Endometrial Neoplasms ; classification ; epidemiology ; mortality ; pathology ; Female ; Humans ; Uterine Cervical Neoplasms ; classification ; epidemiology ; mortality ; pathology

Despite its declining incidence, gastric cancer is globally, still, the third most common cause of cancer-related mortality. Gastric cancer is a heterogeneous disease with diverse pathogenesis and molecular backgrounds. Therefore several systems have been proposed to aid in the classification of gastric adenocarcinoma based on the macroscopic, microscopic and anatomical features of the tumor. However, these classifications did not reflect the pathogenesis of the disease. Recently, genomic analysis has identified several subtypes of gastric adenocarcinoma and a detailed understanding of the molecular biology behind the neoplastic phenotype is possible to develop of more effective therapies. We will describe the existing various classification of gastric cancer and the recently introduced molecular biology and immunological classification.
Adenocarcinoma ; Classification ; Incidence ; Molecular Biology ; Mortality ; Phenotype ; Stomach Neoplasms

BACKGROUND/AIMS: The aim of this study was to evaluate clinicopathologic differences between Type II and Type III groups that were classified by Siewert in cardia cancer. METHODS: A hundred forty-one patients who were diagnosed as gastric cardia cancer and underwent surgery between January 1990 and December 2006 by single surgeon at Department of Surgery, Yonsei University College of Medicine were included in this study. The Kaplan-Meier method and log rank test were used for survival analysis. RESULTS: Barrett's adenocarcinoma was recognized in two patients so called type I. There were significant differences between type II and III in aspect of depth of invasion, Lauren's classification, and the number of retrieved lymph nodes in which cancer infiltrated. In type III, prognostic factors affecting survival were depth of invasion and nodal status in contrast to the no demonstrable prognostic factors existing in type II. However, there were no differences in recurrence and survival between two groups. CONCULSIONS: Several clinicopathologic differences exist between type II and III cardia cancer. In the future, further evaluation is needed regarding the classification and entities of the cardia cancer.
Adenocarcinoma/classification/mortality/*pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Barrett Esophagus/pathology/surgery ; *Cardia ; Esophageal Neoplasms/classification/mortality/pathology ; Female ; Humans ; Kaplan-Meiers Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms/classification/mortality/*pathology ; Survival Analysis

For intraoperative consultation of mucinous adenocarcinoma involving the ovary, it would be useful to have approaching methods in addition to the traditional limited microscopic findings in order to determine the nature of the tumors. Mucinous adenocarcinomas involving the ovaries were evaluated in 91 cases of metastatic mucinous adenocarcinomas and 19 cases of primary mucinous adenocarcinomas using both an original algorithm (unilateral > or =10 cm tumors were considered primary and unilateral <10 cm tumors or bilateral tumors were considered metastatic) and a modified cut-off size algorithm. With 10 cm, 13 cm, and 15 cm size cut-offs, the algorithm correctly classified primary and metastatic tumors in 82.7%, 87.3%, and 89.1% of cases and in 80.6%, 84.9%, and 87.1% of signet ring cell carcinoma (SRC) excluded cases. In total cases and SRC excluded cases, 98.0% and 97.2% of bilateral tumors were metastatic and 100% and 100% of unilateral tumors <10 cm were metastatic, respectively. In total cases and SRC excluded cases, 68.4% and 68.4% of unilateral tumors > or =15 cm were primary, respectively. The diagnostic algorithm using size and laterality, in addition to clinical history, preoperative image findings, and operative findings, is a useful adjunct tool for differentiation of metastatic mucinous adenocarcinomas from primary mucinous adenocarcinomas of the ovary.
Adenocarcinoma, Mucinous/*classification/pathology/secondary ; Adolescent ; Adult ; Aged ; *Algorithms ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Ovarian Neoplasms/*classification/mortality/pathology

BACKGROUND: The purpose of this study was to clarify whether the patients' age is an independent prognostic factor in curatively resected gastric adenocarcinoma. METHODS: Clinicopathologic information was reviewed for consecutive patients undergoing curative gastrectomy for gastric cancer during 6-year period (Jan. 1996-Dec. 2001) at the Keimyung University School of Medicine at Daegu. Overall survival was examined by the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards was used to identify whether age had independent prognostic significance for survival. RESULTS: The patients were divided into two groups: 838 patients (72.4%) with age of less than 65 years old, and 320 patients (27.6%) with age more than 65 years old. In these two groups, there were statistically differences in WHO classification, Lauren classification, vascular invasion, T stage, total stage, operational morbidity and mortality, and overall survival rate. The 5-year overall survival rate of age less than 65 years old was 87.8%, and 83.0% of age more than 65 years old (p=0.019). Multivariate Cox regression analysis revealed that age was an independent prognostic factor to predict overall survival in curatively resected gastric cancer (p=0.038). However, after excluding cases who died within 1 month after gastric resection, overall survival rate was significantly different between two groups (p=0.050), but Cox regression analysis showed that age was not an independent prognostic factor (p=0.054). CONCLUSION: The age is not an independent prognostic factor in curatively resected gastric cancer patients, and survival differences are due to an increased operative mortality in elderly patients.
Adenocarcinoma ; Aged ; Classification ; Daegu ; Gastrectomy ; Humans ; Mortality ; Multivariate Analysis ; Prognosis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Gastric cancer is the third-leading cause of cancer-related death in Korea. As the Korean population is ageing, the number of extremely old patients with this disease is increasing. This study examined the clinicopathological characteristics of gastric cancer in extremely old (over 85 years) patients who received treatment or conservative observations and compared the treatment outcomes according to the treatment modality. MATERIALS AND METHODS: A total of 170 patients over 85 years of age were diagnosed with gastric cancer. Of these, 81 underwent treatment for gastric cancer and 89 received conservative observations. The clinicopathological characteristics of the treatment and conservative groupswere compared. RESULTS: The mean age of the patients was 86.5 years. The conservative group included significantly more patients with older ages, macroscopically advanced cancer and upper-middle located cancer. The overall survival rate of the treatment group was significantly higher than that of the conservative group. The disease-specific mortality rate was significantly lower in the treatment group than in the conservative group. Multivariate analysis revealed the clinical course, alarm sign, and macroscopic classification to be independent prognosis factors. CONCLUSION: By itself, the chronological age should not be used as a strategy to determine whether treatmentwill be administered for gastric cancer. Patients who have early gastric cancer or lower-risk preexisting comorbidities should not be discouraged from treatment, even if they are older than 85 years.
Aged, 80 and over ; Classification ; Comorbidity ; Humans ; Korea ; Mortality ; Multivariate Analysis ; Prognosis ; Stomach Neoplasms* ; Survival Rate

Acinetobacter baumannii is the most abundunt species of the Acinetobacter genus. The incidence of bacteremia caused by Acinetobacter baumannii among bloodstream infection has been increasing since 1986, when the taxonomy of the genus was first described. The mortality rate of bacteremia due to Acinetobacter baumannii is high, with reported ranging from 17 to 52%. We report a case of septic shock due to Acinetobacter baumannii in a 54-year-old man who underwent subtotal gastrectomy, with Billroth II reconstruction, for stomach cancer.
Acinetobacter baumannii* ; Acinetobacter* ; Bacteremia ; Classification ; Gastrectomy ; Gastroenterostomy ; Humans ; Incidence ; Middle Aged ; Mortality ; Shock, Septic* ; Stomach Neoplasms

PURPOSE: The surgical caseload or duration of practice of a surgeon may influence the outcomes of gastric cancer surgery. This study aimed to clarify the surgical quality provided by specialized gastric cancer surgeons. MATERIALS AND METHODS: The postoperative courses of 1, 877 patients who underwent surgery for gastric cancer were retrospectively reviewed. For classification of the surgeon's expertise, the number of yearly resections performed by, and consecutive years of practice of, the surgeons were used. The outcome measures used were the 30-day mortality and long-term survival. RESULTS: Surgical mortalities of patients who underwent surgery by a specialized surgeon and those by a general surgeon revealed no statistically significant difference. A significant difference in the five-year survival rates was found with surgeons with at least two consecutive years of practice compared to those with less than two years, when 50 or more cases had been conducted per year (63.9% and 59.7%; p=0.0380). In cases of four-years of consecutive practice, the five-year survival rate was significantly improved, even if only 10 cases were performed annually (64.9% and 58.3%; p=0.0023), although the best survival rate was found with surgeons that had performed 50 or more surgeries per year. CONCLUSION: Improved survival rates, with acceptable surgical mortality, can be achieved for gastric cancer when the surgery is performed by a specialized surgeon. A specialized gastric cancer surgeon can be defined as one who has operated on more than 50 new cases per year, with 2 or more consecutive years of surgical practice.
Classification ; Gastrectomy ; Humans ; Mortality ; Outcome Assessment (Health Care) ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

OBJECTIVE: To determine the clinical application of the new classification of adenocarcinoma of esophagogastric junction (AEG). METHODS: The data of cancer of distal esophagus, cancer of cardia, and proximal gastric cancer were reviewed. Clinicopathologic characteristics, surgical modes and survival were analyzed according to Siewert's standards. RESULTS: Among the 203 patients that were up to the standard, 29 had adenocarcinoma of the distal esophagus (Type I), 80 had true carcinoma of cardia (Type II), and 94 had subcardial carcinoma (Type III). The 5-year survival rates of the 3 types of patients after the operation were 34% for Type I, 27.5% for Type II, and 24.5% for Type III (P<0.05). Further analysis of the patients with curative resection suggested there was no significant difference in the 5-year survival rates, with 37.5% for Type I, 34.5% for Type II, and 33.3% for Type III (P>0.05). CONCLUSION Difference has been found in the clinicopathologic characteristics of the 3 types of adenocarcinoma of the esophagogastric junction. The exact relation of the 3 types is still unknown. The TNM classification, complete tumor resection and the extent of lymph node metastasis are critical for the prognosis of the patients.
Adenocarcinoma ; classification ; mortality ; surgery ; China ; Esophageal Neoplasms ; classification ; mortality ; surgery ; Esophagectomy ; Esophagogastric Junction ; pathology ; surgery ; Female ; Humans ; Male ; Retrospective Studies ; Survival Analysis ; Survival Rate

It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.
Bilirubin/blood ; Carcinoma, Hepatocellular/*classification/mortality ; Creatinine/blood ; Humans ; International Normalized Ratio ; Liver Cirrhosis/*classification/mortality/surgery ; Liver Neoplasms/*classification/mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; ROC Curve ; Risk Factors ; *Severity of Illness Index ; Survival Rate