Humans ; Stomach Neoplasms ; diagnosis ; therapy

OBJECTIVETo investigate the clinicopathological characteristics and prognostic factors of stage III gastric cancer.

METHODSA retrospectively study of 1007 patients with Stage III gastric cancer in a single institute in China was performed. The patients underwent surgical resection from January 1991 to December 2005. Univariate and multivariate analyses were performed using log-rank test and Cox proportional hazards model to access the prognostic factors in stage III gastric cancer patients who received curative (R0) gastric resection.

RESULTSThe mean age of the 1007 patients was 58.7 years and the male-to-female ratio was 2.6:1.0. There were 242 patients with stage IIIA disease, 403 patients with stage IIIB, and 362 patients with stage IIIC. R0, R1, and R2 resection were performed in 754 patients (74.9%), 56 patients (5.5%), and 197 patients (19.6%), respectively. The 5-year survival rate (37.8%) of patients who received R0 resection was significant higher than that of patients who received R1(21.2%) and R2(8.9%) resection (P<0.05). Multivariate analysis revealed that pN stage, pT stage, and Borrmann type were independent prognostic factors (all P<0.01).

CONCLUSIONSStage III gastric cancer patients have certain clinicopathological characteristics and R0 resection should be performed if possible. Lymph node count, depth of tumor invasion, and Borrmann type are independent prognostic factors in stage III gastric cancer patients undergoing R0 resection.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Young Adult

OBJECTIVETo clarify the clinicopathological features and prognosis, and to evaluate the rational surgical therapy for superficial spreading early gastric cancer (EGC).

METHODSSuperficial spreading EGC was defined as tumor invading the mucosa or submucosa layer with the diameter> or =50 mm, and common EGC as tumor with diameter < 50 mm. The clinicopathological data of 62 patients with superficial spreading EGC and 224 patients with common EGC were collected and analyzed retrospectively.

RESULTSNo significant differences in age, sex, differentiation, depth of invasion, growth manner, vessel involvement and lymph node metastasis were found between superficial spreading and common EGC(P>0.05), but significant differences were seen in tumor site, macroscopic type, scope of gastrectomy and lymphadenectomy between the two groups(P<0.05). Superficial spreading EGC located in the middle or the whole of stomach accounted for 45.2%, and presented mixed macroscopic type more frequently(48.4%), such as II(C+II(A 5 cases, II(C+II(B 9 cases and II(C+III( 16 cases, and more total gastrectomy and more D(2) lymphadenectomy(16.1% and 40.3% respectively) were executed, compared with common EGC. Due to cancer residual,two patients underwent enlargement of the scope of gastrectomy,two underwent total gastrectomy and one underwent operation again after surgery. The 5-, 10-year tumor-free survival rates for superficial spreading EGC were 98.4% and 91.4%, while 97.0% and 91.2% for the common EGC (chi(2)=1.16,P=0.282).

CONCLUSIONSSpecial clinicopathological features can be seen in superficial spreading EGC, and the lesion is superficial and extensive. Prevention of cancer residual in remnant stomach is the key point and D(2) lymphadenectomy is suitable enough for operation.

Adult ; Aged ; Female ; Gastric Mucosa ; pathology ; Humans ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

BACKGROUNDMicrocalcifications play a very important role in detection of breast cancer, especially early stage breast cancer. However, ambiguity still exists in understanding the relationship between radiological and pathological characteristics of microcalcifications. The definitive indication of a biopsy has not been established. The purpose of this study is to evaluate the relationship of classification of breast microcalcifications using full-field digital mammography to the pathological characteristics.

METHODSFor all the women an open biopsy had been conducted. One hundred and three mammographs showing clustered microcalcifications from 98 consecutive patients were reviewed along with their pathological records. To investigate the value of each criterion for the detection of cancer, univariate and multivariate analyses were performed on the entire sample and then on morphological subgroups.

RESULTSPathological examination showed 67 malignant lesions (65.05%) and 36 benign lesions (34.95%). In the univariate analysis, four radiological variables were significant: morphological type (P = 0.001), complicated by a mass (P = 0.002), number of microcalcifications per cluster (P = 0.02) and linear or triangular distribution of clusters (P = 0.009). In the multivariate analysis, two criteria remained significant: morphological type (P < 0.001) and complicated by a mass (P = 0.001). The percentage of malignancy was 37.0%, 60.0%, 78.8%, and 88.9%, respectively, for type 2 (regularly punctiform), type 3 (dusty), type 4 (irregularly punctiform) and type 5 (vermicular) microcalcifications (Le Gal's classification). The malignancy was 78.6% for microcalcifications complicated by a mass and 48.9% without a mass. The difference was significant (P < 0.05). The relationship between morphological types of microcalcifications and the pathological characteristics was also studied. In subgroups, type 3 (dusty) microcalcifications complicated by a mass (P = 0.001) or with the number of microcalcifications more than 10 (P = 0.024); and type 2 (regularly punctiform) with a diameter of the area over 20 mm (P = 0.024) or complicated by a mass (P = 0.025) were statistically significant as criteria for malignant tumour.

CONCLUSIONSMost cases of microcalcifications of type 4 or 5; type 3 complicated by a mass or with the number of microcalcifications more than 10; type 2 complicated by a mass or with a diameter of the area over 20 mm; are indicative of cancer. Open biopsy is recommended to acquire definitive pathological diagnosis for these cases. For the remainder of the morphological types, stereotaxic biopsy or followup should be considered.

Adult ; Aged ; Breast ; pathology ; Breast Diseases ; classification ; Breast Neoplasms ; diagnosis ; Calcinosis ; classification ; Female ; Humans ; Mammography ; Middle Aged ; Multivariate Analysis

OBJECTIVETo evaluate bromodeoxyuridine/DNA (BrdUrd/DNA) double-parametric flow cytometric analysis in detection of gastric carcinoma and to study the correlations of cellular BrdUrd labeling index (LI), G(2)/M phase fraction (G(2)/MPF) and DNA content, with lymphatic and vascular invasion and prognosis.

METHODSSixty cases of fresh tumor samples were examined by BrdUrd/DNA double-parametric flow cytometry.

RESULTSBrdUrd LI and G(2)/MPF values were both significantly higher in patients with lymphatic invasion than those without invasion (P < 0.01). There was statistically significant difference between the 5-year survival rates in cases with and without lymphatic invasion (P < 0.01). Both BrdUrd LI and G(2)/MPF values were significantly higher in patients with lymph node metastasis than those in cases without metastasis (P < 0.01). There was a significant difference in 5-year survival rates between patients with and without lymph node metastases. The incidence of lymph node metastasis was significantly higher in aneuploid carcinoma (P < 0.05), and the patients with aneuploidy had significantly poor prognosis. BrdUrd LI was significantly higher in patients with more than 5 metastatic lymph nodes than those with 1-4 metastatic lymph nodes (P < 0.05) and no metastasis (P < 0.01). G(2)/MPF values in cases with more than 5 and 1-4 metastatic lymph nodes were higher than that in cases with no metastasis (P < 0.01 and P < 0.05, respectively). There were significant differences in 5-year survival rates among patients with no lymph node metastasis, 1-4 nodes metastasis and more than 5 nodes metastasis. G(2)/MPF values were significantly higher in patients with and without vascular invasion (P < 0.01).

CONCLUSIONCorrelations exist among cellular BrdUrd LI, G(2)/MPF, DNA content and lymphatic involvement, vascular invasions and prognosis in gastric carcinoma.

Adult ; Aged ; Aged, 80 and over ; Bromodeoxyuridine ; Cell Proliferation ; DNA, Neoplasm ; analysis ; Female ; Flow Cytometry ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Prognosis ; Stomach Neoplasms ; blood supply ; pathology

OBJECTIVETo evaluate the efficacy of different modes of lymphadenectomies in the surgical treatment for early gastric cancer (EGC) in order to provide evidence for reasonable selection of lymphadenectomy for the ECG.

METHODSThe clinicopathological data of 325 EGC patients were reviewed. The lymph node metastasis (LNM) rate of different levels and the efficiency of different modes of lymphadenectomies were analyzed, and the correlation between LNM and clinicopathological features were analyzed either.

RESULTSThe overall LNM rate in the EGC was 14.8%, and the overall LNM degree was 3.0%. In the ECG located in the lower third of the stomach, the rate of first level nodal involvement was 14.5%, which was detected in the No. 3, No. 4, No. 5, No. 6 station of draining lymph nodes for the stomach; and it was 6.9% in the second level lymph nodes which were seen in the No.7 and No. 8a station. There was rare metastasis in the No. 1, No. 9, No. 11p, No. 12a and No. 14v station. In the ECG located in the middle third of the stomach, the rate of first level nodal involvement was 13.8% , which was found in the No. 1, No. 3, No. 5 and No. 6 station, and it was 6.9% in the second level nodes only seen in the No. 7 and No. 8a station. The LNM rate was significantly higher in the lesion larger than 3.0 cm in diameter, or having submucosa invasion, or being poorly differentiated, or with lymphatic involvement than that of the lesion smaller than 3.0 cm in diameter, without mucosa invasion or lymphatic involvement, or being well differentiated (P < 0.05).

CONCLUSIONBased on our data, it is suggested that the D1 or D1 + lymphadenectomy of the No. 7 station of lymph node may be suitable for the lesion smaller than 1.0 cm in diameter or only located in the mucosa; the D1 + lymphadenectomy of the No. 7 and No. 8a station of lymph nodes may be suitable for the lesion larger than 1.0 cm in diameter, or being depressed type or with submucosa invasion in the middle and/or lower third of the stomach. For the lesion larger than 3.0 cm in diameter, the No. 1 and No. 9 station lymph node should be dissected. It is also suggested that regular D2/ D3 lymphadenectomy should be avoided in the surgical treatment for the early gastric cancer whenever the tumor situation is suitable.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Treatment Outcome

BACKGROUNDThis study was to evaluate bivariate bromodeoxyuridine (BrdUrd)/DNA flow cytometric analysis in detection of gastric carcinoma and to study the relations of cellular BrdUrd labeling indices (LI), G2/M-phase fraction (G2/MPF) and DNA ploidy pattern to lymphatic involvement, venous invasion and prognosis.

METHODSFresh tumor samples from 60 patients with gastric carcinoma were analyzed by bivariate BrdUrd/DNA flow cytometry. The results were correlated with lymphatic vessel invasion, lymphatic node metastasis, the number of metastatic lymphatic nodes, and venous invasion. Propidium iodide (PI) was used as a fluorescent probe for total cellular DNA, and a monoclonal antibody against BrdUrd was used as a probe for BrdUrd incorporated into DNA. Fluorescent-labeled goat anti-mouse antibody was used as a second antibody. S-phase fractions were measured by in vitro BrdUrd labeling, and DNA ploidy and G2/MPF were also measured. Comparison of survival was performed with the log-rank test, the Chi-square test for qualitative data, and Student's t test for quantu data.

RESULTSBrdUrd LI and G2/MPF values were significantly higher in tumors with lymphatic vessel invasion than in those without invasion respectively (P < 0.01); the patients who had tumors with lymphatic vessel invasion showed a significantly poor prognosis (P < 0.01). Both BrdUrd LI and G2/MPF values were significantly higher in tumors with lymphatic node metastasis than in those without metastasis (P < 0.01). A statistical significant difference was noted in the 5-year survival rates between the patients with lymph node metastasis and those without metastasis. Compared with diploid carcinoma, the incidence of lymph node metastasis was significantly higher in aneuploid carcinoma (P < 0.05), and the patients with aneuploid carcinoma showed a significantly poor prognosis (P < 0.05). BrdUrd LI was significantly higher in patients with more than 5 metastatic lymph nodes than those with 1 - 4 metastatic lymph nodes (P < 0.05) and those without metastasis (P < 0.01). G2/MPF values in those patients either with more than 5 metastatic lymph nodes or 1 - 4 metastatic lymph nodes were higher than those without metastasis (P < 0.01 and P < 0.05). A statistical significance was seen in the 5-year survival rates among the patients with no metastatic lymph node, 1 - 4 metastatic nodes and more than 5 metastatic nodes (P < 0.01). G2/MPF values were significantly higher in patients with venous invasion than in those without invasion (P < 0.01).

CONCLUSIONSPositive correlations exist between cellular BrdUrd LI, G2/MPF with lymphatic involvement and prognosis, and DNA aneuploid with lymphatic involvement and prognosis. The same was true between G2/MPF value and venous invasion in gastric carcinoma.

Adult ; Aged ; Bromodeoxyuridine ; metabolism ; Cell Cycle ; Cell Division ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Ploidies ; Prognosis ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate

OBJECTIVETo study the relationship between hRad17 mRNA expression and clinicopathologic factors and lymph node metastasis of gastric cancer, and to assess the significance of predicting the extent of lymph node metastasis and prognosis.

METHODShRad17 mRNA expression was examined in matched primary lesions, normal gastric mucosa and lymph node metastatic lesions among 52 gastric cancer patients by reverse transcription polymerase chain reaction (RT-PCR), polyacrylamide gel electrophoresis (PAGE) and silver stain with the relation between hRad17 mRNA expression and clinicopathologic factors analyzed. At the same time, hRad17 mRNA expressions in 5 gastric benign lesions and SGC7901 gastric carcinoma cell lines were also examined.

RESULTSThe primary tumor samples (88.4% positive) showed a significantly higher level of hRad17 expression compared with matched normal tissue (76.9% positive) (P = 0.014), so did the lymph node metastatic samples (94.2% positive) (P = 0.001). The hRad17 mRNA expression showed a low level in benign lesions, but very high in SGC7901 cell line. The hRad17 mRNA expression showed a higher level in patients with the number of lymph node metastasis above 15 than below 15 (P = 0.02), so did the diffused growth than the mass-like growth (P = 0.04).

CONCLUSIONThe method of PAGE and silver stain can improve the sensitivity of RT-PCR. The degree of lymph node metastasis and invasiveness of carcinoma cells are more serious in cases with hRad17 mRNA overexpression, and extensive lymph node dissection should be carried out for these patients. Examination of hRad17 expression by RT-PCR before surgery is indicated to arrive at an optimum treatment scheme and to estimate the prognosis.

Cell Cycle Proteins ; genetics ; Gastric Mucosa ; metabolism ; Humans ; Lymphatic Metastasis ; RNA, Messenger ; analysis ; Stomach Neoplasms ; metabolism ; pathology

OBJECTIVETo evaluate the status of lymph node metastasis (LNM) and reasonable procedure in early gastric cancer (EGC).

METHODSTwo hundred and ninety-two patients with histologically proven mucosal or submucosal gastric cancer who underwent gastrectomy/lymphadenectomy were included in this study. The numbers of total dissected lymph node were all above 15 in all patients. The clinical characteristics, pathologic features, and LNM were assessed by univariate and multivariate analysis.

RESULTSLNM were observed in 43 of 292 cases (14.7%), and 6.4% in mucosal lesions and 22.4% in submucosal lesions. The LNM was identified in 12.7% at the first level, 7.2% at the second level and 0.34% at the third level. The LNM frequency was found in the 6, 3, 4, 1, 5 lymph node (from high to low) consequently at the first level and the 7, 8a lymph node at the second level. The EGC with nodal involvement and the tumors < 2.0 cm in diameter were all depressed type. The diameter of elevated type with LNM was no less than 3.0 cm in this series. The depth of invasion and lymphatic vessel involvement were independent influencing factors in LNM on multivariate analysis (P<0.05).

CONCLUSIONSLess extensive surgery might be considered for the elevated type EGC, and tumors 3.0 cm in diameter. With respect to the depressed type EGC/tumors > 3.0 cm in diameter, gastrectomy with D2 lymphadenectomy is proper.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy ; methods ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo objectively evaluate the practical significance of different extended surgeries in early gastric cancer(EGC) patients, and to choose reasonable gastrectomies and lymphadenectomies.

METHODSA total of 217 EGC patients were investigated undergone normalized D2 or above extended surgery and their clinicopathological data were recorded in detail. The efficiency of the extended lymphadenectomies, complications and operation causes were analyzed, and the correlation between the group 2 lymph node metastasis (LNM) and clinicopathological factors were assessed, too.

RESULTSThere was no nodal involvement in the No.5 and No.6 lymph nodes among the total gastrectomy in the upper third of the stomach, neither was in the No.10, 11p and 11d lymph nodes among the combined splenectomy, and neither was in the No.15 lymph nodes among the combined transverse mesocolon resection in the lower third of the stomach. There was no distant nodal involvement in the EGC. Above all, most of them were mistaken for advanced gastric cancer preoperatively and intraoperatively, the operation time was longer and the blood loss was more during operation. Among the resected nodes of group 2 in the lower third of the stomach, metastasis was not found in the No.11p, 12a and 14v lymph nodes. The rate of the No.7 and 8a nodal involvement in the submucosa cancer was higher than that in the mucosa cancer(P<0.05) and so did the No.7 in the lymphatic penetration positive(P<0.001). The No.1 and No.13 nodal involvement were only seen in the high risk cases, such as submucosa cancer, the lesion diameter more than 3.0 cm, depressed type and lymphatic involvement.

CONCLUSIONIt is not necessary to execute total gastrectomy in the upper third of the stomach, combined organ resection (such as splenectomy, transverse mesocolon resection), and distant lymph node dissection in the EGC. In the lower third of the stomach, the No.11p 12a and 14v lymph nodes shouldn't be dissected. With respect to the high risk nodal involvement cases in the lower third of the stomach, the No.1 lymph nodes should be dissected and so does the No.13 lymph nodes if it's tumefied. It is the key point of reasonable operation to exactly diagnose the EGC before and during the surgery.

Adult ; Aged ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome ; Young Adult