BACKGROUNDEsophageal adenocarcinoma is becoming an increasingly important problem. It has been the most rapidly increasing malignancy in western countries in the last decades, and its prognosis is poor. The aim of this study was to evaluate the relationship between tumor invasion depth and lymph node metastasis for adenocarcinoma of the esophagus and esophagogastric junction, and to analyze the impact of lymph node metastases on survival of the patients.

METHODSThe study group comprised 121 patients with adenocarcinoma of the esophagus or esophagogastric junction, who underwent esophagectomy between January 1985 and December 2003 at either the Royal Adelaide Hospital or the Flinders Medical Center, Australia. Overall, there were 101 males and 20 females, with a mean age at surgery of 62 years (range 36 - 80). All of them were followed up for 6 months to 13 years (mean, 6.5 years). The relationship between tumor invasion depth and lymph node metastasis, as well as between survival and lymph node metastasis in these patients were analyzed by Chi-square or Fisher's exact test. A P < 0.05 was considered statistically significant.

RESULTSThe tumors were located entirely within the esophagus in 83 patients, and involved the gastro-esophageal junction in 38. The overall resection rate was 96.7% (117/121). When tumor invasion was within mucosa or submucosa of the esophagus (T1), the lymph node metastasis rate was 22.2% (10/45), the mean number of metastatic lymph nodes was 0.3, and the proportion of more than 4 lymph nodes metastases was 0% (0/45). When tumor invaded the adjacent structures of the esophagus (T4), the lymph node metastasis rate was 85.7% (6/7); the mean number of metastatic lymph nodes was 5.1, and the proportion of more than 4 lymph nodes metastases was 71.4% (5/7). There was a significant difference between T1 and T4 (P < 0.01). The 5-year survival rate for patients without lymph node metastasis was 52.9%, for those with 1 - 4 nodes involved was 11.5%, and for patients with more than 4 positive nodes was 0.0% (P < 0.01).

CONCLUSIONSThere is a close association between tumor invasion depth and lymph node metastasis for adenocarcinoma of the esophagus and esophagogastric junction. Both the number and rate of lymph node metastasis are significantly correlated to the depth of tumor invasion. Moreover, when the tumor invades deeper into the esophageal wall, the percentage of patients with more than 4 involved nodes increases. Both the lymph node status and the number of metastatic nodes are important prognostic factors for the disease.

Adenocarcinoma ; mortality ; pathology ; Adult ; Aged ; Aged, 80 and over ; Esophageal Neoplasms ; mortality ; pathology ; Esophagogastric Junction ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Stomach Neoplasms ; mortality ; pathology

OBJECTIVE: To assess the value of proximal gastrectomy (PG) and total gastrectomy (TG) for the treatment of cancer of cardia and fundus. METHODS: Publications on comparision between PG and TG in the treatment of cancer of cardia and fundus were collected, the data from the publications were matched with the PG group and the TG group respectively according to its corresponding surgical resection, and the data on postoperative complications, motality and 5-year survival rate were meta-analyzed by fixed effect model and random effect model. RESULTS: Thirteen reseaches on 2 219 patients were included in this study, 2 of which were randomly controlled studies. There were no significant differences in the postoperative complications (OR=1.00, 95%CI: 0.44-2.28,P>0.05) and mortality (OR=1.25, 95%CI: 0.62-2.48,P>0.05) between the PG group and the TG group, while there was significant difference in the 5-year survival rate (HR=0.87, 95%CI: 0.76-0.99,P=0.04). The 5-year survival rate in the TG group was higher than that in the PG group. CONCLUSION Total gastrectomy for the treatment of cancer of cardia and fundus has better long-term therapetic effect.
Cardia ; pathology ; Gastrectomy ; methods ; Gastric Fundus ; pathology ; Humans ; Prognosis ; Stomach Neoplasms ; mortality ; surgery ; Survival Rate

OBJECTIVETo investigate the impact of tumor size in the prognosis of T4a stage gastric cancer.

METHODSThe best cut-off point depending on tumor size was selected by Kaplan-Meier. Compare cliniclópathological characteristics between small size gastric cancer (SSG) and large size gastric cancer (LSG). Univariate analysis was done by Log-rank test and multivariate analysis was performed using the Cox proportional hazard regression model. The independent prognostic factors of patients were performed subgroup analysis.

RESULTSEight centimetre was the optimal cut-off of tumor size for T4a stage gastric cancer. There were significantly differences between SSG and LSG in tumor location (χ² = 15.695), histological grade (χ² = 4.393), macroscopic type (χ² = 5.629) and early recurrence (χ² = 4.292). Univariate analysis showed age (χ² = 4.463), tumor size (χ² = 9.057), macroscopic type (χ² = 6.679), histological grade (χ² = 5.122), location of tumor (χ² = 8.707) and N stage (χ² = 132.954) are related to survival (P < 0.05). Among them, tumor size (HR = 1.339), histological grade (HR = 1.169) and N stage (HR = 1.876) were independent risk factor for survival (P = 0.05). For SSG, N stage (HR = 2.014) and histological grade (HR = 1.192) were independent risk factor for survival (P = 0.05), and for LSG, N stage (HR = 1.876) was independent risk factor for survival (P = 0.000). Further stratified analysis indicated that the 5-year survival rate of LSG is significantly lower than that of SSG in T4a stage patients of gastric cancer without lymph nodes metastasis or poorly differentiated (HR = 0.182 and 0.653, P < 0.01).

CONCLUSIONSTumor size is an independent prognostic factor in patients of T4a stage gastric cancer. Tumor size cut-off point of 8 cm can exert significant impact on the prognosis of T4a stage gastric cancer without lymph nodes metastasis or poorly differentiated.

Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Stomach ; pathology ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate

We underwent protein assay for Myc expression in 76 human gastric cancer tissues using immunohistochemistry. Expression of Myc protein was analyzed according to proliferative indices measured by flow cytometry. Levels of Myc protein expression was evaluated by correlating with biologic and clinical parameters. In 36 (47.4%) of 76 primary gastric cancers, overexpression of Myc was observed. We could observe expression of Myc protein in a significant portion of early gastric cancer (42.9%). Expression of Myc protein was demonstrated to be more frequent in poorly differentiated cancer cells (p=0.043). However, expression of Myc protein had little influence over progress or extent of the disease. Expression of Myc protein was significantly correlated with increased proliferative activity (p=0.032) and patients with high levels of Myc expression had poor disease-free survival. In a certain proportion of human gastric cancer, Myc protein may function as a regulator of cancer cell growth and expression of Myc may represent an aggressive phenotype of gastric cancer.
Adult ; Aged ; Cell Division ; Female ; Flow Cytometry ; Human ; Immunohistochemistry ; Lymphatic Metastasis ; Male ; Middle Age ; Neoplasm Invasiveness ; Neoplasm Staging ; Proto-Oncogene Proteins c-myc/analysis* ; Stomach/pathology ; Stomach/chemistry ; Stomach Neoplasms/pathology ; Stomach Neoplasms/mortality ; Stomach Neoplasms/chemistry* ; Survival Rate

OBJECTIVETo investigate the related factors and prognosis of peritoneal dissemination and hepatic metastasis in gastric cancer, and the impact of palliative surgery on the prognosis.

METHODSThe clinicopathologic and follow-up data of the patients with gastric carcinoma treated in our hospital from Aug. 1994 to Jul. 2005 were analyzed retrospectively.

RESULTSThe clinicopathologic factors correlated with peritoneal dissemination included serosal penetration, whole stomach cancer, undifferentiated type, female and hepatic metastasis, while those correlated with hepatic metastasis included Borrmann IV, lymph node metastasis and peritoneal dissemination (P< 0.05). The postoperative one-year survival rate of the patients with hepatic metastasis (H group) were lower than that of the patients with peritoneal dissemination (P group)(P< 0.05). The one- year survival rate of the patients with peritoneal dissemination undergoing palliative resection was significantly higher than that of the patients undergoing by-pass operation or feeding neostomy, and exploratory laparotomy (P< 0.05), while there was no significant difference among the three groups of the patients with hepatic metastasis.

CONCLUSIONSThe short-term prognosis of the patients with hepatic metastasis is poorer than that of the patients with peritoneal dissemination. Palliative resection could improve the short-term survival rate of the patients with peritoneal dissemination, while it had no significant impact on the survival rate of the patients with hepatic metastasis.

Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; mortality ; secondary ; Male ; Middle Aged ; Neoplasm Metastasis ; Peritoneal Neoplasms ; mortality ; secondary ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate

BACKGROUND: Gastric cancer in elderly patients is one of the most important health issues in Korea, when considering its incidence and mortality rate. We have obtained the preliminary data concerning the diagnosis and treatment of gastric cancer in elderly people by analyzing the clinical and pathologic features. METHODS: We retrospectively analyzed 268 patients who were diagnosed with gastric cancer and who also underwent surgical procedures in Bundang Seoul National University Hospital from May 2003 to May 2005. The patients were divided into two groups: those aged<65 (n=162) and those aged> or =65 (n=106). We compared the clinical and pathological characteristics between the older and younger groups. RESULTS: The elderly group had more patients with well differentiated carcinoma (11.8% vs. 33.0%, respectively, p=0.001) and the intestinal type (34.0% vs. 59.4%, respectively, p<0.001). The frequency of microsatellite instability-high (MSI-H) was higher in the elderly group (5.6% vs. 17%, respectively, p=0.010). There was no significant difference in the postoperative recovery time (p=0.374) and the operation-related complication rate between the two groups. CONCLUSIONS: Gastric cancer in elderly patients demonstrated more pathologic types that have a known favorable outcome when compared to the younger patient group. We should more frequently consider surgery for the elderly patient with operable gastric cancer because of they have similar postoperative recovery compared to the younger patients.
Aged* ; Diagnosis ; Humans ; Incidence ; Korea* ; Microsatellite Repeats ; Mortality ; Pathology ; Retrospective Studies ; Seoul ; Stomach Neoplasms*

OBJECTIVETo analyze the clinicopathologic features and prognosis of young patients with gastric cancer by comparing with older patients.

METHODThe clinicopathologic data of 157 younger adults (age, 40 years) was analyzed and compared retrospectively. All of the 1918 patients were surgically treated between January 1980 and December 2000.

RESULTSThe rates of poorly differentiation, diffusive growth, Borrmann 4 type, whole-stomach invasion were significantly higher in younger cases than those in the elder counterparts (P < 0.05), especially in young female patients. The rate of early gastric cancer was significantly higher in young patients than that in older patients (P < 0.05), especially in young male patients. There was significant difference between the survival rate of younger male cases (median survival, 35 months) and younger female cases (median survival, 19 months) (P = 0.0219), but no significant difference was found between elder male and elder female (median survival, 26 vs. 30 months). TNM stage, operative curability, gross type were independent predictive factors of survival for younger patients.

CONCLUSIONSYounger female gastric cancer patients tends to have worse prognosis than older patients, while younger male patients have better prognosis due to higher percentage of early gastric cancer when diagnosed. Pathologic staging and operative curability are the independent predictive factors of survival for younger patients.

Adult ; Female ; Humans ; Male ; Prognosis ; Proportional Hazards Models ; Stomach Neoplasms ; mortality ; pathology ; Survival Analysis

OBJECTIVETo investigate the clinicopathologic features of the patients with node-negative metastasis (pN0) gastric carcinoma confirmed by routine pathologic examination (Ha&E staining),and their relationship with survival.

METHODSThe clinico-pathologic data of 87 pN0 gastric carcinoma patients were analyzed retrospectively. Kaplan-Meier (Log-rank) method was used to compare the survival rate,and Cox regression method was used to screen the independent prognosis factors for pN0 gastric cancer.

RESULTSThere were 69 males and 18 females. D(2) lymphadenectomy was performed in 75 (86.2%), and D(3) in 13 cases (13.8%). Distal gastrectomy was performed in 59 (67.8%), total gastrectomy in 24 (27.6%) and proximal gastrectomy in l4 cases (4.6%). Twenty-three (26.4%) cases received postoperative chemotherapy and 64 (73.6% ) did not. The 5-year survival rate of the 87 pN0 gastric carcinoma patients was 56.5%. There were no differences in survival rate considering age, tumor location, gastrectomy, lymph nodes dissection, differentiation grade, and tumor-stroma relationship (P > 0.05), while the differences were significant in survival rate between the patients with postoperative chemotherapy,lymphatic invasion,venous invasion or not,and different pT staging (all Pa< 0.05). The Cox regression analysis revealed that pT staging and postoperative chemotherapy were independent prognostic factors.

CONCLUSIONpT staging and postoperative chemotherapy are independent prognostic factors. It is necessary to develop a precise staging technique to select a suitable surgical therapy or confirm which patients should accept postoperative chemotherapy in pN0 gastric carcinoma patients.

Adenocarcinoma ; mortality ; pathology ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; mortality ; pathology ; Survival Analysis ; Survival Rate

BACKGROUND/AIMS: Metastasis to the stomach is rare. The aim of this study was to describe and analyze the clinical outcomes of cancers that metastasized to the stomach. METHODS: We reviewed the clinicopathological aspects of patients with gastric metastases from solid organ tumors. Thirty-seven cases were identified, and we evaluated the histology, initial presentation, imaging findings, lesion locations, treatment courses, and overall patient survival. RESULTS: Endoscopic findings indicated that solitary lesions presented more frequently than multiple lesions and submucosal tumor-like tumors were the most common appearance. Malignant melanoma was the tumor that most frequently metastasized to the stomach. Twelve patients received treatments after the diagnosis of gastric metastasis. The median survival period from the diagnosis of gastric metastasis was 3.0 months (interquartile range, 1.0 to 11.0 months). Patients with solitary lesions and patients who received any treatments survived longer after the diagnosis of metastatic cancer than patients with multiple lesions and patients who did not any receive any treatments. CONCLUSIONS: Proper treatment with careful consideration of the primary tumor characteristics can increase the survival period in patients with tumors that metastasize to the stomach, especially in cases with solitary metastatic lesions in endoscopic findings.
*Endoscopy, Gastrointestinal ; Female ; Gastric Mucosa/*pathology ; Humans ; Male ; Melanoma/*pathology ; Middle Aged ; Stomach Neoplasms/mortality/*secondary/therapy ; Survival Analysis

OBJECTIVETo find out a simple and reproductive prognostic index in gastric cancer patients,which can be used as a comparable parameter among different regions of China.

METHODSThe perigastric metastatic lymph nodes(PGMLN) with long-term survival data were retrospectively evaluated in 148 gastric cancer patients, undergone potentially curative resections.

RESULTSThe 3-year cumulative survival rate was 62.8% and the survival rate decreased significantly with the increase of PGMLN, especially when the PGMLN was more than 6. The PGMLN had a clear linear relationship with total positive lymph nodes(r=0.94, P<0.01), while it had little correlation with total resected lymph nodes(r=0.18,P=0.2).

CONCLUSIONSPGMLN is a convenient and reliable prognostic factor in gastric cancer patients, which may be a good candidate of comparable parameters among different regions of China.

Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; mortality ; pathology ; Survival Rate