PURPOSE: According to the 2nd English Edition of the Japanese Gastric Cancer Association (JGCA) in 1998, in case of distal gastric cancer, the 14v (superior mesenteric vein) lymph node (LN) is included in the N2 group. However, in Korea, a modified radical gastrectomy is performed, and a 14v LN dissection is not done as a routine procedure. Thus, we investigated the rate of metastatic 14v LNs, evaluated the necessity of dissection of the 14v LN, and searched for indications of 14v LN dissection. MATERIALS AND METHODS: From April 2004 to August 2005, we enrolled the patients who were diagnosed as having advanced gastric cancer in the distal third portion of the stomach. We performed a distal gastrectomy with D2 lymph node dissection as defined in the 2nd English edition of the JGCA classification. We calculated the positive rate of metastatic LNs of each station and analyzed the relationship between the positive rates of No.6 LNs and 14v LNs. We also compared the positive 14v LN group with the negative 14v LN group. RESULTS: The total number of patients was 50, the mean age was 56 (range 30~80) years, and sex ratio (Male/Female) was 1.63 : 1. In 47 (94%) cases, distal a gastrectomy with gastroduodenostomy was done, and in the remaining 3 (6%) cases, a distal gastrectomy with gastrojejunostomy was done. The most frequently metastatic LNs were nos. 3 and 6 (54%). The metastatic rate of the 14v LN was 10%, which was similar to that of LN no. 9. In the comparison of the 14v positive group with the 14v negative group, there were significant differences in the numbers of metastatic LNs (mean 25.4 vs 4.91, P<0.001) and the numbers of metastatic no. 6 LNs, (mean 6.8 vs 1.42, P<0.001), and if no. 6 LNs were metastatic, the possibility of metastasis to the 14v LN was 19.2%. In the 14v positive group, all cases were more than stage 3 by the UICC 6th edition. CONCLUSION: In cases of advanced cancer with metastasis to the no. 6 LN, there was a good chance of metastasis to the 14v LN. Thus, in the operative field, if the tumor is advanced to more than stage 3 by the UICC classification and the no. 6 LN is metastatic, a 14v LN dissection is necessary. However, the usefulness of a 14v LN dissection should be evaluated prospectively through an analysis of tumor recurrence and long-term survival.
Asian Continental Ancestry Group ; Classification ; Gastrectomy ; Gastric Bypass ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Recurrence ; Sex Ratio ; Stomach ; Stomach Neoplasms*

PURPOSE: Gastrointestinal stromal tumorsm (GISTs) are the most common mesenchymal tumors that arise anywhere in the tubular GI tract. The prognosis for GSTIs is important because f GISTs may metastasiwx in the liver or the abdominal cavity in an early stage. For the reason we examined the tumor size, the mitotic number, ki 67, p53, and c-kit mutation as independent prognostic factor for GISTs. MATERIALS AND METHODS: A retrospective study was conducted in 76 patients who had been re-evaluated for confirmation of diagnosis between Jan 1998 and Dec. 2001. at Catholic University of medicine. RESULTS: There were significant difference between the tumor size, mitotic indices, ki 67, c-kit mutations and the 5-years survival rates. Tumor size (> or = 5 cm) and mitotic index (> or = 5/50 HPF) were statistically related to a significantly poor prognosis (P=0.017 and P=0.042, respectively). c-kit mutations in exon 11 were found in 7 cases c-kit mutation was observed more frequently in high risk patients, and there was a significant difference between c-kit mutation and survival (P=0.037). Elevated ki 67 was noted in 34 out of the 76 cases. High risk patients showed elevated ki67 index more frequently and there was significant relation with the survival rate (P=0.0417). CONCLUSION: We think that tumor size, mitotic index, Ki 67 and c-kit mutation are as independent prognostic factors for GISTs, but more research is needed.
Abdominal Cavity ; Diagnosis ; Exons ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Liver ; Mitotic Index ; Prognosis* ; Retrospective Studies ; Stomach* ; Survival Rate

PURPOSE: Although several chemotherapy regimens used against advanced gastric cancer (AGC) have been studied extensively in an attempt to further improve the prognosis of patients, to date, no standard chemotherapeutic regimens have been established. The aim of this study was to determine the anti-tumor efficacy and safety of TS-1 or TS-1 plus cisplatin (CDDP). MATERIAL AND METHODS: We treated 78 patients with AGC either with 80 mg/m2 of TS-1 for 28 days, which was followed by a 2-week rest, or with 80 mg/m2 of TS-1 for 21 days and 60 mg/m2 of CDDP on day 8 every 5 weeks. RESULTS: Tumor response rates in the neoadjuvant chemotherapy group and in the recurrent or post-palliative surgery group were 87.5% and 32.4%, respectively, and they were 28.6% and 48.4%, respectively, in the TS-1 group and the TS-1 plus CDDP group. The survival rates in the recurrent and the post-palliative surgery group were significantly different according to the degree of tumor response (P=0.0016), but the one-year survival rates according to the kinds of regimens (TS-1 or TS-1/CDDP group) were not significantly different. The incidences of grade 3 or 4 adverse effects in the TS-1 and the TS-1/CDDP groups were 14.3% and 36.8%, respectively. CONCLUSION: The anti-tumor efficacy and safety of TS-1 and TS-1 plus CDDP in Korean patients with AGC seemed to be high with modest adverse effects, thus suggesting the possible use of this regimen as a standard chemotherapy for gastric cancer.
Cisplatin ; Drug Therapy ; Humans ; Incidence ; Prognosis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Dopamine is a neurotransmitter, but in the GIT, the roles of dopamine are a regulator of epithelial cell proliferation, an endogenous protective factor, and a regulator of stomach cancer cell proliferation. By using two different gastric-cancer cell lines, we assessed the effects of dopamine and dopamine receptors on the proliferation of human gastric-cancer cells. MATERIALS AND METHODS: To assess the effects of dopamine and dopamine receptors on the proliferation of human gastric-cancer cells, we investigated cell proliferation and the expression of D1, D2L, and D2S receptor in two gastric-cancer cell lines, SNU 601 and KCU-C2. The effects of dopamine and dopamine receptors on the level of the cell proliferation were determined by staining with an A/H/E (acridine orange, hoechst and ethidium bromide) mixture. RESULTS: After dopamine treatment, the cell viability was significantly decreased in SNU 601 cells (P<0.05) where the D2L receptor was absent, but not in KCU-C2 cells. After treatment with raclopride, a D2 receptor antagonist, dopamine-dose-dependent inhibition of cell proliferation was observed in SNU 601 cells (P<0.05). After treatment with SCH 23390, a D1 receptor antagonist, dopamine significantly increased cell proliferation in KCU-C2 cells (P<0.05), but inhibited cell proliferation in SNU 601 cells (no D2L receptor). CONCLUSION: The dopamine signal via the D1 or the D2S receptor inhibited proliferation of gastric-cancer cells, but that via the D2L receptor increased proliferation. These results suggest that the regulatory effects of dopamine in the gastric-cancer cell proliferation may be controlled by using dopamine receptors.
Cell Line ; Cell Proliferation ; Cell Survival ; Citrus sinensis ; Dopamine* ; Epithelial Cells ; Ethidium ; Humans ; Neurotransmitter Agents ; Raclopride ; Receptors, Dopamine ; Stomach Neoplasms

PURPOSE: Free cancer cells exfoliated from cancer-invaded serosa contribute to peritoneal dissemination, the most frequent pattern of recurrence in patients with gastric cancer. To detect free cancer cells, CEA and CA19-9 were introduced as the markers of gastric cancer, and many methods, such as cytology, immunoassay, and reverse transcription polymerase chain reaction (RT-PCR), exist for detecting them. The aim of this study is to define the clinical significance of using immunoassay to measure the levels of CEA and CA19-9 in the peritoneal washings in patients with gastric cancer. MATERIALS AND METHODS: The peritoneal washing fluids were obtained from 130 patients with gastric cancer who received a curative gastrectomy, palliative gastrectomy or open and closure. The pCEA and pCA19-9 levels were measured by using immunoassay and cytology. The results were compared with the clinicopathological data. RESULTS: The pCEA and pCA19-9 levels were correlated with tumor invasion, lymph-node metastasis, and stage (P<0.05). CONCLUSION: A correlation was found between elevated pCEA and pCA19-9 levels measured by immunoassay and the TNM stage. Therefore, a combined pCEA and pCA19-9 assay could be a sensitive detector of peritoneal dissemination, as well as a predictor of postoperative prognosis. pCEA and pCA19-9 may also determine the adjuvant management strategy.
Gastrectomy ; Humans ; Immunoassay ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Prognosis ; Recurrence ; Reverse Transcription ; Serous Membrane ; Stomach Neoplasms*

PURPOSE: The aim of this study was to investigate the causes of under-staging in patients with advanced gastric cancer that was proven to be unresectable after a laparotomy. MATERIALS AND METHODS: We retrospectively analyzed 25 gastric cancer patients who had undergone a diagnostic laparotomy between 2001 and 2005. For the preoperative evaluation, spiral CT and multidetector-row CT were performed. We analyzed the clinicopathologic features of patients and compared the image findings and the results of surgery. The causes of under-staging were divided into 3 groups; patient factor, CT factor, and interpretation factor. RESULTS: Grossly, there were 12 cases of Borrmann type-III tumors and 13 cases of Borrmann type-IV tumors. The most frequent histologic type was poorly differentiated adenocarcinomas (8 cases) and signet ring cell carcinomas (7 cases). There were 13 cases of adjacent organ invasion, and the pancreas was the most frequently invaded organ (9 cases). There were 17 cases of peritoneal metastasis, and 3 cases of distant lymph node metastasis. For the cause of under-staging, there were four cases of patient factor, 19 cases of interpretation factor, and 9 cases of CT factor. In three cases, the cause of under-staging could not be identified. CONCLUSION: CT interpretation factor was the most frequent cause of under-staging in the preoperative diagnosis with gastric cancer patients. Therefore, more cautious CT interpretation is necessary to avoid unnecessary laparotomies in gastric cancer patients.
Adenocarcinoma ; Carcinoma, Signet Ring Cell ; Diagnosis ; Humans ; Laparotomy* ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Retrospective Studies ; Stomach Neoplasms* ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

PURPOSE: We analyzed the clinicopathologic features, including treatment and outcome, and the survival rates between young and elderly patients with gastric cancer. MATERIALS AND METHODS: Clinical information was reviewed for 1086 patients who had undergone a gastrectomy for gastric cancer during a 10-year period from 1990 to 1999, and the patients were assigned to one of two groups: the A group (<40 years of age, 91 patients) and the B group (> or =70 years of age, 85 patients). RESULTS: Compared to the B group, the A group had more females (47.3% vs 32.9%), a greater frequency of family history of cancer (15.4% vs 3.5%), and greater proportions of histologically poorly differentiated tumors (84.5% vs 40.2%) and Lauren diffuse-type tumors (69.1% vs 35.1%)(P<0.05). There was no difference in TNM stage. Cardiopulmonary co-morbidities were more in the B group, respectively, 1.1% (A group) and 11.8% (B group)(P<0.01), but the morbidity and the mortality were similar. Although there was no difference in curability, the B group underwent less aggressive operations in lymph-node dissection above D3 and had a shorter operation time, a smaller number of retrieved lymph nodes, and less adjuvant chemotherapy (P<0.001). However, there were no differences in the disease-specific 5-year survival rates, 67.6% and 67.0% respectively. CONCLUSION: Young and elderly patients with gastric cancer had different clinicopathological features. Especially, elderly patients underwent relatively less aggressive treatment. In spite of these facts, the outcome of treatment and the disease-specific survival rates were not different.
Aged* ; Chemotherapy, Adjuvant ; Female ; Gastrectomy ; Humans ; Lymph Nodes ; Mortality ; Stomach Neoplasms* ; Survival Rate*

PURPOSE: Recently, interest in peroxisome-proliferator-activated receptors (PPAR) has increased, although clinical studies of the effect of PPAR-gamma expression on gastric cancer have not been reported yet. In this study, we investigated the role of PPAR-gamma expression in gastric cancer patients. MATERIALS AND METHODS: One hundred twenty-eight (128) samples of both gastric cancer and normal tissues were obtained from 128 patients who had undergone at a curative gastrectomy at Seoul Medical Center from Jan. 2001 to Dec. 2005. PPAR-gamma expression was determined by using immunohistochemical staining, and the results were analyzed. The statistical analysis was based on clinicopathological findings and the differences in survival rates. RESULTS: The mean age of the patients was 61, and the male:female ratio was 1.9:1. PPAR-gamma expression was significantly higher in cancer tissues than in normal tissue (81.3% vs. 57.0%, P<0.001). There was insignificant difference between well and moderately differentiated types and poorly differentiated types in terms of the expression of PPAR-gamma (87.0% vs. 74.6%, P=0.074). In the univariate analysis the survival rate was significantly increased when PPAR-gamma was expressed in normal tissue (P=0.003). In the multivariate analysis, only the UICC TNM staging had significance related to the survival rate. CONCLUSION: The rate of PPAR-gamma expression was higher in cancer tissue than it was in normal tissue from gastric cancer patients. In the univariate analysis, PPAR-gamma expression in normal tissue had significance with respect to survival, but the multivariate analysis showed no such significance. Thus, we should further evaluate more cases to determine whether or not such a significance exists.
Gastrectomy ; Humans* ; Multivariate Analysis ; Neoplasm Staging ; Peroxisome Proliferator-Activated Receptors ; Seoul ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Tumor size has been reported to be one of the prognostic factors in the preoperative setting and 8 cm has been confirmed as a cut-off value for large gastric tumors with respect to postoperative complications. The aim of this study was to investigate the clinicopathologic features and the prognosis in patients with tumors larger than 8 cm in diameter. MATERIALS AND METHODS: We retrospectively studied 2,260 patients with gastric cancer who underwent a gastrectomy from 1983 to 2001 at the Department of Surgery, Korea University College of Medicine. For a comparative analysis we divided the cases into the large and the small groups according to tumor size. The clinicopathological factors associated with large gastric tumors were analyzed by using univariate and multivariate analyses. To determine which variables were independent prognostic factors for overall survival, we applied the Cox proportional hazards model and we used P<0.05 as the cutoff value for statistical significance. RESULTS: Univariate and multivariate analyses disclosed that tumor location (P<0.001), resection type (P<0.001), curability (P<0.001), depth of invasion (P<0.001), number of metastatic lymph nodes (P<0.001), differentiation (P<0.001) and combined resection (P<0.001) were significantly different between the two groups. The independent factors for survival identified by using the Cox proportional hazards model for large gastric tumors were nodal status (P<0.001), curative resection (P<0.001), depth of invasion (P=0.010), type of resection (P=0.018) and age (P=0.033). CONCLUSION: Large gastric tumors showed more aggressive local findings than their smaller counterparts. In patients with large gastric tumors, a curative resection was the most important factor for the prognosis. Therefore, we suggest that every effort should be made to do a curative gastrectomy and an accurate preoperative examination.
Gastrectomy ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Postoperative Complications ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: This study was conducted to evaluate the treatment outcomes and the prognosis for gastric cancer patients with hepatic metastasis. MATERIALS AND METHODS: This retrospective study was based on the medical records of 85 gastric cancer patients with hepatic metastasis (62 synchronous and, 23 metachronous) who received chemotherapy with or without resectional therapy from March 1990 to March 2006. The survival rate was analyzed according to clinicopathologic factors and therapeutic factors, such as whether or not a gastrectomy, a hepatic resection, and/or chemotherapy had been performed. RESULTS: The median survival of gastric cancer patients with hepatic metastasis was 11 months (synchronous: 11 months and metachronous: 17 months). The rates of gastrectomies and hepatic resections in the synchronous group were 24.1% and 16.1%, respectively. A 23.5% prevalence of extra-hepatic metastasis was observed. The median survivals of patients who underwent a gastrectomy with a hepatic resection, a gastrectomy alone, and non-surgical treatment were 60, 18, and 9 months, respectively (P<0.05). The disease-free median survival of the metachronous group was 8 (3~39) months. There was no difference in initial pathologic stage and frequency of hepatic metastasis after the gastrectomy in the metachronous group. In the synchronous group, extra-hepatic metastasis, a gastrectomy as the operative procedure, a hepatic resection as the operative procedure and the response to chemotherapy were statistically significant in the univariate analysis, and a hepatic resection as the operative procedure, the response to chemotherapy, and extra-hepatic metastasis were independant prognostic factors identified by the multivariate analysis. In the metachronous group, extra-hepatic metastasis, the response to chemotherapy and differentiation were statistically significant in the univariate analysis, and extra-hepatic metastasis was an independent prognostic factor identified by the multivariate analysis. CONCLUSION: An aggressive surgical therapy and effective chemotherapy are necessary in the treatment of gastric cancer patients with hepatic metastasis.
Drug Therapy ; Gastrectomy ; Humans ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis* ; Prevalence ; Prognosis* ; Retrospective Studies ; Stomach Neoplasms* ; Surgical Procedures, Operative ; Survival Rate