survival time was 24.7 months. The 1-, 3- and 5-year overall survival rates for the study population were 67.1%, 38.5% and 17.6%, respectively. Univariate analysis showed that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion, and CA19-9 level were all significant predictors for poor survival. Multivariate analysis also showed that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion were all significant predictors for poor survival.

CONCLUSIONOur results suggest that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion are significant predictors for poor survival in patients with pancreatic head cancer.

Adult ; Aged ; CA-19-9 Antigen ; blood ; Carcinoembryonic Antigen ; blood ; Carcinoma, Pancreatic Ductal ; blood ; pathology ; surgery ; Cohort Studies ; Female ; Humans ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Microvessels ; pathology ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Neoplastic Cells, Circulating ; Pancreatic Neoplasms ; blood ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Survival Rate ; Tumor Burden

Primary colorectal choriocarcinoma is a rare neoplasm. Only 19 cases have been reported worldwide, most of which involved adenocarcinomas. The prognosis is usually poor, and the standard therapy for this tumor has not been established. A 61-year-old woman presented with constipation and lower abdominal discomfort. She was diagnosed with primary adenocarcinoma with focal choriocarcinomatous differentiation in the sigmoid colon and liver metastasis. Because the serum beta-human chorionic gonadotropin level was not significantly elevated, and because only focal choriocarcinomatous differentiation was diagnosed, we selected the chemotherapy regimen that is used for the treatment of metastatic colorectal adenocarcinoma. The patient survived for 13 months after the initial diagnosis. This is the first case in Korea to assess the suppressive effects of the standard chemotherapy for colorectal adenocarcinoma against coexisting colorectal choriocarcinoma and adenocarcinoma.
Adenocarcinoma/*diagnosis/drug therapy/pathology ; Antineoplastic Agents/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; CA-19-9 Antigen/analysis ; Chorionic Gonadotropin, beta Subunit, Human/blood ; Colon, Sigmoid/pathology ; Colonic Neoplasms/*diagnosis/drug therapy/pathology ; Colonoscopy ; Constipation/etiology ; Female ; Fluorouracil/therapeutic use ; Humans ; Leucovorin/therapeutic use ; Liver Neoplasms/secondary ; Middle Aged ; Organoplatinum Compounds/therapeutic use ; Prognosis ; Tomography, X-Ray Computed