No abstract available.
Drug Therapy*

No abstract available.
Drug Therapy* ; Stomach Neoplasms*

No abstract available.
Humans

PURPOSE: We evaluated the socio-personal and clinical factors that can affect preoperative quality of life to determine how to improve preoperative quality of life in patients with gastric cancer. MATERIALS AND METHODS: The preoperative quality of life data of 200 patients (68 females and 132 males; mean age 58.9+/-12.6 years) with gastric cancer were analyzed according to socio-personal and clinical factors. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 and the EORTC QLQ-STO22, a gastric cancer-specific module, were used to assess quality of life. Patients were asked to complete the questionnaire preoperatively by themselves. RESULTS: Patients with a higher academic background and stage I disease tended to have higher global health status scores. Highly educated younger men had better physical functioning scores. Highly educated and well-nourished patients with stage I cancer had higher role functioning scores. Married patients had better emotional scores. The symptom scales were affected by sex, age, education level, nutrition, and cancer stage. CONCLUSIONS: Preoperative quality of life in patients with gastric cancer can be improved by nutritional support and treatment of symptoms caused by disease progression. Psychological support may be helpful for patients with a poor quality of life.
Disease Progression ; Education ; Female ; Health Records, Personal ; Humans ; Male ; Nutritional Support ; Preoperative Period ; Quality of Life* ; Stomach Neoplasms* ; Weights and Measures ; Surveys and Questionnaires

PURPOSE: We compared the quality of life (QOL) and nutritional outcomes following both Billroth I (BI) and Billroth II (BII) reconstructions after a subtotal gastrectomy in order to identify which reconstruction would produce a better QOL and nutritional outcomes and to provide better follow-up management. MATENRIALS AND METHODS: We studied 273 patients without evidence of recurrent disease following a curative distal subtotal gastrectomy for gastric cancer. Among them, 135 underwent a BI reconstruction and 138 a BII reconstruction. The nutritional status was assessed by using levels of hemoglobin, serum albumin, iron, and vitamin B12 and by calculating the relative body weight, the body mass index, and the percentage of body fat. The QOL was measured by using the Troidl score and by treatment-specific symptoms based on the criteria, somewhat modified by the authors, of Korenaga and others. RESULTS: There was no significant difference in QOL between the BI and the BII groups. More than half of the patients revealed anemia, regardless of the type of reconstruction. The serum vitamin B12 level of the BII group was lower than that of the BI group. The BII group showed a tendency toward lower hemoglobin levels and serum iron concentrations than the BI group did. CONCLUSION: The quality of life was not impaired in most patients after either a BI or a BII reconstruction. However, both resulted in iron deficiency anemia, although the incidence was higher after a BII reconstruction. The patient's serum iron and vitamin B12 should be measured periodically and these must be administered if the measurements reveal a below normal range.
Adipose Tissue ; Anemia ; Anemia, Iron-Deficiency ; Body Mass Index ; Body Weight ; Follow-Up Studies ; Gastrectomy ; Gastroenterostomy* ; Humans ; Incidence ; Iron ; Nutritional Status ; Quality of Life* ; Reference Values ; Serum Albumin ; Stomach Neoplasms ; Vitamin B 12

PURPOSE: There is no established treatment-related prognostic factor for gastric cancer except a curative tumor resection. This study was done to clarify the prognostic value of early postoperative intraperitoneal chemotherapy (EPIC) in patients with serosa-positive gastric cancer. MATERIALS AND METHODS: We analyzed retrospectively the postoperative survival data of 209 patients with serosa- positive gastric cancer treated by surgery and chemotherapy. The survival period for patients was calculated from the date of resection until cancer-related death or the last date of follow-up; Kaplan-Meier survival curves were plotted and compared by using the log-rank test. A multivariate analysis was done by using the Cox proportional hazards model. RESULTS: Statistically significant differences in survival rates were noted based on gender, depth of invasion, lymph node metastasis, distant metastasis, stage, location of tumor, macroscopic type, extent of gastric resection, curability of surgery, and adjuvant chemotherapy. Five-year survival rates of patients who received EPIC and systemic chemotherapy were 49 per cent and 25 per cent, respectively (P=0.009). A multivariate analysis revealed that invasion of an adjacent organ, lymph node metastasis, total gastrectomy, and palliative surgery were poor independent prognostic factors. Also, EPIC had a marginal prognostic value (P=0.056). CONCLUSION: Perioperative intraperitoneal chemotherapy can possibly be one of the independent prognostic indicators in case of serosa-positive gastric cancer.
Chemotherapy, Adjuvant ; Drug Therapy* ; Follow-Up Studies ; Gastrectomy ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Palliative Care ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: We have preoperatively and postoperatively investigated the characteristics of anemia in patients with gastric cancer in order to provide optimal medical care for the patients. MATERIALS AND METHODS: Preoperative hemoglobin, serum iron, serum ferritin, serum vitamin B12, and serum folic acid were measured for 321 patients with gastric cancer. These were measured again for 287 patients 6 months postoperatively. RESULTS: Ninety-four patients (29.3%) had preoperative anemia. Preoperative hemoglobin, serum iron, and serum vitamin B12 levels were higher in the patients with early gastric cancer than in patients with advanced gastric cancer. Preoperative hemoglobin, serum iron, and serum ferritin levels were higher in male patients than in female patients. The patients who had preoperative anemia showed a high probability of having postoperative anemia (P<0.001), and the patients who had low serum ferritin levels preoperatively showed a high probability of having low serum ferritin levels and iron deficiency anemia postoperatively (P<0.001). CONCLUSION: Preoperative ferritin deficiency should be improved by iron supplement, even though the patient may not be anemic at that time. Periodic postoperative measurements of the hemoglobin, serum iron, serum ferritin, serum vitamin B12, and serum folic acid levels are highly recommended because postgastrectomy anemia is not rare. Finally, if any low hemoglobin, serum iron, serum ferritin, serum vitamin B12, or serum folic acid levels are found, they should be treated in an appropriate way.
Anemia* ; Anemia, Iron-Deficiency ; Female ; Ferritins ; Folic Acid ; Gastrectomy ; Humans ; Iron ; Male ; Stomach Neoplasms* ; Vitamin B 12

PURPOSE: Alpha-fetoprotein (AFP) is widely accepted as a useful tumor marker for diagnosis of hepatocellular carcinomas. On rare occasions, however, an abnormal elevation of serum AFP also has been reported in an adenocarcinoma of the gastrointestinal tract. We evaluated the influence of preoperative abnormal elevation of serum AFP (AFP positivity) on the prognosis of resectable gastric cancers. MATENRIALS AND METHODS: 812 gastric cancer patients, who were investigated for serum AFP before their operations and who underwent gastric resections with D2 or more extended lymph node dissection, were enrolled in the study. The survival rates were calculated by using the Kaplan-Meier method and were compared by using the log-rank test. A multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Fifty patients (6.2%) were AFP positive (10.1~4322.6 ng/ml). The survival rate of the AFP positive group was significantly lower than that of the AFP negative group ( 46.6% vs. 67.0%; P=0.0002). The depth of tumor invasion, the degree of regional lymph node metastasis, distant metastases, the TNM stage, the gross type, differentiation, the extent of gastric resection, and the curability of the surgery also significantly influenced survival. Multivariate analysis revealed that the depth of tumor invasion, the degree of regional lymph node metastasis, the curability of the surgery, and AFP positivity were independent prognostic indicators. CONCLUSION: Preoperative serum AFP can be used as an independent prognostic factor of resectable gastric cancer.
Adenocarcinoma ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diagnosis ; Fetal Proteins* ; Gastrointestinal Tract ; Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Recurrence of gastric cancer is not infrequent even though the surgery was curative. The main purpose of this study was to evaluate the relationships between the clinicopathological factors and the recurrence patterns to develop the strategies for the adjuvant treatment. METHODS: We followed the postoperative courses of 578 patients with gastric cancer who underwent curative surgery at the Department of Surgery, Kyungpook National University Hospital from 1990 to 1994. RESULTS: One hundred and forty patients (24.2%) died of a recurrence of the gastric cancer, and 40 (6.9%) died without recurrent disease. The most frequent mode of recurrence was peritoneal seeding (40.0%), followed by hematogenous recurrence (29.2%) and local recurrence (25.0%). The incidence of peritoneal recurrence was significantly higher in subgroups of patients with serosal invasion (47.2% and 17.2%; p=0.011) and with poorly differentiated tumors (47.4% and 27.3%; p=0.002). The incidence of hematogenous recurrence was significantly higher in subgroups of patients without serosal invasion (41.4% and 25.3%; p=0.011) and with well or moderately differentiated tumors (47.7% and 18.4%; p=0.002). The recurrence rates according to the lymph node dissection and postoperative systemic chemotherapy were not significantly different. CONCLUSION: In patients with serosal invasion or with poorly differentiated tumors, an effort to prevent peritoneal recurrence is needed. And in patients with well or moderately differentiated tumors, an effort to prevent hematogenous recurrence is also needed.
Drug Therapy ; Gastrectomy ; Gyeongsangbuk-do ; Humans ; Incidence ; Lymph Node Excision ; Recurrence* ; Stomach Neoplasms*

BACKGROUND: To clarify the clinical significance of CEA and CA19-9 in patients with gastric cancer, we evaluated the correlation between tissue expression, the peripheral and the portal levels of these tumor markers, and ten clinicopathological factors, as well as the prognosis. METHODS: Surgical specimens from 40 patients with gastric cancer were examined by using immunohistochemical staining with anti-CEA and anti-CA19-9 monoclonal antibodies. Serum levels of CEA and CA19-9 in the portal and the peripheral blood were measured by using immunoradiometric assays. RESULTS: Positive values of the portal venous CEA were more common in patients with lymph-node metastasis, distant metastasis, and lymphatic invasion than in those without these factors. Curative surgery was performed in 50.5% of the patients with high portal CEA levels and in 90.6% of the patients with low portal CEA levels. Positive values of the peripheral venous CEA were significantly higher in cases with lymph-node metastasis. The positive rate of CA19-9 immunohistochemistry was significantly higher in patients with distant metastasis and in non-curative surgery. The positive rate of peripheral venous CA19-9 was higher in cases with distant metastasis. The three-year survival rate of patients with negative tissue CEA was significantly higher than that of patients with a positive result. The peripheral venous levels of CEA and CA19-9 reflected the portal venous levels accurately. CONCLUSIONS: These results suggest that immunohistochemical examination of CEA in patients with gastric cancer is useful for the evaluation of the biological aggressiveness and progression of the disease and can be used for making a prognosis.
Antibodies, Monoclonal ; Biomarkers, Tumor ; Humans ; Immunohistochemistry ; Immunoradiometric Assay ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms* ; Survival Rate