OBJECTIVETo analyze the relationships between smooth-muscle tumors of gastrointestinal (GI) tract and gastrointestinal stromal tumors (GISTs), and the efficacy of surgical management.

METHODSThe clinical and pathological data of 135 cases of GISTs were collected, including cases of leiomyomas/leiomyosarcoma between 1993 and 2003 and GIST between Jan. 2000 and Jul. 2005. The surgical outcomes were analyzed retrospectively.

RESULTS82.1% of former leiomyomas/leiomyosarcomas was corrected to GISTs. Overall 5-year survival rate was 79.7%. Univariate analysis revealed preoperative metastasis, tumor size, mitotic index, and postoperative metastasis or recurrence were correlated with overall survival in patients with completed resection. Multivariate analysis showed that only postoperative metastasis or recurrence were the indicators of poor prognosis, but without statistical significance (P=0.064). However, multivariate analysis for disease-free survival showed that preoperative metastasis and mitotic index were two independent predictors of poor prognosis (P=0.001 and P<0.001).

CONCLUSIONSMost former leiomyomas/leiomyosarcomas of GI tract should be corrected to the diagnosis of GISTs. Complete surgical resection is the choice of treatment for GISTs. Preoperative metastasis and mitotic index are two independent predictors of poor prognosis.

Female ; Gastrointestinal Stromal Tumors ; diagnosis ; surgery ; Humans ; Male ; Prognosis ; Survival Rate

OBJECTIVETo observe the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blocker (ARB) on tumor growth and angiogenesis in implanted gastric cancer mouse model, and to explore the probable mechanism of ACEI and ARB anticancer effect.

METHODSNude mouse model with human gastric cancer was established by subcutaneously inoculating human gastric cancer cell line SGC-7901. One week later, 60 mice were randomly divided into 5 groups: control group, perindopril group, captopril group, losartan group, and valsartan group. These groups respectively received the normal saline, perindopril (2 mg/kg), captopril (5 mg/kg), losartan (50 mg/kg), valsartan (40 mg/kg) by gavage once a day. Twenty-one days after treatment the tumors were removed and the tissues were stained by immunohistochemistry method to observe the expression of VEGF, MMP-7 and microvessel density (MVD).

RESULTSIn all the ACEI and ARB groups, tumor volumes were significantly inhibited and MVD also decreased significantly as compared with control group (all P<0.01). In captopril and perindopril groups, the expression of VEGF and MMP-7 decreased significantly as compared with control group(all P<0.05). In losartan and valsartan group, the expressions of VEGF were significantly decreased as compared with control group (all P<0.05). The expressions of MMP-7 between ARB groups and control group were not significantly different.

CONCLUSIONACEI and ARB can inhibit the tumor growth in gastric cancer model and suppress the angiogenesis of the tumor.

Angiotensin II Type 1 Receptor Blockers ; pharmacology ; Angiotensin-Converting Enzyme Inhibitors ; pharmacology ; Animals ; Cell Line, Tumor ; Female ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neovascularization, Pathologic ; Stomach Neoplasms ; blood supply ; pathology

OBJECTIVETo explore the factors affecting the long-term survival of patients with curative resection of gastric cardia cancer.

METHODSThe data of 108 patients who underwent radical resection of gastric cardia cancer from Jul. 1994 to Dec. 2003 in our hospital were investigated retrospectively. The Kaplan-Meier method and long-rank test were used for bivariate comparisons of survival. Multivariate analysis was done by the Cox regression model (Backward Wald).

RESULTSSurvival status of the 108 patients was ascertained in Dec. 2004. Among them, 68 were Siewert type II and 40 were Siewert type III. Seventy-four patients had lymph node metastases (68.5%). The mean follow-up time was 37 months (95% CI: 29.3-44.7 months) and the middle follow-up time was 26.6 months (95% CI: 25.8-34.2 months). The 1-,3- and 5-year cumulative survival rates were 77.2%, 33.6% and 21.8%, respectively. According to the Kaplan-Meier and log-rank methods, splenectomy, lesion size, depth of tumor invasion and regional lymph node status were prognostic factors. Multivariate regression analysis indicated that only depth of tumor invasion (P=0.009) and lymph node metastases (P=0.001) were independent prognostic factors.

CONCLUSIONDepth of tumor invasion and lymph node metastases have negative effects on the survival of patients with gastric cardia cancer undergoing curative resection. Splenectomy may only be appropriate for patients with direct tumor invasion to the spleen and the extent of gastric resection does not influence survival in patients with curative gastric cardia cancer.

Adult ; Aged ; Aged, 80 and over ; Cardia ; pathology ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Regression Analysis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo investigate the clinicopathological characteristics and prognosis of colorectal mucinous adenocarcinoma (MAC) and non-mucinous adenocarcinoma (NMAC).

METHODSClinical data of 2089 cases with colorectal cancer from 1994 to 2007 in our hospital, including 169 patients diagnosed as mucinous adenocarcinoma were analyzed retrospectively.

RESULTSAs compared to NMAC, the tumor diameter of MAC was longer[(5.52+/-3.56) cm vs (4.62+/-2.68) cm, P<0.01]; the age of MAC was younger [(52.3+/-16.5) vs (58.7+/-13.6) years, P<0.01]. The rates of tumor location in colon (97 cases,57.4% vs 814 cases, 44.3%, in MAC and NMAC) were significantly different (P<0.01). Compared with NMAC, MAC had more lymph node involvement (103 cases, 60.9% vs 929 cases, 50.1%), more often in serosa infiltration (116 cases, 68.7% vs 914 cases, 49.8%), more peritoneal dissemination (26 cases, 15.4% vs 125 cases, 6.8%), and adjacent organ invasion (44 cases, 26.0% vs 300 cases, 16.3%) (P<0.01). The rate of radical resection (86.4% vs 91.5%), hepatic metastasis (5.3% vs 8.5%) and local recurrence had no significant difference between patients with mucinous and non-mucinous adenocarcinoma (P>0.05). In comparison to NMAC patients, MAC patients were worse in long-term overall survival, the survival of receiving radical resection and of TNM stage (II+III) group (P<0.01). Survivals were not significantly different in TNM stage I and IV groups between mucinous and non-mucinous adenocarcinoma (P>0.05).

CONCLUSIONSColorectal mucinous adenocarcinoma patients have worse outcome in comparison to non-mucinous adenocarcinoma patients. Mucinous adenocarcinoma may have special biological behavior, which is an independent prognostic factor for patients with colorectal cancer.

Adenocarcinoma, Mucinous ; diagnosis ; pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; diagnosis ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Young Adult

OBJECTIVETo explore the prevalence, clinical features and prognosis of multiple primary neoplasms in patients with colorectal carcinoma (CRC).

METHODSData of colorectal cancer patients admitted to our hospital from June 1994 to June 2002 were analyzed retrospectively. Patients were divided into multiple-cancer group (MCG) and single- cancer group (SCG). Clinical features and prognosis were compared between two groups.

RESULTSThe incidence of multiple cancers was 7.4 % (83/ 1125). Forty- seven patients had multiple colorectal cancers metachronous CRC(S) in 12 and synchronous CRC(S) in 35. Thirty- six patients 5 patients with synchronous cancers had malignant tumors outside colorectal tract,12 of whom were gastric carcinomas. No significant differences were found between MCG and SCG regarding gender, onset age, Dukes stage and differentiation of index CRC. Cancer family history (P=0.002) and colorectal adenoma (P=0.036) were significantly more common in MCG than those in SCG. The local recurrence or distant metastasis in MCG was significantly higher than that in SCG (P=0.047), though there was no significant difference in survival between the two groups. Forty- one percent of index tumors were located in right colon in MCG, significantly higher than that in SCG (P=0.048). The secondary tumors were mainly adenoma cancerization in MCG.

CONCLUSIONCancer family history and colorectal adenoma seems to be at high risk for developing multiple cancers in CRC patients. Gastric cancer and colorectal adenoma cancerization were common secondary tumors of multiple primary neoplasms in patients with colorectal carcinoma.

Adenomatous Polyps ; genetics ; Adult ; Aged ; Colorectal Neoplasms ; diagnosis ; epidemiology ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Multiple Primary ; diagnosis ; epidemiology ; pathology ; Prognosis ; Retrospective Studies ; Risk Factors

OBJECTIVETo compare the clinicopathological characters and operative prognosis of gastric cancer complicated with Krukenberg tumor and with pelvic peritoneal dissemination.

METHODSThirty-nine female cases of gastric carcinoma with pelvic metastasis were treated operated on between August 1994 and March 2006. Among them, 18 cases were complicated with Krukenberg tumor and 21 cases with pelvic peritoneal dissemination. The clinicopathological characters in the two groups were recorded and compared and the operative prognosis were analyzed.

RESULTSThere was no significant difference in age, tumor location and size, hepatic metastasis, organic encroachment, infiltration degree, positive lymph nodes, differentiated degree, tissue typing, Borrmann typing, value of carcinoembryonic antigen between the two groups (P > 0.05). The rate of P3 (peritoneal dissemination) in the cases of Krukenberg tumor (44.4%) was significantly lower than that in pelvic peritoneal dissemination group (85.7%) (P < 0.01), whereas the focal resection rate (77.8%) and multi-organ dissection rate (55.6%) were significantly higher than in pelvic peritoneal dissemination (38.0%, 23.8%) (P < 0.05). The mean survival of all cases was 12.6 months. The mean survival in the patients with Krukenberg tumor and pelvic peritoneal dissemination was 20.5, 15.0 months, respectively (P < 0.05). The mean survival of total focal resection, palliative focal resection, non-focal resection was 19.9, 12.5 and 5.7 months, respectively (P < 0.01). Non-focal resection, pelvic peritoneal dissemination, P3 of peritoneal implantation, hepatic metastasis, organic encroachment, total gastric cancer were unfavorable prognosis factors for all cases.

CONCLUSIONSCompared with pelvic peritoneal dissemination, the gastric cancer with Krukenberg tumor is associated with more limited peritoneal dissemination, higher resection rate and better prognosis. Focal resection can improve the prognosis.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Krukenberg Tumor ; pathology ; surgery ; Middle Aged ; Neoplasm Seeding ; Pelvic Neoplasms ; pathology ; secretion ; surgery ; Peritoneal Neoplasms ; pathology ; secondary ; surgery ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo investigate the protein expression, methylation promoter, somatic and germ-line mutations of E-cadherin gene (CDH1) in hereditary gastric cancer in China and to investigate its possible roles.

METHODSEight probands diagnosed with ICG-HGC criterion were enrolled in our database from June 1994 to October 2007. Tumor tissues were detected for CDH1 expression by using immunohistochemistry (IHC) methods. CDH1 DNA sequencing was performed for all its 16 exons both in tumor and normal tissues of the same patients to detect somatic and germ-line mutations. Methylation promoter study was performed by using specific primers and polymerase chain reaction (PCR) methods.

RESULTSIHC analysis confirmed that the CDH1 expression was negative in 7 probands and downregulated in the other on proband. Six mutations in five probands were found with DNA sequencing: two silent mutations and four missense mutations. All six mutations were absent in normal tissues, thereby excluded its presence in germ-line cells. Both DNA missense mutations and gene silencing through promoter methylation was found in 4 probands. Two probands has only promoter methylation and one proband had only silent mutation. No DNA missense mutations or promoter methylation was found in one proband.

CONCLUSIONSCDH1 gene germ-line mutations are relatively rare in hereditary gastric cancer in China, and whereas CDH1 somatic mutations and promoter methylation synergistically induce CDH1 downregulation in these patients.

Cadherins ; genetics ; DNA Methylation ; DNA Mutational Analysis ; Germ-Line Mutation ; Humans ; Promoter Regions, Genetic ; genetics ; Stomach Neoplasms ; genetics

OBJECTIVETo investigate the effect of spleen preservation on the outcome of radical resection for cardia cancer.

METHODSData of 108 cardia cancer patients(Siewert types II and III ), undergone radical resection with D(2) or D(3) lymphadenectomy between July 1994 and December 2003 in our department, were analyzed retrospectively. Survival status was ascertained on December 2004. Of these 108 patients, 38 underwent splenectomy and 70 splenic preservation. Clinicopathological features and outcomes of the splenectomy and non-splenectomy groups were compared.

RESULTSSeventy-four patients (68.5%) had lymph node involvement; 18 patients (16.7%) had involvement of lymph nodes in the splenic hilus. Postoperative morbidity in two groups was similar. Overall 5-year survival rate in the non-splenectomy group was significantly higher than that of the splenectomy group (38.7% vs 16.9%, P=0.008). Multivariate regression analysis indicated that tumor invasion (P=0.009) and lymph node metastasis (P=0.001) were independent prognostic factors rather than splenectomy. Although splenectomy was associated with survival, it was not an independent prognostic factor (P= 0.085).

CONCLUSIONSSplenectomy does not improve survival of patients undergone curative resection for gastric cardia cancer. Thus, the spleen should be preserved in patients without direct cancer invasion of the spleen.

Adult ; Aged ; Aged, 80 and over ; Cardia ; pathology ; surgery ; Female ; Heart Neoplasms ; surgery ; Humans ; Lymph Node Excision ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Spleen ; surgery ; Splenectomy ; Stomach Neoplasms ; surgery ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate the inhibitory effect of epigallocatechin-3-gallate (EGCG) on growth and angiogenesis of gastric cancer and to explore its molecular mechanism.

METHODSHeterotopic tumor was established by subcutaneously injection with SGC-7901 cells in nude mice. Once the tumor was established, the mice were allocated randomly into two groups and received intraperitoneal injection of EGCG or phosphate buffered saline respectively. Tumor growth was measured by caliper in two dimensions, and angiogenesis was determined with tumor microvessel density (MVD) by immunohistochemistry. Protein levels of vascular endothelial growth factor (VEGF) and activation of signal transducer and activator of transcription 3(Stat3) in tumor cells and tumor tissues were examined by Western blot. VEGF release in tumor culture medium was determined by ELISA and VEGF mRNA expression in tumor cells by RT-PCR.

RESULTSIntraperitoneal injection of EGCG significantly inhibited the growth of gastric cancer[(0.32+/-0.08) g vs(0.81+/-0.12) g, t=7.24, P<0.01], and an average of 60.4% suppression of primary tumor growth was observed. Microvessel density in tumor tissues receiving EGCG treatment was also markedly reduced(15.2+/-4.3 vs 24.6+/-6.6,t=3.41,P<0.01),and an average of 38.2% suppression was observed. EGCG treatment markedly reduced VEGF protein level in vitro and in vivo. Secretion and mRNA expression of VEGF in tumor cells were also suppressed by EGCG in a dose-dependent manner. This inhibitory effect was associated with reduced activation of Stat3. Stat3 activation was dose-dependently suppressed by EGCG in tumor cells, and an average of 53.5% reduction was observed in tumor tissues, but EGCG treatment did not change total Stat3 expression.

CONCLUSIONEGCG reduces expression of VEGF in gastric cancer by inhibiting activation of Stat3, thereby inhibits tumor growth and angiogenesis of gastric cancer.

Animals ; Catechin ; analogs & derivatives ; pharmacology ; Cell Line, Tumor ; Female ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neovascularization, Pathologic ; STAT3 Transcription Factor ; metabolism ; Signal Transduction ; Stomach Neoplasms ; blood supply ; metabolism ; pathology ; Vascular Endothelial Growth Factor A ; metabolism ; Xenograft Model Antitumor Assays

OBJECTIVETo explore the effect of advanced gastric cancer on vagniae vasorum of gastric vessels. To provide evidence for the surgical treatment of gastric cancer.

METHODSThe study included 107 specimens of left and right gastric arteries (55 left and 52 right ) from 59 patients who underwent radical gastrectomy for carcinoma. All specimens were dealt with frozen section method, then they were stained with HE, enzyme histochemical method and immunohistochemical method, respectively.

RESULTSMetastatic cancer cells or tubercles were found inside vagina vasorum in some stage IV and III specimens. Cytokeratin positive of tumor cells in or on vagina vasorum was showed on 26 slices from 14 tumors. Among them, 4 slices from 2 tumors belonged to stage III, and 22 slices from 12 tumors belonged to stage IV. Observed under light microscope, the lymphatic capillaries within vagina vasorum were dark brown with 5'-nucleotidase staining in 107 specimens, the capillary tubes within vagina vasorum were blue with alkaline phosphatase staining in 101 specimens. The two structures changed with the development of gastric carcinoma. Average area and bulk density of lymphatic vessel vaginae vasorum were associated with TNM staging of gastric cancer (P=0.001 and P=0.004).

CONCLUSIONVaginae vasorum dissection, which may not be applied for early gastric cancer, is recommended when clearing lymph nodes around arteries in radical gastrectomy for carcinomas in stage II and above.

Adult ; Aged ; Female ; Humans ; Keratins ; Male ; Middle Aged ; Neoplasm Staging ; Stomach ; blood supply ; pathology ; Stomach Neoplasms ; blood supply ; pathology ; Vasa Vasorum ; pathology